So My Child is a Registered & Licensed Dietitian Nutritionist - PDF document

11/9/2018 Brittyn Coleman, MS, RDN/LD, CLT So My Child is a • Registered & Licensed Dietitian Nutritionist Problem Feeder … • Certified LEAP Therapist What Next? • LEND (Leadership Education in Neurodevelopmental Disabilities) Fellow • Sibling of an individual on the Spectrum Brittyn Coleman, MS, RDN/LD, CLT • Private Practice: Autism Dietitian Brittyn Coleman, MS, RDN/LD, CLT • Registered & Licensed Dietitian Nutritionist • Certified LEAP Therapist • LEND (Leadership Education in Neurodevelopmental Disabilities) Fellow • Sibling of an individual on the Spectrum • Private Practice: Autism Dietitian Conflicts of Interest Agenda • RECAP : causes of selective eating + picky eating vs problem feeding No conflict of interest to declare. • Define feeding therapy & help with building a feeding team • Review helpful tips for selective eating • Identify nutrient deficiencies (& how to fix them!) • Review food sensitivities (& how to test for them!) 1

11/9/2018 Selective Eating Why is Selective Eating Common in ASD? • Children with ASD more likely to avoid foods and exhibit neophobia than their • Sensory Processing Disorder typically developing siblings and children without ASD (Schreck, 2004) • Eating is one of the most sensory-rich activities! • Children with ASD on average ate fewer foods (33.5 vs 54.5 foods) (Zimmer, 2012) • Oral dysphagia (refers to problems with using the mouth, lips and tongue to control food or liquid) • 70 ‐ 90% of parents who have a child with ASD report problems with food selectivity • Nutrient deficiencies and limited intake of foods (Mulle, 2013) • Food sensitivities & other gut issues • Odds of children having a feeding problem are five times greater in a child with ASD (Sharp, 2013) • Certain medications Picky Eaters vs Problem Feeders Why is Selective Eating Common in ASD? • Most parents with children with selective eating refer to them as • Sensory Processing Disorder “picky eaters” due to the lack of terminology • Eating is one of the most sensory-rich activities! • In children with ASD, they are more likely to be problem feeders • Oral dysphagia (refers to problems with using the mouth, lips and • Is there a difference? tongue to control food or liquid) YES! • Nutrient deficiencies • Food sensitivities & other gut issues • Certain medications Feeding Therapy • Many different types of feeding therapy depending on clinic • My recommended approach: Sequential Oral Sensory (SOS) Approach • SOS Approach to Feeding was developed by Dr. Kay Toomey (psychologist) to be implemented by other allied health professionals (Occupational Therapy, Speech Language Pathology, etc) 2

11/9/2018 Feeding Therapy “The SOS Approach focuses on increasing a child’s comfort level by exploring and learning about the different properties of food. The program allows a child to interact with food in a playful, non ‐ stressful way, beginning with the ability to tolerate the food in the room and in front of him/her; then moving on to touching, kissing, and eventually tasting and eating foods.” Feeding Therapy General Feeding Tips • Needs to be done along side a FEEDING TEAM! • Limit grazing by structuring 3 meals and 2-3 snacks per day • Build your feeding team • Have no more than 3 different foods on your child’s plate at a time • Occupational Therapy • Use manageable amounts (start small!) • Speech Language Pathology • Registered Dietitian (an INTEGRAL part of a feeding team) • Use appropriate mealtime language • Pediatrician • Use positive reinforcement • Behavioral Health Positive Reinforcement General Feeding Tips • Prevent burn-out by rotating the same food every other day • Change one property of the same food each time offered (shape, flavor, texture, or color) • Keep meal-time a positive and pleasant atmosphere • Do NOT bribe, beg, or force child to ”take a bite” • Practice ”social modeling” and have the whole family eat healthfully 3

