June 2012

Operation Dining Time – Week One

by Mary on June 19, 2012

[If you’ve been following us on Facebook, you know that we’ve been in the midst of completely overhauling J’s diet. To date, he has tried 27 new foods in three weeks! At the request of numerous people, we’re going to write up what we’ve done to get him to try new foods. The plan at this point is to post this in sections and then compile the whole thing in one place. You can also read a general overview that Tim wrote over on Special-ism. Stay tuned.]

This is the story of a family desperate to get their son to eat more than seven foods. Yes. Seven foods. It used to be six foods, but we added pretzels in the last year. Note that these seven foods were highly specialized – it couldn’t be just chicken nuggets; it had to be Tyson Breast Nuggets (only sold in boxes) straight from the freezer to the microwave on one special kind of plate. It had to be Tostitos Bite Sized Rounds tortilla chips. It had to be Premium brand saltine crackers. Heck, we celebrated when we got the J-man to eat the snack food from a SQUARE container instead of a RECTANGULAR container.

ODT 1

Our original, well-used, well-loved food card.

Together with the J-man’s teachers and therapists (aka World’s Greatest Teachers), we devised a plan to begin adding new foods to his diet. The J-man had shown interest in other foods (ABSOLUTELY the first step, or we never would have tried it. He had to be ready to do this too!). We expected it to be a very long process to even add ONE new food, since every time we tried before, the J-man simply wouldn’t try the food, or would “kiss it” or “touch it to his face” or do all those other things the experts tell you to do. We decided all the adults had to be completely invested in the process, and that we would cheer each other on to stay strong.

The J-man’s teachers came up with an amazingly structured program for him. They came up with new terms for eating that we had never used before, because we thought part of the problem was his expectation regarding word meanings – before, “taste” had simply meant “touch it to your lips” and “eat” had meant “here, have one of your preferred seven foods.” They changed it up.

Before, the J-man was a “grazer” – we didn’t have set meal times, and when he was hungry, he simply asked for one of his preferred foods, and we hopped up and got that for him. (I spent a lot of time hopping up to get someone food instead of eating my own meals.) We decided on set meal times, and had to stick to them. Most important for the J-man, we allowed him to be hungry. Really hungry. We found out that hunger was a pretty darn good motivator for him.

So, Operation Dining Time began. We started with this – and I’m copying from the actual written plan here:

  • One new food will be introduced at a time. Cheese will be the first food. We will use string cheese cut into small pieces. Teachers and parents will discuss when it is time to introduce a new food.
  • One tiny bite of the new food will be given at each dining time. The J-man must first eat the bite of new food – and then will get his designated food for that meal. If he does not eat the tiny bite of new food, then he does not get his designated food. The new food will then be presented at the next meal time.
  • Applesauce will no longer be given during meal times. (Ed. Note: we use applesauce as the medium to get ground-up vitamins and allergy medications – as well as melatonin at night – into the J-man. We decided from the beginning not to give that up, but we lowered the volume of applesauce given dramatically, and it’s ONLY given to get him to take meds morning and night.)
  • A new meal schedule will be implemented:

    8:00 Breakfast: 1 piece of toast, 3-4 nuggets
    12:00 Lunch: 5 nuggets and 1 piece of toast
    3:00 Snack: J-man’s choice of 3-5 pieces of each preferred snack food
    6:00 Dinner: 5 nuggets and 1 piece of toast

  • New language will be used for each step. Meal time will now be called “time to dine” or “dining time.”
  • The following terminology will be used for first bites of a new food:
    1. Put on tongue
    2. Hands down
    3. Munch, munch, munch (aka, chew)
    4. Gulp (aka, swallow)
    5. Clean mouth (food all gone)
  • Teachers will make visuals for each step. Visuals will be used at school and home during each meal time.

ODT 2

The table setup. Visual instructions for eating (face blurred because picture is of another child – but pretend the child is demonstrating the action); “dining time” strip from the picture schedule; First/Then (in this case it says “First cucumber, Then snack” – since we have a lot of new firsts and he can read, we just wrote out ‘cucumber’)

ODT 3

Larger version of visual instructions for eating. We had to invent a whole new vocabulary since certain words like eating, tasting, chewing, etc. have specific meanings to him, meanings that aren’t quite correct, and changing a meaning of something once it’s entrenched in his vocabulary is very hard.

The teachers also created a video of the child in the pictures actually EATING the food, while they voiced the steps one takes to try a new food. The J-man liked the video, and wanted to watch it over and over, which was fine with us! We also turned it on while he was at the table for Dining Time, along with having the picture cards above and beside his plate.

Days 1 and 2: The first 40 hours, the J-man ate only the 3 tiny bowls of applesauce. We didn’t totally restrict fluids (of course) but we did not allow him to simply drink the calories he needed either. He followed us around, asking for foods by name, because we had put away the food card. We only offered food at meal times, and always only offered the new food first. If he refused to try the new food for 10 minutes, we put all food away until the next meal time. (This is the part where you feel like the world’s shittiest parent, by the way.)

The J-man actually got kind of pale and shaky looking by the second Lunch Time, and that’s where the World’s Greatest Teachers stepped it up again. They wrote a Social Story explaining that the reason his tummy hurt was that he was HUNGRY, and the way to NOT be hungry was to “Put food on tongue.” They wrangled a piece of string cheese into his mouth and literally manually moved his jaws to get him to chew it while they held his hands… and he swallowed it. They immediately gave him a tortilla chip (reward food).

That was going to be it – he was going to get to eat ANY preferred food he wanted for the rest of that Dining Time period. The original goal was 1 bite of new food, then say, a plate of nuggets, or a container of snack, or a full piece of toast. Instead, because he’s just awesome, the J-man assumed he had to eat another piece of cheese to get the reward food, and so he DID! He ended up eating almost two whole pieces of string cheese that day, with reward foods following each bite. Tim and I were called to the school to watch the magic happen during Snack Time, and to make sure that the J-man would eat for us as well. And so he did, although he did test us first to make sure we would also make him eat the new food.

We went the next couple of days, adding in grilled chicken and apple slices. The J-man tried a new tactic – holding the chewed food in his mouth until someone wasn’t looking, then spitting it out. We and the teachers waited him out. Waiting him out seemed to be a common theme. We found that grilled chicken wasn’t his favorite protein, but that he would eat it if hungry enough.

By Friday though, we sent in 2 more new foods – baby carrots and strawberries – both foods he had shown an interest in before. And, he tried them. He liked them both. But he would still only eat a new food with a snack food as reward. Nuggets were not a big enough motivator for him. So, World’s Greatest Teachers changed it up again.

And that is a different post.

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