INTRO

 

Welcome to the autism 360 podcast the  360 method a weekly podcast where we  talk about everything autism 360. each  week we catch you up with what’s going  on in the program we chat with team  members and very special guests and we  talk all things mindset as well as  exploring relevant ideas that autism  parents think about this week we’re  talking about dietetics and nutrition  with my wonderful guest Melanie Lewis  it’s so lovely to have you Mel  thanks for having me Ella I’m really  grateful for this opportunity and to  talk to all of your members in the  program yay so Melanie hails from Sunny  Brisbane Australia and has been working  as a dietitian for over 10 years amazing  amounts of experience for us to draw on  Melanie is a pediatric specialist and  specifically works in the area of autism  management and dietetic support yay so  excited to um jump into that chat today  I am your host Ella Bailey I’m an Autism  360 veteran coach and Explorer of all  things parenting support before becoming  an Autism 360 team member I worked in  psychological research and behavioral  psychology just so you know a little bit  about me but welcome to you our lovely  listeners you are why we do what we do  we are you know you are why Mel does  what she does so please send us your  feedback we’d love to hear your thoughts  we’ve got some uh wonderful questions  from parents  um uh coming up later in the podcast so  if you’ve got a question for Mel maybe  we’ll have to snag her again and grab  her um back on the podcast  um if you are interested please do drop  us a line at hello  autism360.com we would love to hear from  you so before we get started um I’d like  to acknowledge the category people of  the Euro Nation on Whose land I live and  work and from where this podcast is  being broadcast today and also just make  the disclaimer that this podcast and  especially Mel’s dietetic advice does  not substitute  um for individualized medical or Allied  Health support if you are concerned  about yourself or about a loved one  please do seek help from a professional  so now we get to chat Mel hooray  I would love to hear just a bit about  you you know how did you become

 

 

CHAPTER I

interested in working with autistic kids  and their families let’s let’s hear the  story yeah so I actually graduated as a  dietitian way back in 2008. a few years  before I then trained as a pediatric  dietitian  and when I started working as a  pediatric dietitian I started getting  all of these referrals for children who  were picky eaters and fussy eaters and  when I started um doing the assessment  and working with these families I  realized that their pickiness and the  fussy eating behaviors went far beyond  that typical fussy eating that we see  and often it was going into very  restricted dietary patterns and problem  eating patterns that we do see  um with children who are autistic and I  realize at that time that I just I  wasn’t skilled enough to be working with  these families so then I I went out and  um I seeked a lot of different training  one of them being the SOS approach to  feeding and from doing that training I  was actually able to get a job in  Melbourne in a multi-disciplinary  feeding Clinic where I worked with an  occupational therapist and a speech  pathologist we also had a pediatrician  and a psychologist that we could lean on  to when needed but it was really working  in that feeding Clinic that helped me to  really understand the challenges of  these children and their families and  working along with some of the best OTS  and speeches in the business really  helped me to become a better dietitian  so that I’m at a point now where I can  really hopefully with families and  parents some really useful advice to  help the child learn to expand their  dietary intake so it’s been a journey  um you know way back starting in 2012  where I started in the feeding Clinic  um and from there my passion grew and  grew and grew and I love it  really challenging because it’s heart  wrenching some days but it’s a beautiful  area of dietetics to be working in and I  would not change it at all yeah that’s  amazing and so is that  um a clinic that is still running in  Melbourne they’re still operating as a  feeding Clinic down there from all  government funded organization  um and that that was services  that were taken over by  um Western Health and I’m pretty sure  they’re still running but not in the  same capacity as it was when I was there  yeah okay awesome and I mean what do you  notice as kind of the most common  challenges the the ones that you would  see in the day-to-day in the clinic and  now day to day in your especially yeah  so I was I’ve been thinking about this  question because it’s actually quite um  a loaded question oh interesting okay  when you think about what are the  challenges well I guess from if I think  of it from a dietetic point of view I  guess the challenge stuff you know these  children not being able to meet their  nutrient requirements um very restricted  dietary intake you know based on those  sensory sensitivities that we see or you  know grow some fine motor skills which  can impact on their ability to so  healthy on the oral motor skills so when  we see these kids going to that very  restricted white diet which is a soft  diet and a practical diet but however  that on core nutrients so iron protein  sometimes calcium sometimes vitamin A  vitamin C B12  um that’s what that’s one of the biggest  challenges because if a child is not  well nourished it’s going to impact them  on in many different areas development  behaviors energy levels we can see  constipation obviously nutrient  deficiencies and then obviously the  other challenges associated with  restricted eating is the stress that it  causes upon family meal times  social outings what to put in a child’s  school lunch box and all that parental  anxiety and stress that we see when a  child’s only eating 10 maybe less number  of food so I think it all starts first  with a lack of proper nutrition  um which then impacts on on everything  else and of course that fear of trying  Foods is a huge challenge for these kids  yeah yeah absolutely that white diet  I’ve seen obviously I’m not a dietitian