11/9/2018 Nutritious Foods for Feeding Therapy Why is Selective Eating Common in ASD? • Sensory Processing Disorder • Eating is one of the most sensory-rich activities! • Oral dysphagia (refers to problems with using the mouth, lips and tongue to control food or liquid) • Nutrient deficiencies • Food sensitivities & other gut issues • Certain medications Identify Nutrient Deficiencies Identify Nutrient Deficiencies • Important to test nutrients inside the cell vs outside the cell to show functional deficiency • Test a wide range of nutrients to ensure comprehensiveness • SpectraCell tests 35 different micronutrients and shows deficiencies and borderline deficiencies • Identify deficiencies and correct them with a dietitian or physician Identify Nutrient Deficiencies Identify Nutrient Deficiencies 4

11/9/2018 Replete Nutrients Why is Selective Eating Common in ASD? • Sensory Processing Disorder • Eating is one of the most sensory-rich activities! • Oral dysphagia (refers to problems with using the mouth, lips and tongue to control food or liquid) • Nutrient deficiencies • Food sensitivities & other gut issues • Certain medications Food Sensitivity Self ‐ Limitation Type 1 Type 3 Type 4 • Children with autism may have undiagnosed food sensitivities or (Food Allergy) (Immune Complex (Cell Mediated Hypersensitivity) intolerances causing gastrointestinal pain, constipation, diarrhea, Mediated Hypersensitivity) IgG migraines, or eczema Mechanism IgE IgM T-Cells • Some children can make the connection between foods and the way Complement Neutrophils Neutrophils they feel, therefore they self-limit Mast Cells Basophils Basophils Cells Involved Basophils Macrophages Macrophages • Depending on severity of ASD or lack of self-awareness, they may not be Eosinophils NK Cells NK Cells able to communicate or describe their discomfort, or may possibly Eosinophils Eosinophils Monocytes Monocytes accept it as “normal” T-Cells Food Sensitivity Food Sensitivity Type 1 Type 3 Type 4 Type 1 Type 3 Type 4 (Food Allergy) (Immune Complex (Cell Mediated Hypersensitivity) (Food Allergy) (Immune Complex (Cell Mediated Hypersensitivity) Mediated Hypersensitivity) Mediated Hypersensitivity) IgG IgG Mechanism IgE IgM T-Cells Mechanism IgE IgM T-Cells Complement Complement Neutrophils Neutrophils Neutrophils Neutrophils Mast Cells Basophils Basophils Mast Cells Basophils Basophils Cells Involved Basophils Macrophages Macrophages Cells Involved Basophils Macrophages Macrophages Eosinophils NK Cells NK Cells Eosinophils NK Cells NK Cells Eosinophils Eosinophils Eosinophils Eosinophils Monocytes Monocytes Monocytes Monocytes T-Cells T-Cells 5

11/9/2018 Food Sensitivity Food Sensitivities Food Sensitivity Why is Selective Eating Common in ASD? • Sensory Processing Disorder • Eating is one of the most sensory-rich activities! • Oral dysphagia (refers to problems with using the mouth, lips and tongue to control food or liquid) • Nutrient deficiencies • Food sensitivities & other gut issues • Certain medications Medications Common Medications in ASD Medication Nutrient Depletions • Many medications used in autism or ADHD/ADD can cause loss of B Vitamins appetite Iron Vitamin K Antibiotics Vitamin B6 Calcium Zinc • Some medications can cause nutrient depletions, and long-term Magnesium use could cause deficiency SSRIs Vitamins B1-B9 Chromium Melatonin CoQ10 (Fluoxetine, Sertraline, etc.) • Antibiotics can cause many gastrointestinal issues due to their Vitamin D Vitamin B1 effect on the bacteria in the gut Calcium Vitamin K Anti ‐ Convulsants Folate Copper (Dilatin, Tegretol, Mysoline, etc) Biotin Selenium Vitamin B12 Zinc Vitamin B12 Antacids Folate Iron Vitamin D Zinc (Pepcid, Zantac, Prevacid, etc) Calcium 6

11/9/2018 Closing Remarks 1. Build a feeding team for your child with selective eating 2. Test for nutrient deficiencies and correct them 3. Uncover food sensitivities and avoid them 4. Review medications and possible depletions 5. Always have an individualized approach! Brittyn Coleman, MS, RDN/LD, CLT 1 ‐ on ‐ 1 consults via video all over the U.S.! P: 415-278-1770 | F: 888-977-1915 Brittyn@autismdietitian.com 7