Simon is a 7 year-old boy with severe autism and profound learning disability. He relies on routines for security and will scream uncontrollably for hours if his routines are disturbed in any way or when he is presented with new situations. Simon has never eaten solid food. His mother has made several attempts to wean him but he has resisted and gags at anything other than liquid, which he has to have from the same bottle with the same teat.

Strategies

• Introduce one or two set periods outside of his usual bottle times, when Simon is to be offered tempting food (e.g. ice cream) by someone he likes and trusts
• Reward tolerance of food at these times immediately with a favourite activity (even if he does not chew or swallow)
• During this process, continue to allow the usual bottle feeds to continue so that Simon does not feel these feeds are threatened and becomes stressed
• As Simon’s tolerance of the food increases, rewards can be adapted to encourage him to eat bigger portions, and in time, other types of food
• It should be expected that progress may be very slow, with backward steps as well as forward ones. Everyone involved should be clear about this and ready to support one another so that expectations remain realistic
• The focus should be on minimising stress for Simon and maximising his enjoyment, as he is likely to respond to too much pressure by returning to his familiar, limited diet
• Limited food and/or drink intake is relatively common in this population. It can be very difficult to increase or widen this. Referral to a dietician for specialist advice may well be required to assess and address the problems.