CHAPTER II

I don’t really know what I’m looking at  but I do see that as something that is a  bit of a pattern like our safe foods are  really our  starchy carbs our our pasta we love a  plain pasta over here in the autism  world don’t we exactly and it really  does not all of it but a lot of that  eating comes down to the sensory  components so  prepare those white deconstructed Foods  so plain not without the meat sauce  um chippies white bread maybe some  vanilla yogurt and all of these foods  are very productive predictable in the  way that they look in the way that they  taste in the way that they smell and  they’re usually very easy to chew and  swallow which can be a sensory element  and it can also be an oral motor delay  and these kids just put very softer  textures because foods like steaks or  mixed textures can be quite complex and  difficult to manage if you’re still  learning to have a proper coordination  with your tongue and your chewing for  example  yeah that’s so interesting I mean  just kind of a ballpark guest do you  think that sort of half of the autistic  kiddos that you see have sensory as  their main eating struggle or is it less  than that more than that I would say  more yeah okay so 90 of children I work  yeah  issues as their main reason for not  being able to eat a variety of foods and  you know that sensory issue is a very  real psychological  um event that’s happening within the  body and we know that it then results in  that fear that’s that fear and say  associated with trying foods and and why  kitties can cry at meal times they can  gag and they’ve been asked to try our  food or even when they have to lick it  sometimes we see vomiting when it’s  quite extreme you know all day without  eating because the thought of eating  that food is too overwhelming it’s too  hard and it’s certainly about that  little one being naughty it’s a real  response that is happening in in the  brain causing a block to put that food  in there now  yeah yeah absolutely right and I guess  from um a psychological perspective you  know that experience of that sensory  um event is as real as any other  experience that we have in the world  including you know everything we see  everything we touch everything we  everything else that we process so I  mean when when things are so complex you  know when there’s so many different  things that go into what a kid can or  cannot  um engage with kind of food wise and and  from a dietetic perspective what do you  feel is the thing that families should  prioritize when it comes to eating and  they’re autistic you know yeah so I  couldn’t again a great question  um also a loaded question yeah  focus on isn’t there but I think for me  in in practice I think the most  important thing um when I do my dietetic  assessment  um is really to try and understand why  eating is so challenging for this  particular child okay art is different  um and yes we say sensory but what is it  it might be just the smell of food it  might be the look of food that’s why  when we do an assessment it’s really  important to try and unpack it all and  when I talk about that I mean really  trying to help parents to understand why  eating is so hard they know it’s hard  but to help parents understand the the  nitty-gritty of the difficulties and the  challenges because then that helps  parents move forward with the strategies  that we’re going to talk about so for

