Eating Interventions: Eating too little

Some neurodiverse children eat very little food. It becomes a medical concern as the child’s immunity becomes low, they fall ill frequently, cannot play or move as they want to or like to, get irritated quickly which results in overall unhappiness and many behavioural issues. An unhappy child finds it difficult to learn or relate positively to learning. 

Again, let us remember that eating is a lifestyle issue. While there are specific interventions to help with eating too little, interventions work well when the right environment and attitudes are in place. It is important for the entire family to follow, model and reinforce the behaviour we expect of the children. Working together and supporting each other is important. 

Setting up the environment and attitude

The family should have a good routine for waking up and getting physical activity in the morning. It is important to drink water to stimulate bowel movement and build a sense of hunger. This is especially important for #pooreaters. 

Having access to food throughout the day does not help with building an appetite. Food should be available at fixed time intervals that are part of a schedule. Even if a child ate poorly at breakfast, giving them a large glass of milk as a mid-morning snack may not be a good idea, as it interferes with the next meal. 

Relying on children’s hunger and letting them starve if they do not eat also does not help build good eating habits. Again, most neurodiverse children have poor interoception - they may not understand the relationship between eating, feeling full and that satisfaction leading to good quality time. If we let them starve, they may end up getting accustomed to staying hungry. 

Reading books about food, learning about different kinds of food and tastes, communicating ‘I like’ and ‘I don’t like’ for foods, cooking and baking, talking about feelings while having these conversations can help in building food positivity in children. 

All members of the family eating together as frequently as you can is important. While you eat together, talk about food and how you enjoy good food. Model to children that one can safely try new food, it is okay to try and that sometimes you may end up liking new food too!

Intervention for quantity

1. Notice how much food the child is able to eat, at the beginning. This is the baseline for how much the child needs to eat. Measure this in spoonfuls, bites or mouthfuls.
2. Make a visual schedule for the previously decided measure and the child ticks each box as they finish each measure. We can also use tokens that the child can remove for the countdown. This helps the child track how much they have eaten and how much more is left. Predictability helps manage anxiety. 
3. Once the child gets comfortable eating that portion for a few days, gradually increase the measure over a number of days. Decide the pace of increment carefully so we do not overwhelm the child with suddenly increasing demands. 
4. Clearly inform the child whenever demand is increased. 
5. With some children, preparing them with a social story helps. Writing a menu together and discussions about food also help the child to prepare himself to eat. 

Increasing variety

1. Once the child becomes comfortable with the schedule of eating, introduce one new food every three days, just one spoonful - preparing by writing a schedule and social story. 
2. Slowly, new foods became staple foods. 

You can read the other parts of this series at the links below:

Eating Interventions: Attitudes towards food

Eating Interventions: Eating too much

Eating Interventions: Eating too fast or slow

Please note that these interventions are shared for general guidance. Designing and executing interventions - more importantly - noticing how the child responds and modifying the interventions so the child does not get distressed, is a specialist job. Consult qualified therapists as necessary.