DAYCARE INCLUSION

Eating to nourish the body is a foundational need (Maslov's Hierarchy) for all children.  When we offer foods that are too difficult for them either from a motor or sensory perspective, we will know it by challenging or unsafe behaviors. 

When a child is served foods he/she is not willing to eat, it will look like this:

• Reluctance to come to the table.
• Unable to remain seated at the table.
• Pushing plate away.
• Throwing food to the floor.
• Refusing to touch food.
• Turning head away when the spoon is offered.
• Tantrums / Meltdowns.  
• Talking to keep from eating.
• Playing with food.
• Lets food drop out of mouth or spits food out.
• Screams, kicks, cries, hits at caregiver, flails arms, bites.
• Overstuffs mouth.
• Gags or vomits.
• Holds food in cheeks. 

Appropriate positioning at the table for a meal is critical.  The regulations for daycare facilities include the use of "developmentally appropriate seating". Highchairs with safety straps, chairs and tables of suitable size shall be available for each child and "any time feeding tables are used, children's feet must be able to rest comfortably on a footrest". 

When a child is not positioned appropriately, it will look like this:

• Need to be constantly repositioned.
• Leaning heavily to one side or sliding down in the chair.
• Wanting to stand to have foot support or stability. 
• Unable to use a utensil to feed self because tabletop is too high.
• Feet are dangling and not touching the floor.
• Unable to remain seated for the duration of the meal.
• Irritability during mealtime.

Children who are picky eaters or problem feeders may eat less quantity at each meal and therefore need more frequent meals. Children with sensory challenges may need crunchy or chewy foods, icy cold liquids to suck or have an overall need to use their mouth to self-regulate. 

When a child is not getting enough calories or hydration during the day it will look like this:

• Increase in challenging behaviors. 
• Attempting to climb on top of things. (**Remember, food service in a natural environment is in the kitchen and occurs at counter height levels. They are looking for something to eat or drink. Where is my cup?)
• Increased irritability or crying.
• Constipation (lack of sufficient water or fiber).
• Difficulty with sleeping at nap time and at nighttime. 
• Parents needing to wake up to feed the child during the night which usually means reliance on liquid nutrition (milk or Pediasure) which perpetuates a cycle of less solid food intake and food consumption during the day. It is a vicious cycle.
• Being less alert and sleep during daytime hours.

This is a soap box I climb atop because it is the one place I feel there may be trauma involved. I am sure it is unintended, but it is trauma nonetheless. Every day when a “picky eater” is dropped off at school and eats little more than a few crackers and the milk offered at lunch it can be a scary place for him to return. Knowing that every day he will experience hunger because he is not capable of either eating the food he is served or in the location he is expected to eat it. This is real, and if you don’t think it is happening, walk into any daycare that cares for children who are neuro divergent. A hungry child is a difficult child to manage emotionally. When this happens daily it results in repeated trauma. We are doing this in every center that prohibits appropriate accommodations for this population. 

Based on the "Louisiana Administrative Code 1919: Food Service and Nutrition: 

• "Drinking water shall be readily available indoors and outdoors to children at all times." While this seems very strait forward, we need to remember that children with special needs are often minimally verbal or nonverbal and do not have the capacity to ask for water when they need it.

• "Centers may allow parents to bring food into the center."  Most parents are not aware of this policy, nor do they even know their child is not eating while at daycare because centers do not communicate this with the parent. 

• "Children shall be allowed a reasonable time to eat each meal and snack."  There may be a good reason a child is lingering at the table and not eating in a timely manner. We need to consider that it may be due to sensory challenges.  The proximity to the other children, the noise and activity at the table or poor praxis (planning, organizing, executing). 

Head Start Centers, God bless them, are sticklers for "Policy" and that means "no outside food can be brought into the center". So, what is the alternative for these children? Crackers. The children who do not eat what is served at Head Start are offered 1-2 packs of crackers at mealtime. Milk and crackers. Is that the best alternative we have? An email response from a coordinator at the center assured me "Children who are selective eaters are provided foods that they will eat --our Nutrition Manager approves these meals."  I have never seen a child being offered an alternative (unless it is due to an allergy issue) when they are not eating what is being served and I have been working for 20+ years. 