CHAPTER III

example we know that a literally is not  going to move from eating  um chicken nuggets to  it was like that might be it’s too hard  task or too hard for us to ask that  child to do so that’s why we start by  like first understand where your child  is at in the feeding Continuum what it  is about the food that is easy for them  to eat what it is about the food that’s  hard for them to eat and let’s start  from where your child is at and create  realistic strategies to help your child  learn to introduce new foods into their  diet and we do that in a very  step-by-step approach so you know  parents are properly understand their  parents feeding their child’s feeding  difficulties then I think the next  priority to work on um is trying to  establish family meals because you know  feeding is so hard for these families  sometimes it’s easier to have meals at  different times of the day  sometimes kids are more comfortable  eating dinner in their room in front of  the TV or with an iPad on so sometimes  establishing family meals is actually a  really hard ask for families so again we  would just set the ball really low the  goal really low and we would say let’s  just start with achieving one family  meal a week and it’s not about your  child eating family meals at this point  we’re going to start with just having  safe foods on their dinner plate because  our goal is is to help your child come  to the dinner table without them feeling  stressed or anxious about what they’re  going to be served and what we’re going  to ask them to try and then from there  once we’ve created what we call a safe  family meal time and then we can start  to introduce new foods and then when we  talk about introducing new foods the  next thing I like parents to focus on is  the 32 steps which tells us that a child  learns to eat a new food in a very  step-by-step approach with that last  step being eating or putting that food  in there now if that makes sense so the  first steps wow 32 okay  I’ve learned to tolerate and touch that  food and it might be simple as putting  one piece of the family meal on the  plate if it’s tolerated on the plate  then we would pop it on the learning  plate  for the child to eat and the learning  plate is just a bread and butter plate  where a piece of carrot might go on and  the child is first just expected to  tolerate it  move on so they’re the three most  important things helping parents  understand why eating is so difficult  for their child establishing family  meals and then starting with the 32  steps and just starting with helping  your child to tolerate and touch Foods  before we even move on to eating a food  yeah yeah that’s so interesting I mean  do you find that most parents really  don’t have  a great understanding of why It’s Tricky  for their kiddo to tolerate new foods  yeah I do yeah I do and when we really  take it down when we really talk about  the sensory properties of food and why  it is easier for your child to eat and  why that food is harder and when we talk  like deconstructed meals it tends to  really be a little bit of a light bulb  moment for parents  why it’s easier for them to eat any type  of junk food but it’s hard for them to  eat home-cooked meals so yeah I do find  that or you know parents know that their  children have sensory issues but how how  that really impacts on their ability to  try new foods or eat a variety of foods  is not fully understood and that’s our  job to explain it to them yeah yeah of  course you know why would somebody know  that I guess until it became a problem  right  yeah exactly absolutely I remember you  mentioning in the um webinar that we did  together not long ago the importance of  eliminating grazing during the day can  you talk a little bit about that yeah  absolutely and and that was probably my  other uh priority area for families to  focus on  um eliminating grazing is really  important because we actually  um Nick is to understand that we eat at  set times of the day  um one that helps them um to build an  appetite for a main meal so one of the  area one of the things we talk about  with children learning to eat Foods or  family meals is that they do actually  have an appetite they do actually have  to feel a little bit hungry  um but we also know that when grazing  occurs children can often fill up on  party foods or foods that we call  sometimes foods which provides their  body with no nutrient value and it  displaces everyday foods that they might  be able to eat it displaces you know

