Following last week's blog How to get a neurodiverse child to eat a wide variety of food and increase food tolerance? (emued.com), here is a step-by-step protocol to broaden the variety of foods your child consumes.
Before we jump into things, it is important to highlight that if you are concerned about your child's consumption of food, you must seek professional advice from a doctor, dietician or other relevant medical professional. Malnutrition and food refusal is a serious issue and should be addressed by a qualified and experienced professional.
How would it feel to cook only one meal per evening for the whole family? This protocol follows a specific sequence on how to take tiny steps towards your child eating the meal you cooked for the family.
Practicing this approach should be fairly easy as it is supposed to be relaxed, provide your child with lots of choice, reinforce progress and it doesn't have any negative consequences for your child.
This food intervention can be practiced 1 to 3 times per day until your child eats all the non-preferred foods across 2 consecutive sessions or all the non-preferred foods have been eaten across 3 - 5 sessions.
First, identify up to five non-preferred foods to target during treatment. Gather up to five preferred foods, toys and activities that your child loves (and doesn't get often) to be used as reinforcers.
The reinforcer of choice will be accessed according to the engagement with the targeted non-preferred foods at a specific demand level.
Non-preferred Foods (Target)
Preferred foods, toys, activities to use as reinforcers
The protocol is divided into 'meals' consisting of one bite of each target food. For each trial, your child:
(a) selects a non-preferred food, using a visual or the actual food piece on the plate, and
(b) what to do with that food, using a picture choice board.
Once your child selects and engages with a food on one trial, it is removed from the plate. The meal is complete once all foods are gone.
Here are the 16 ways the child can choose to engage with each non-preferred footd. These are called levels of engagement:
1. Look at food
2. Touch food
3. Bring to nose and smell
4. Touch piece of food to lips
5. Touch piece of food to tongue
6. Hold food on tongue for 3 s, spit out
7. Bite food with front teeth
8. Chew food 3x, (back teeth), spit out
9. Chew food 5x, (back teeth) spit out
10. Chew food 10x, (back teeth) spit out
11. Swallow 1 bite of food
12. Swallow 2 bite of food
13. Swallow 3 bite of food
14. Swallow 4 bite of food
15. Swallow 5 bite of food
16. Swallow 6 bite of food
For each non-preferred food, you will have to print a sheet hat looks something like the image below. This is just a sample and it will need to be laminated so that you can rub off and change the coloured dots (more details below):
Send an email at email@example.com if you would like the full visual.
To make it more clear and visual for your child, every action will have a green, yellow or red dot associated with it. The coloured dots represent the level of reinforcement the child receives for that particulat action. If the child chooses an action with a red dot they get a neutrual response (but not negative). If they choose an action with a green dot, they get access to a preferred reinforcer for 1-2 minute. You can adjust the levels to include yellow dots that will lead to a moderate level of reinforcement such as positive socail praise (e.g. hi 5, tickles, fist bump).
a. Green dot = access to all reinforcers for approximately 1 – 2min
b. Yellow dot = access to positivve social praise
c. Red dot = no positive reinforcers, no negative consequences. Move on to the next trial.
BUT... how do you know what colour dot to put on what action?
You will present a small piece (i.e. 2cm square) of each non-preferred food and see what level of action your child chooses. This is where you will put a green dot. you will also put a green dot for every other level higher than this. Every level lower will have a red dot.
Let's get started!
Explain the process and expectations of the tasting game.
Put a piece (or more depending on the level you are working on) of each non-preferred food on the plate.
Ask your child to choose a food.
Ask your child to choose and action they want to do.
Let them know what the outcome is (e.g. "You chose to kiss the blueberry. Kiss is red. That's okay. Remeber, if you want iPad, you can choose a green action)
Let your child know they can do the action.
Once your child engages with a food remove it from the plate.
Now repeat step 2 to 7.
The meal is complete once all foods are gone.
At any point in the practice the child can leave the table. This is important especially if your child is becoming stressed and anxious.
Once your child has chosen and carried out an action for each food, the "meal" is finished.
Practice 1 to 3 times per day until your child eats the full "meal" of non-preferred foods.
How do you progress?
Once your child has engaged in an action with a green dot across 3 - 5 sessions, change the green tod to yellow or red. This means the criteria for your child to access the highly preferred reinforcement is increased. For example, your child has put the blueberry on their tongue 3 meals in a row. The next meal, you will put a red dot next to the 'touch tongue' image.
When practicing introducing non-preferred foods, the child can leave the table at any moment to go relax in a designated "hang out" area. During this time, the child doesn't have access to any highly preferred reinforcers. There are no consequences for going to the "hang out" area. It is important to stay neutral and pleasant when your child decides to leave the table. Do not try to persuade them back to the table. Do not express any disappointment. And when they choose to return, welcome them back!
A non-preferred food can be removed from the "meal" when your child consumes 6 bites successfully for 3 to 5 "meals" in a row. Celebrate this accomplishment by putting a picture of the food on a "Super Star" food board! Generalize the consuption of the new food by including it in meals.
Congratulations for introducing new foods in your child's diet and increasing their food tolerance!
This process can seem complicated to implement so if you feel you need more support or you come accross challenges (such as challenging behaviours, it is important to consult a professional who can help to individualize the program. This is especially essential to prevent future issues with food.
If you like the protocol, but would like guidance to implement it, you can book a complementary Discovery Call with us!
This protocol has been developed based on the research article: Holly C. Gover, Gregory P. Hanley, Kelsey W. Ruppel, Robin K. Landa & Juliana Marcus (2023) Prioritizing choice and assent in the assessment and treatment of food selectivity, International Journal of Developmental Disabilities, 69:1, 53-65, DOI:10.1080/20473869.2022.2123196
Link to this article: https://doi.org/10.1080/20473869.2022.2123196