Before choosing strategies involve Max’s mum in prioritising goals for his feeding. Involving dad in discussions may also be beneficial as it is important that strategies are used consistently. This may involve discussions aimed at increasing the parents understanding of:

• Typical feeding development and the impact of Max’s developmental delays.
• Max’s strengths and principles of how Max learns new skills.
• The benefits of regular meals and snacks and providing supportive mealtime environments.

Once goals have been prioritised choose one or perhaps two strategies that will assist in achieving goals. Choose strategies that build on Max’s strengths and that parents feel are realistic and achievable. As these are implemented further strategies can be added.

Suggested strategies may include:

Max has shown that his appetite improves when meals he has not been grazing during the day.  Establishing predictable meal and snack times will support Max to develop cycle of hunger and satiety improving appetite. 

• Aim for 2-3 hours between meals and snacks.  Ensure meals and snacks have a clear beginning and end. 
• Between meals and snacks only water is available.  Grazing on biscuits and chips etc. is avoided.

For Max to increase the variety of foods in his diet and learn to engage in the social interactions of mealtimes the mealtime environment needs to change.  Max manages in a different environment at childcare.  He needs assistance to generalise this skills to home.  Change will most likely need to be achieved gradually as parents and Max gradually shift their expectations. 

• Gradually move seating back from the TV at mealtime and move towards the family meal table. 
• Change the seating slightly.  Try turning down the sound on the TV. 
• Begin by changing one meal at a time. Consider having lunch outside.

Once Max is sitting with others to eat and TV is no longer being used as a distraction consider adding a new strategy. 
Strategies may aim to encourage social interactions, increase feeding independence or introduce new foods depending on family priorities. 

• Begin with a food that Max will eat and modify it to achieve a ‘just noticeable difference in taste, texture or appearance’  e.g. Max likes mashed potato consider modifying texture or adding a minute amount of another vegetable such as pumpkin or sweet potato.  As this is accepted very gradually increase the amount added.  This technique needs to be implemented very gradually in children with altered sensory perceptions.  
• Increase Max’s awareness of what others are eating and work towards Max accepting new foods.  Steps to learning to eat include accepting food on the plate, touching and exploring the food, smelling the food, licking the food, taking a bite and then finally chewing and swallowing.  Children need support to move through these steps at their own pace.
• Avoid serving food in its packaging.   Serving food from the package limits food choices as children focus on the details of the package rather than the food.
• Provide food experiences through play and other activities where there is no expectation to eat.

• Parents are receiving support to manage other difficult behaviours.  It may be appropriate to use similar strategies to manage mealtime behaviours.
• Possible sensory issues associated with food choices may be addressed through activities that promote acceptance of messy play.  Experiencing food textures in situations where there is no expectation to eat may be helpful.
• Speech Therapy interventions to address difficulties in communicating, following routines may be used to support mealtimes.   Identification of delays in oral motor development may also benefit from Speech pathology interventions.

Resources

• Lori Ernsperger, Tania Stegen-Hanson.  Just Take a Bite: Easy: Effective Answers to Food Aversions and Eating Challenges! Future Horizons Inc. 2004
• Mealtimes - Relaxed and Social video
• Feeding Independence video

Follow-up 

Regular follow up is recommended to:

• Support parents to implement strategies consistently.  Progress may be slow and inconsistent i.e. there may be periods of improvement alternating with periods of regression.  Parents may need assistance to reflect on changes and recognise achievements.
• Evaluate progress and effectiveness of strategies.  Consider progress in terms of changes in both Max’s eating and parental concerns.
• Build on initial strategies. Strategies may be implemented in small steps that need building to achieve goals.
• Revise goals.  Progress is likely to be slow and priorities may change over time.

Max is capable of learning new skills and changing his eating and mealtime behaviours.  Max is growing well and the need for rapid change is not urgent.  If he was found to have any vitamin or mineral deficiencies these would be treated with supplements.  A consistent approach over many months will achieve small changes to improve Max’s eating and mealtime behaviours.  It is unlikely that he will still be eating exactly the same foods as an adult.

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