Louisiana Administrative Code 1509. Policies states children cannot be "deprived of foods and beverages". We need us to RETHINK what “being deprived of food and beverages” means in relation to the neuro-divergent population. In instances when they are required to eat whatever is served at the center without regard to IF they are eating anything at all, are we depriving them? When they are unable to ask for hydration and are not being automatically offered it on a routine basis are we depriving them?  When a child is at a center from 7:30/8:00 am (breakfast) through 4:00/5:00 pm (pick up) they are at a center for approximately 9 hours. Neuro-divergent children WILL go all day without eating or eating very little. This is not good for their health and can be one of the most extreme contributions to behavioral challenges. Not to mention how traumatic it is to be dropped off at a place every day where you know you will be hungry and in pain from not eating.

Lastly, then I will step off the soap box... COMMUNICATION. When facilities do not communicate with the parent about what and how much the child is eating when this is clearly a problem, is this abuse? Allowing a clearly unsafe and unhealthy situation to occur repeatedly, day after day after day and say nothing...is this abuse by neglect? On one occasion, I was seeing a child who literally ate almost nothing at the center. I asked a facility to log what and how much the child ate for lunch so that the parent and I could see and track variety and volume. I was told that "it is not in the teachers job description, so it would not be done." Hard swallow, deep sigh. Same center says, "if he does not eat here, this may not be the right place for him." There was obviously no room for accommodation. And yes, this was a federally funded center. The child wound up leaving the center completely. 

Sufficient sleep quality and duration is a foundational need (Maslov's Hierarchy). Sleep disturbances in ASD are common and include difficulties initiating and maintaining sleep, frequent and prolonged night awakenings, irregular sleep–wake patterns, short sleep duration, and early-morning waking. Between 44% and 83% of children and adolescents with ASD report coexisting sleep abnormalities, adversely affecting daily functioning.  Poor sleep is a contributing factor to behavior challenges. 

What it looks like when a child is not getting enough sleep: 

1. Irritability.

2. Tantrum behaviors.

3. Aggressive behaviors.

4. Difficulty staying awake or needing to sleep when their peers are awake.

5. Irregular sleep and eating pattern.

6. Inability to get the body still to go to sleep. 

Here are some recommendations for supporting the child. 

1. Address the sleep environment:  dark, quiet and cool. Often children with ASD have sensory sensitivities.  The environment should be adapted to make sure your child is as comfortable as possible. This is an accommodation. 
2. Establish and stick to a routine: the routine should be predictable and include relaxing activities such as soft music (if the child likes it), rhythmical activities (swinging or rocking), deep pressure (weighted blanket), a transition object (lovey). These are accommodations. Ensure the child is not hungry and avoid use of electronics.  
3. Sleep\wake schedule: the schedule should be regular with not much of a difference between the weekday and weekend schedule. At daycares, it is important for the parent and child to communicate about what this would look like. 
4. Teach your child to fall asleep alone: Children who have difficulty getting their body still many need adult support to fall asleep. It may take time for the child to learn how to do that on his own. f your child needs a parent present to fall asleep at bedtime, he might need a caregiver to help him fall asleep at the daycare center. This is an accommodation. 
5. Offer sufficient exercise: Daytime exercise can make it easier to fall asleep and children who exercise tend to have deeper sleep. Avoid allowing your child to exercise too close to bedtime as it can make it difficult for him to fall asleep.
6. Avoid caffeine particularly close to bedtime, which can be alerting making it difficult for your child to fall asleep. Caffeine is found not only in coffee, but also in tea, chocolate and some sodas.
7. Naps are helpful for preschool children, but should not be taken late in the afternoon as they can interfere with bedtime.

Stay tuned