CHAPTER IV

a  fruit for example there they might be  able to eat displaces a tub of yogurt  that they might be able to eat so we  want families to teach their children  that it’s important to eat breakfast  morning tea lunch afternoon tea dinner  and possibly a supper food which might  be a glass of milk a type of yogurt for  example and we just focus on the child’s  strengths so some of those every day  they can eat of course in mind that  their diet will have some sometimes  foods and and that’s okay for us when  we’re learning to explore a range of new  foods and learning how to improve our  um our nutritional intake yeah  interesting I guess um you know  dietetics is something that is maybe  um I suppose traditionally on the  periphery maybe of of autism traditional  autism care you know we’ve got our our  typical tick boxes our beaches and our  OTS but you know what do you think the  or what do you hope the future  um is of dietetics in autism support I  personally am excited about it but what  are your thoughts yeah exactly you’re  right dietetics is not often considered  as part of a child’s care  um and I think for the future I would  like to see more of the ndis funding go  towards supporting dietetics as part of  its plan I’d also like to see some  doctors not all doctors but some doctors  understand the importance of dietetics  because we all know know that we need to  get nutrition right  um yes we need to teach a child how to  um  um you know toilet train for example and  improve their speech in communication  skills but dietetics is equally as  important because without the nutrition  that underlies everything we can’t make  as big a progress in other areas as we’d  like to and I’d also like to see more  multi-disciplinary feeding clinics in  the world that would be great OT  speeches dietitians we’re an important  team to hug together we need each other  to support each other  um and also I’d love to see more  dietitians I guess show an interest in  supporting autistic children and doing  some further training because it is it  is challenging for dietitians  um we’re not specifically trained in  this area and we do have to go out there  and seek further training and if you can  work alongside an OT and or a speech who  also specializes in feeding difficulties  with children  yeah yeah absolutely well we certainly  love um having your expertise here in  the program  um and you know getting that specialist  input is so important especially when  you know as other clinicians it’s really  important to recognize like it’s great  to ask for that multi-disciplinary  support you know why wouldn’t you when  you’ve got  an expert and I always you know I’m a  little bit of a neuroscience nerd and  it’s so obvious the importance between  of the overlap right between nutrition  and Neuroscience because obviously you  are what you eat right your brain can’t  function if it doesn’t have the building  blocks that it needs  um to do that thing you get that through  eating and we’ve got a um a really  interesting question here from one of  our listeners  um CeCe from Singapore who says my child  will eat anything I feed her myself she  will accept anything however when I  place Foods she usually eats in front of  her to self-feed

CHAPTER V

she does not and  becomes very distressed she’s four years  old and has ASD level two any  suggestions and so I thought perfect  this is perfect Mel will know I’ll ask  Mel  and thanks CeCe for sending it through  um it’s a complex question I guess for  me as a clinician before I would offer  up any any recommendations there are  many questions that I would ask as part  of an assessment so you know some of  those questions that I’d like to  understand is a little bit more about  CC’s daughter’s sensory experiences you  know does she upset with you know mess  on her hands and her face  um because that might impact on her  ability  um to self-feed or not what is her  ability to use Cutlery has she ever  tried what are her gross and fine motor  skills because it’s all impacts on her  ability to pick up Cutlery or even use a  hands for coordination  um when she said if she spent with an  iPad or a screen  um you know does she have an aura motor  delay has she ever has she ever fed  herself single textured finger foods for  example or is it just the main meals so  there are lots of questions that I would  like to know before jumping in and  providing  um some questions but I’m sorry some  tips but some tips that I could provide  without meeting um Cece’s daughter is I  guess it obviously feeding is really  hard for this little one you know the  fact that she probably goes on autopilot  um when mum is feeding her and when we  say autopilot it means her sensory  system is shut down a little bit  um and she just lets mum feed her and  when mum’s feeding her mum’s not gonna  make a mess mum’s gonna get it straight  in her mouth  um so she doesn’t have to worry one  about coordination and two she doesn’t  have to worry about that sensory element  that occurs when we do get food on our  face and hands which can be very  distressing and very overwhelming so  because it sounds quite complex we would  really start from the bottom of the  feeding Continuum and start with some  very basic  um recommendations so I guess the first  recommendation we talk about is allowing  Stacy’s daughter to explore food through  Messi food play not even about feeding  but just helping her to have a sensory  Exploration with the food that she  usually liaise just in a small amount  and we would get parents to join in with  this as well so just about running our  fingers through it  um looking at it smelling it just  exploring it first the other thing we  would talk about is that when um CC  starts the feeding of the meal we want  her daughter to be able to have a spoon  in her hand so that just starts with the  idea that we are moving towards  um self-feeding but it doesn’t in a way  that’s not so overwhelming it’s just  there she doesn’t want to hold it it’s  just next to her mum can explain this is  your spoon when you’re ready you can  start exploring even if we just get her  mixing the food with the cutlery and the  spoon  the other thing we would want to try and  focus on too is if she’s not eating um  finger foods yet we really need to focus  on that first so we do need to focus on  things like you know maybe soft crackers  um cubed fruits  um and she’s mastered finger foods we  then move over to a little bit more of a  basic texture like a yogurt where we  need to feed ourselves with a spoon a  nice thick yogurt that doesn’t make too  much mess  and then from there once those  self-feeding skills are improved with  our fingers and hopefully feeding with  the yogurt we then move on to that  focusing more on that main meal and we  would explain oh hopefully Mum would  explain to her daughter that okay I’m  just going to get you to feed yourself  two mouthfuls and

