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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
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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
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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
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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
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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
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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
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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
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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
