26 January 2008

The Vexed Issue of Food

I'm scribbling my weekly shopping list, and the mail has arrived. Oh look; there's an important looking envelope from Reader's Digest Sweepstakes. Apparently I've already won. Great! A few million will certainly come in useful. I'll open it later....

My grocery list has a format; it's my habit to arrange my list in three columns, in groupings that are roughly similar, and roughly in the order I know my favorite store has them arranged. I know that doing this saves time based on the way it doesn't work when I'm in an unfamiliar store's layout. It's a small trick that seems to make a difference. Until the store decides to rearrange things, but that doesn't happen often. That's the easy part.

What actual food to buy is what presents the challenge. Every parent will encounter difficulties with getting their child to eat what's best for them. Some children are easier than others. Autistic children bring a whole new dimension to the concept of difficult.

To understand why this is, it's important to consider that autism causes impairment in the way sensory information is processed. This includes sight and sound, and smell, taste, and touch.

Sometimes the first of these will be the culprit. I know of an autistic child who refused for months to eat anything that wasn't white. She never explained why. I know of several children who will not accept a plate upon which any kind of food is touching any other. One will go so far as to insist on the order of the portions. The potatoes must not be next to the carrots, and so on. The imposed dietary laws make mealtimes in these households chaotic. To an uninitiated outsider, it can appear completely insane, which it is. But let them only witness the kind of flapping, screaming meltdown caused by the toast not being the correct shade of brown, or whatever, and they may gain some insight.

One day I accidentally gave my sons the wrong lunch boxes. It was like giving kryptonite to Superboy. Twice. Still makes my head ache thinking about it.

I can't say for certain that sound doesn't play a part in all this, although it hasn't personally been in issue for us. In fact I wouldn't dare say it didn't, because I'd be sure to find out otherwise. Nothing is too improbable to be a defining trigger for some poor ASD kiddie somewhere. If a food is somehow unpleasantly noisy to an autistic child, they will let you know.

I have found smell, taste, and touch to be the most trouble. Smell and taste make sense, but the sensation of touch was the most surprising for me. I never considered it. How a particular food feels in the mouth and throat, which is something an autistic child can't explain, can make all the difference in whether a food is accepted, or sparks a crisis.

For instance, both of my children rejected potatoes outright because of the texture. After years of Taipan's robust example and urging, they eventually did come around to the allure of french fried ones, but that didn't, you'll appreciate, feel like a significant win in the pursuit of a rational diet. They will not eat them prepared in any other way. Frying seems to transform the texture into something far less icky for them, as it does most foods for everyone else.

By the way, my view is: if a child refuses to eat a particular food or combination of foods, it isn't worth fighting them over it. If you press the point you'll have the kind of hysterical conniption that can mar an entire day. And they still won't eat it. You will not win.

Personally, I decided early on that I wouldn't fight over food. I would fight over safety issues --yes, indeed, most certainly-- but not food. It is important to prioritize what you insist on. Be selective about skirmishes. The trick is to try choosing mostly the ones where you stand a chance of winning.

Luckily, Ben has developed an almost reasonable attitude to food. He's always been keen to emulate his father, and the Taipan will eat pretty much anything. Taipan's main requirements are that his meals be colossal. Ben got a lot of modeling during his formative years, and tried many things only after he witnessed his dad chowing down. As a result, Ben will eat all kinds of meat and fish, cheese and eggs, milk, fruits and vegetables. He loves salads. The breadth of what is acceptable to him seems miraculous, even better than a normal kid. That is, until a closer look reveals some deep quirks.

Take toast. It must be burned. I'm not kidding. When he was small, we must have had some toaster malfunction or other, because we went through a brief period of time when we had to scrape overdone toast. Ben imprinted this, and decided that was how he liked it. For him it truly isn't toast unless you can scrape black off it. Short of that, and it's still just bread, and he will reject it. Loudly, and adamantly. Now that he's a big boy of eleven, he likes to make it himself. When it pops up, if it isn't carbonized, back down it goes. I have gradually become accustomed to the acrid, brimstone smell of Ben's breakfast.

For some reason, I remember my dad insisting that 'charcoal toast' as he called it was a folk remedy for an upset stomach. I think it is a tried and true litmus test for ascertaining if a child is really too nauseous to go to school, or is just faking. From what I have read, the idea that burnt toast is good for you is simply not true. For the record, it is medicinal activated charcoal that is evidently beneficial.

Linus has always been much more challenging. His range of acceptable foods is extremely narrow and rigid. For a start, he's a one-food-at- a-time boy. If he wants some cheese, that is all he will have. It must be grated in a bowl. Sliced is unacceptable, and melted is out of the question. He gets the grated cheese all over the place, but I deal with it because it is the only dairy product he eats.

The trouble with Linus is that given his way, he'd eat only Doritos and chocolate cake. These foods, as everyone knows, are virtually nutrition free. He loves empty carbs.

