Food issues - mostly behavioral

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We were doing just swimmingly with food. We found ways to introduce new foods and it was going great. Then almost daily we've been going downhill at the table for the last 6 months. We think it is mostly anxiety, but it's only with food.

Things we are having issues with:

He doesn't want food to touch his lips so he either throws the food in with a fork (nearly stabbing himself) or eats with his fingers, throwing it in and then chewing open mouthed
he won't sit at the table if people are using spoons and bowls.
he refuses to use a spoon or bowl
He hates slurping sounds
He has to sit 2 feet from the table and turn sideways - sometimes closing his eyes to keep from seeing other people eat.

it's become a nightmare. He does much better if he's alone at the table, but still, anxious and still no food touching his lips. Which didn't used to happen - NONE of this used to happen.

Where do I go for this? I have a referral out for the feeding clinic at Kennedy Krieger? But is this an OT thing? A feeding clinic thing? or a behavioral therapist thing?

We live in Maryland/DC/Baltimore area.

I'm certainly no expert, but it sounds like there are a multitude of sensory issues bombarding him at once. Would it be possible to break them down and tackle them one at a time? Some issues may not be as critical as others but become issues because perhaps he's irritated and that makes him more sensitive to everything and then it all kind of avalanches from there, maybe. What was the very first thing that seemed to be the issue? I'd start with that first. Best of luck.

I definitely agree that there is sensory stuff going on - mostly sight and sound. Sight is probably the biggy, but it's the touch that is new - the not wanting to have foods touch the lips. As you can imagine. That is reallllly difficult to overcome.

We have tried having him eat at a separate table, but it all still happens. Even when he is eating alone, which is what he would prefer anyway, but we don't want to allow to become habit.

I wouldn't worry as much about developing a bad habit right now. My guess from experience is that you have will have time to reverse a habit once you get a handle on why he's having these issues, and once you get him eating better. I have found that I need to go toward my son and do whatever he needs me to do for a while. This helps me understand him and builds trust. Then I have the knowledge and his trust in order to work towards normalcy.

I don't know... it took us YEARS to get him to eat at the table with us. I would hate to go back to square one, but if that is what we have to do, that's what we have to do. Maybe have him eat by himself and try to work on ONE thing - sitting at the table and facing front, not turned sideways. There's so much right now, that meals are a DISASTER.

SOS (Sensory Oral Sequential) Feeding Therapy is done by OT's who specialize in feeding and concentrates on exactly these types of issues. The only trouble might be finding a therapist who treats him like an intelligent 6 yo instead of a pre-schooler. (My son was NOT engaged by, "let's paint pictures with the applesauce!"). Likely you need to back WAY off and gradually increase his exposure and tolerance to the sensory issues.

Really stupid question, but did all these feeding issues pop up all of a sudden, or gradually over that six months? If they all popped up all of a sudden, maybe something specific stressed him.

A child we know (not ours--and not ASD as far as I know) had a traumatic episode that triggered feeding issues. I am just throwing that out there, for that reason. I don't know if something like that would worsen sensory issues with food, but you never know.

Today at lunch my older son (17) was sitting at the table, reading. I sat down at the table with some water, while the younger son with Autism had his lunch. It was Macaroni and Cheese - whcih is a new food for him (he was afraid to try pasta for the longest time). He got himself a fork and ate semi normally. Still out too far from the table. Still a bit twisted in his seat and still not "quite" using his fork properly, but not stabbing food into his mouth, but using his lips (some) and the back of his teeth to carefully take the food off the fork without scraping his teeth - closing his eyes while he did that.

It's still "messed up", but much more relaxed and less frantic. I think if we sit with him at the table (so he's used to company) but don't eat around him, that might be a good start to getting him to work on some other behaviors - one by one... baby steps.

My turn for a stupid question: is there a reason why he can't use his top teeth and tongue to remove the food from his fork?

My daughter has always been a fussy/weird eater. For us personally, I find the more I focus on "fixing" some of her "weird" eating habits (different utensils for different foods, if anything is saucy, she needs more than one plate/bowl, nothing can touch, etc) the worse they get. I just started giving her a utensil for each food from the beginning and stopped saying anything about it and over time she just started using one utensil (usually) on her own. In that regard, it reminds me of my son's tics: drawing any attention seems to make it worse.

A friend of mine does SOS and she reports having a lot of success. My daughter got "feeding therapy" in some form or other when she was younger from both an ST and an OT. I do not have a clear sense of which one was more successful. I mean, the OT was more successful, but he was more successful in general because he just meshed with my daughter better. I believe my daughter found her ST to be annoying, if "annoyed" is a feeling experienced by toddlers, but I do not think it was her technique as much as it was her approach.