Refusing to Eat

What are our options if our friend with autism becomes so attached to a certain cup, plate, spoon, or chair that they literally refuse to eat or drink without it? What can we do if they do not respond to our attempts to coerce, bribe, threaten to take away a privilege, or otherwise encourage them to eat or drink? When this situation arises, it can threaten the health and well-being of the person with autism, sometimes in rather dramatic ways.

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A therapist sent a message asking for ideas after one pre-teen landed in the hospital with dehydration after refusing to eat or drink after her favorite “sippy” cup broke. The situation is becoming so serious there is consideration of inserting a g-button. This is a last resort, of course, but, if it becomes necessary, there is some concern that the youngster will yank it out. Below are some ideas I shared with the family, therapist, and medical team.

1. I’m assuming the parents have purchased a new cup. In most cases, the transition to a new object can only work if the new cup or utensil is the same brand, same shape, and same color. Change – even in small details – can be very frustrating for some of our friends with autism.
2. Sometimes my friends who have these issues are tied to the smell of the object. I’m guessing just the bottom part of the cup broke, so, if the parents still have access to the top of the old cup, they might be able to put the old lid on the new cup to bring back the familiar smell.
3. They can also wash a new cup a number of times using the same type of washing they used with the old cup – dishwasher or hand washing or whatever using the same type of soap – to bring back that familiar feel and smell. I would also encourage them to fill it with the liquid the youngster usually drinks, then pour it out before washing then filling and washing over and over. (Think of breaking in a new blanket or pillow or seasoning a new cast iron skillet.)
4. Sometimes we tend to “make a big deal” over these types of transitions. It may work better to be matter-of-fact, saying nothing about the new cup and following the same routine for meals as usual – same time of day, same chair & table, same food, same atmosphere and conversation, etc.
5. Even if it doesn’t seem as if the youngster understands the conversations, it is absolutely critical that no one discuss her stubbornness, her refusal to eat or drink, or any other aspect of this situation in front of her, when she is asleep, or at any time or place with a remote chance of her overhearing the conversation/debate.

Because this situation is seriously threatening the health and well being of this youngster, it is critical to come up with a solution to get her back in the habit of eating and drinking. Then it would be good to start a specific program to slowly help her tolerate transition and change. For example, if the family is, indeed, able to acclimate the youngster to a new cup, they will want to purchase and “season” 5 or 6 cups to rotate in and out every day.

NOTE TO READERS AND LISTENERS: I am Cathy Knoll, a board certified music therapist and long-time friend of many folks with autism. At FAQautism.com we are committed to providing free, practical, everyday tips for making life better for people with autism. Feel free to send me a confidential email at talk@FAQautism.com with your thoughts or challenging situations or innovative solution. And don’t forget to check out our website for a wealth of ideas and a glimpse into the world of autism. http://FAQautism.com

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