Anatomy of a Mealtime Session

I thought it might be helpful to show you an entire mealtime session. And talk you through what's going on and why.  Luckily, the meal I recorded was a decent one, and you can see many of Greyson's issues presenting themselves throughout.  Notice that I try to stay positive throughout the entire session, as it is extremely important that he doesn't associate mealtimes with negativity.

I always prepare everything I'll need for the meal before getting him in the chair, that way he knows that when he's in the chair, it's time to work, not time to watch mommy get things from the kitchen.  I begin the meal by offering him a choice of which spoon he'd like so that he feels he already has some control over the situation.  This particular evening at dinner, he loved "drinking" water from the lid of the water bottle.  I thought this was the perfect reinforcement for mealtime, so that's what I used.  Not only is he motivated by it, but it is also good practice for a mealtime skill he needs to learn.  I presented this right after he chose his spoon, so that he knew what to expect.

I then tell Greyson what we are eating, and also show him the "duckie" measuring cup that I serve from.  This gives him auditory and visual input about what he's expected to try to eat.  I keep lots of reinforcers available on the table in case one "wears off" and we need to try another.  He was asking for more water, so that became my primary reinforcer to begin.  I let him know that he would get more water after he took a bite (setting forth the expectation).  You can see with his first bite that he has a bit of a sensory response by scrunching up his face a bit.  That's a very normal response for him.  We try to distract from responses like this with the reinforcers and keeping things positive with praise.  For some sessions, he does so well that we are able to space the reinforcers out a bit, and maybe only give them every 2-3 bites.  For this particular session we switched between reinforcing every bite and reinforcing every two bites based on how we was eating and reacting to the situation.  It really is a minute by minute assessment of what he needs to be successful.

Around 2:30 in the video, you will see some avoidance behavior from Greyson.  He keeps his spoon in his mouth to avoid the bite.  This has become the main behavior we are dealing with (avoidance).  He again avoids the bite around 4:47 and 6:03, and I continually remind him that he gets more water after the bite.

Greyson begins struggling a bit around 7:21, and he starts swatting the spoon away.  These behaviors are completely ignored, no response whatsoever (which is hard for me!).  When he swats the spoon away, he gets some pudding on his hands, and that bothers him, so now I have a new reinforcer.  He can wipe the pudding off after two bites.  At 8:55, I notice that the water reinforcer has worn off, so I move onto a new one, his book with animals in it.  Moving on to a new reinforcer lengthens his mealtime so he can get more practice.  You'll see some more avoidance and spoon swatting around 9:21, and I just move away and remind him of the reinforcer.

And at 11:43, you will see one of his biggest sensory responses, a full on gag with the bite.  He used to gag at the just the sight of a smooth food like yogurt, baby food, pudding, etc.  We've moved way past that!  When he gags or has trouble with the bite we try to distract as much as we can, and usually offer a drink as fast as we can, for him to get the bite down as opposed to spitting or wiping it out.  In this case, the drink worked!

We always, always end the mealtime on a positive note.  If the meal is going poorly (which is not the case with this session), then we give an exit demand.  For example, he is refusing every bite, no reinforcer is working, so in order to get down he must do something that we are asking him.  Usually, he must take a bite in order to get down.  This shows him that whoever is feeding him still has the control, that he must fulfill our expectation, and that the meal is ending on a positive note.  For this meal, he did so well that he did not need an exit demand because we ended the meal positively!

I'm so happy to share this great mealtime with you!