Food Chaining Rating Scales: Rate the Plate!

What an interesting weekend for my two little problem eaters. As some of you may have read, my youngest, Vaughn, is also utilizing feeding therapy, food chaining, and sessions with Ms. Stacey.

In fact, the boys actually fight over who's turn it is to see Stacey in the car as we drive out to the hospital.

So last week Vaughn worked on Smash Day with Stacey and they took army guys and smashed up different types of food, some sticky, some fruits, and some vegetables. All in all a good day for Vaughn and the army guys as Vaughn licked the feet off the soldiers and experienced some new tastes. Some he thought tasted good and others not so much. And really there are two pretty important things about Food Chaining in that little example: licking and rating.

As Cheri has mentioned before, anyone off the street can combine two foods together and see what happens--but the beauty of food chaining is that it examines so many aspects of the diet, of the accepted foods, of the child's behaviors, and combines that with ratings the child gives in order to provide direction of what to try next or when to slow down.

The other day, Ewan so eloquently told his brother, "Vaughn, you're not doing it right. You HAVE to rate the plate or I'm telling Stacey!" Yes, the rule master, that wonderful part of his autistic brain that enforces the routines, rituals, and rules actually works in our favor every now and then; and that includes food chaining. Ewan is also very, very good about knowing what he is and is NOT allergic to and will gladly share all the details of his allergies with you.

By the way, Vaughn did end up rating his foods that night but promptly shoved his brother for being told what to do. Oh a day in the life with those two!

The other important part to all this is in reality, not always taking a bite. Sometimes, it's about everything but the bite and it's almost counter-intuitive for us parents. How many times do parents and caregivers catch themselves saying, "Just try it, just take a bite, just eat it, just, just, just." We also say things like, "It tastes good, you should try this," when in reality we don't KNOW what a food tastes like to someone else--we only know how a food taste to ourselves.

What we do with phrases like that is bring on the stress for that little guy or gal. The words bite, try, eat, do it, just one, all have this underlying sense of stress and anxiety for some children. Sometimes we need to take a step back in order to take a step forward. Sometimes, it only needs to be about smelling the food or licking the food and not yet taking a bite. And certainly, if we tell a child a food tastes good or sweet and the child takes a bite and finds the food to be not so good or not sweet at all but salty, then we may have even set the child up for some confusion.

Smelling and licking can be two very important parts to eating. Have you ever been to a restaurant where something is served and you're not quite sure what it is? What's the first thing you do? You SMELL it! You smell it to determine if A) you can figure out the contents of the dish and B) if it appeals to you. Smelling provides the same kind of feedback for the child. Smelling is a good skill and cues that child in to a few things such as 'can I handle this' or 'can I figure out what this is'.

Licking is no less important. So the smell has given the child some information, maybe even enough to where the child is interested in licking to find out more. So the child takes a small lick and determines a little more information about the food. Maybe he or she isn't ready for a bite yet, but licking is something they can handle. It allows the child to get accustomed to the taste and that can definitely work in everyone's favor.

The other day, we took the family out to a Chinese buffet--which by the way, is a great place for some kids who need to branch out a bit. I decided to follow up on some therapy goals for Vaughn as they had tried canned mixed fruits for Smash Day and he did very well with the pears. So I got both boys a small bowl of one pear each and another bowl with one peach each. Ewan loudly exclaims, "I'm not ready to eat this, but I will smell it and lick it!"

So he did, several times he licked the peach over and over. Still, he did not take a bite but rated the licking a "Very good" and Vaughn rated his OK.

Is that a failure because Ewan did not actually take a bite? No way, not at all!

Now we have some more ideas about flavors for Ewan as he did appear to and he himself rated the peaches so highly. Time to take some ideas from Cheri and Stacey and think about all the different things you can do with peach flavoring!! So rather than being disappointed with the experience, I am hopeful about what may come next!

As for those of you dealing with a child who cannot verbalize a rating yet or maybe cannot yet point to an identifiable rating scale: don't despair. Body language and facial expression, even limited expressions, can be very valuable. I've always said the power of observation is one of our greatest tools as parents and clinicians. Know what is normal for a child in different situations, excited, scared, upset, anxious, happy, content, curious, mad, sad, etc... until you know what the baseline is for all these emotions. Then, when the child is getting ready for a meal, even well before sitting at the table for eating, watch him or her for clues to how they might be reacting to the environment or the food while it is cooking or being served.

Happy chaining everyone,
Alicia