I have to work hard to get nutrients into Linus. He'll eat a hamburger, but he only wants the meat, with a dollop of ketchup. No bread, or lettuce or tomato. Just meat. And then it gets weird. He will not eat any of the browned outside of the patty. He will messily pick off every bit of surface that once touched the frying pan. I give him a dish for this, and a cloth to wipe his hands on. It's easier that way. Then he'll eat all the meat inside unless I have accidentally left it a little too rare, in which case he will peel the brown meat carefully off of the pink. It's tricky, because too well done, and he won't eat it at all. The dog loves Linus.

Linus got a DVD for Christmas all about healthy food. It is narrated by Elmo and is in general a screeching irritant but for some reason it induced my son to eat an apple, and to try some salami. It has been fun trying to get Linus to say the word salami; he has trouble with the 'L' sound and keeps trying to say it in a high pitched Elmo squeal. Nevertheless, 'Yay Elmo!'

Then Ben saw the same video, and announced he wanted a sandwich with salami, cheese, lettuce, tomato and mayonnaise. No problem there, until I constructed it incorrectly. Ben became furious with me and agitated because I didn't do it exactly the way it was done on the video. It had to be in exactly the order stated above, and the mayo had to be squirted on top of the lettuce. Who does that? I have passed my entire sandwich making career (which spans decades now, I don't mind telling you) spreading the mayo and similar condiments onto the bread with a knife. To placate Ben, I'm now obliged to try to spread mayonnaise onto crinkly lettuce, which was not really working for me. At that point I felt a familiar urge to chase Elmo with a big stick....

The apple that Linus spontaneously ate was good to see, because he generally won't eat much fruit. Once in a while he gets a hankering for bananas, but not too often. They have to be on the yellow-with-no-spots-whatsoever side of barely ripe. If they are, and he's up for it (and I don't catch him in time) he'll peel all of them and bite off the pointy ends. No one else wants any after that. I love Linus, but he isn't always too reliable about hand washing. Apart from that, he will sometimes eat an apple (or apples, chewing all the skin off of several, leaving a a pile of very fat cores) or a few white grapes. I must stress that he takes the above options only once in a great while. And that's it for fruit. Vegetables are out of the question. When he was very small he would sometimes eat green beans, but he rejected them one day and that was that.

To prevent him going without vitamins altogether, I dope his apple juice with a liquid supplement that contains a long list of them, plus some iron. He prefers the apple juice without it, but has gotten used to the yellow tinged stuff and its taste.

I've had a couple of wins in the past few months with expanding Linus' diet. I have gotten him to eat cubes of beef steak, and sometimes even roast chicken by offering him a squirt of ketchup to dip into. He loves ketchup. I was also advised to try some mineral supplements and omega-3 capsules by a naturopath, and have found if I crush it all up in some nutella, he'll eat it on a sandwich.

I had to make a series of bribes to Ben last year because he didn't want whole wheat bread and pasta, but I knew that Linus would accept them if the other variety wasn't around. Ben loves his white bread, but it had to go. Linus has too few nutritional options to let that opportunity for improvement slide.

Both boys have gone through phases where they'd ask for something, and then when it was ready, refuse to eat it. My tolerance for that is minimal, I have to confess. Especially if it happens more than once in a given day. Ben would sometimes ask for two or three different things, and then reject them. Luckily for both of us, he seems to have grown out of that, because it came close to compromising my policy of not fighting over food. I sometimes felt Ben would do it because he was bored. With Linus, there is the mitigating factor that he can't talk. If he rejects something that he didn't point to, or use one of his few words to ask for, I don't mind as much, but he too has played the food roulette home game. "Let's see if I can make mummy's head explode...."

Now, there might be a let-them-starve impulse wanting to assert itself at this point. I understand that kind of thinking, I really do. "Back in my day, children ate what they were served." Well, yes. Usually.

Part of me longs for that old authoritarian certainty, but it fails to take into account the fact that there are normal grown people walking around today still traumatised by being forced to eat something they hated so much that it made them feel sick. The authoritarian way also overlooks the grim reality that if you plan to deal inflexibly with your children, you have to be prepared to be that way all the time. With an autistic child, you will have the same battles over and over, with the same unpleasant outcome. My youngest child already screams like a steam whistle whenever he's frustrated. I'm sure it's only a semi-quaver short of that required to shatter the windows. I am definitely losing some of my hearing already; it sometimes feels like it's pulping my inner ears. A scenario that would provoke shrill protests every time he wanted something to eat is not something I'm prepared to take on. Not without some of those big industrial orange ear muffs. Hmm. Note to self: should probably get some of those anyway. For when Linus is having an extra bad day.

I read somewhere that the real long term goal of parenting is to raise capable people who love you. Isn't that lovely? I think it's distilled wisdom, and I have embraced it. It's a comfort to me when it all seems too hard. A screaming match every single day over uneaten vegetables or spilled milk isn't how I plan to get there.

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