CHAPTER VI

then I’m gonna take  over so we just start off very small  just building her daughter’s confidence  up and scooping food bringing it to her  mouth we start off with just two  mouthfuls mum takes over the rest and  you would that process for at least a  week and then over time we would build  up the amount of spoons that her  daughter was able to feed herself and so  that’s where we’d start and that’s you  know that’s some recommendations that I  would provide without meeting her and  with that as well we’d also say make  sure there’s a towel or tea towel there  so that um if her daughter does get  messy and distressed she can quickly  wipe her hands and wipe her face because  that can like the distress of making a  mess or the fear of making a mess can be  a huge barrier to these kids  self-feeding as well  wow that is so super interesting thank  you for that I think um  you know there’s there’s so little  understanding out there even other other  professionals to sort of be like I  wouldn’t even know where to start with  that I would just sort of  um I don’t know yeah refer I guess yeah  the parents  um because again it’s like I don’t know  what to do where do I start I’ve tried  this I’ve tried that it didn’t work and  yeah it’s it’s you know having a child  with feeding difficulties is one of the  hardest things parents have to have to  manage and support  yeah and I think um one of the you  probably heard this a million times one  of the things that sort of lay folks  will  um will give as advices oh you know if  they’re hungry enough they’ll eat it  have you heard that a million times  absolutely yeah and look that that works  certainly for  um you know what we say typically  developing children that does work  um but when you’ve got a little e who’s  got a severe fear of food  that they will starve themselves in  something yeah yeah yeah so tricky it’s  just not the same it’s just not the same  um I’ll thank you for coming and um and

 

OUTRO

chatting with me it’s been really really  interesting and I hope that we get some  more questions and maybe we can snag  another little minute of your time it’s  been wonderful  um for anybody who is interested in  checking out Mel’s work I’m going to  leave links to her website and her  referral process um in the show notes so  you can grab those  um thank you again for coming I  appreciate it uh my pleasure and um yeah  I feel like today is really a snapshot  of all the things that we could talk  about in regards to nutrition and  working with children  um that are experiencing extreme feeding  difficulties  yeah there’s lots to say there’s lots to  say so folks out there if you want to  get mailed back you got to let us know  you got to tell us she’s a busy lady  um thank you for listening to the autism  360 podcast the 360 method uh we’ll be  back next week with another interesting  topic that is relevant to autism and  autism parenting  um until then stay safe and think 360.  [Music]  thank you

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Autism and the White food diet
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Autism and the White food diet
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This week, Ella talks all things Occupational Therapy with Senior OT Andrea Barrett from the Autism360 clinical team. Ella and Andrea unpack the confusion around what OTs do and give lots of strategies for parent questions as well as sharing stories of Andrea's amazing program clients.
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Autism 360
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