Shane and Nicholas, 3, are twins who shared a resistance to eating new foods. Their diet was so limited that they weren’t getting the nutrition they needed. After therapy at CHOP’s Pediatric Feeding and Swallowing Center, both now eat a wide variety of foods.

Shane and Nicholas were diagnosed with Autism Spectrum Disorder around 2 years old. One of their challenges included a strong resistance to eating new foods. Both boys would eat a small number of accepted foods — oatmeal, chicken nuggets and French fries — but nothing else. Additionally, neither brother showed any interest in feeding themselves.

Their parents, Jennifer and Gregory, recognized that their sons weren’t getting balanced nutrition, as did their pediatrician and the early intervention specialists who worked with the boys. Their occupational therapist tried to get the boys to explore different food textures and types, use utensils and drink from open cups, but they weren’t making any progress. She referred the family to the Pediatric Feeding and Swallowing Center at Children’s Hospital of Philadelphia (CHOP) for help.

A new strategy for eating

Shane and Nicholas were evaluated at the Feeding and Swallowing Outpatient Clinic in September 2016. A team of feeding specialists observed their eating behavior, and how each of the twins interacted with their parents during meals. They recommended admission into CHOP’s Intensive Day Hospital Feeding Program, a multi-week program in which the boys would come to CHOP every weekday for breakfast, lunch, and an early dinner.

Shane and Nicholas began the Day Hospital Feeding Program in November 2016. A therapist fed them for the first two weeks, following a careful protocol using positive reinforcement techniques, while one or both parents observed through a one-way mirror. For example, if the boys ate new foods, they would be allowed to play with toys. Conversely, they weren’t allowed to play if they refused to eat. For the second two weeks, Jennifer and Gregory used the same method to feed the boys while the specialist observed and coached them.

“It was a successful strategy,” says Jennifer.

“It wasn’t long before my husband and I witnessed our sons eating things they had previously rejected. We also realized that progress would take time and that the most significant changes would happen after discharge as we implemented the strategies at home.”

A network of support

By the end of the program, Shane and Nicholas were eating new foods and beginning to feed themselves. To help the family maintain and build on the progress made during their time at CHOP, the Feeding Program encouraged others involved with the boys’ care to come in for training. Jennifer’s mother and sister volunteered, as did a teacher at the twins’ early intervention program. Having an extended team support them in their efforts helped the family tremendously after they graduated from the program.

“We were very surprised to discover that our sons continued to respond well to the feeding strategies we learned in the program,” says Jennifer. “We still use the exact same methods they taught us at CHOP, and the teachers use the same system at school. We continue to introduce new foods, and their diet continues to improve. As an added bonus, the program helped us introduce more structure into our home routine.”

Jennifer and Gregory acknowledge that the time commitment to participate in the program was a challenge, but knew it was the right decision. “It’s a necessity due to the intensity of the feeding therapy. It was well worth it in the end.”

The change in the twins’ eating behavior has impressed their parents, as has the noticeable improvement in their health. “Shane used to be a little chubby,” says Jennifer. “He’s gotten taller and slimmer. And they both have more energy.”