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TRANSCRIPT
Managing
eating issues
in children
with
Asperger
Syndrome:
Parents’ and Professionals’ Suggestions
Shu Hwa Ong,
Bruce D’Arcy,
Melinda White &
Sylvia Rodger
Table of Contents
Introduction .......................................................................................................................................... 1
Case study #1: Sam, aged 7 .............................................................................................................. 2
Case study #2: Tom, aged 12 ....................................................................................................... 5
Case study #3: Sue, aged 14 .................................................................................................... 8
Case study #4: Ben, aged 9 ....................................................................................... 11
Supplementary Materials
Meal Portions ..................................................................................................................................... 15
Creative Lunch Box Ideas .................................................................................................................. 17
Food and the Senses ........................................................................................................................... 21
Food Selection by Colour .................................................................................................................. 23
Food Selection by Texture ................................................................................................................. 26
Suggestions for Texture/Taste/Nutrition Modification ...................................................................... 28
Food and Nutrition ............................................................................................................................. 30
Does Your Child Need Nutrient Supplementation? ........................................................................... 37
Healthy Snack for Children ................................................................................................................ 38
Reading the Food Label ..................................................................................................................... 40
Ideal Mealtime Practices .................................................................................................................... 41
Food and Growth ............................................................................................................................... 42
Importance of Physical Activity ........................................................................................................ 43
Physical Activity Alternatives ........................................................................................................... 44
Activity Sheets
Daily Food Group Intake Checklist for Children ............................................................................... 46
Meal Planner ...................................................................................................................................... 47
Negotiation Chart ............................................................................................................................... 48
Helpline .............................................................................................................................................. 49
Additional Reading Resources .......................................................................................................... .51
1
Managing eating issues in children with Asperger Syndrome: Parents’ and
professionals’ suggestions
Introduction
Parents/ caregivers have access to considerable nutritional advice about how to keep their child
healthy. Selective eating patterns are more commonly exhibited by children with Asperger
Syndrome (AS) compared with typically developing children. This booklet aims to share some
strategies gathered from health professionals and parents/caregivers. These strategies can be used to
manage selective eating in children with AS.
The booklet details four hypothetical case studies of children with Asperger Syndrome. It lists the
possible dietary implications for managing the children’s eating issues. In addition, this booklet is
supplemented with relevant handouts to provide additional information for parents.
It should be noted that the written case studies are hypothetical; however they were developed from
the discussions with parents of children diagnosed with Asperger Syndrome.
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Case study # 1: Sam, aged 7
Physical status: Sam’s height and weight are within the healthy acceptable range. Sam is
experiencing a healthy growth pattern.
Clinical: Generally well, with no special health concerns.
Common eating behaviours of Sam:
- Likes finger-foods, e.g. fish finger and chicken nuggets;
- Refuses to eat steak, but accepts meat in the form of mince, sausage, stewed or
braised;
- The only vegetables eaten are cooked carrot, mashed potatoes and corn;
- Prefers foods not touching other foods on the plate;
- Fruit juice and banana are the main fruit sources;
- Enjoys eating crackers, crisps, chocolate and yoghurt;
- Likes adding sauces to his foods, mainly tomato sauce and barbeque sauce;
- Mum comments he is always a picky eater, especially regarding food texture.
Possible nutritional risk(s):
- Risk of inadequate micronutrient (i.e. vitamins or minerals) intake
- Excessive sodium intake from sauces and processed foods
How did the parent and professionals manage Sam’s eating pattern:
Parent’s suggestion #1: Only allow Sam to leave the table after he has eaten all the food served to
him
Professionals’ suggestions: Let your child judge how much s/he eats
The serving portions for children are often smaller than those for adults. The quantity of
foods required by children depends on their age, gender and physical activity levels.
See “Meal portions” handout for guidance in judging how much your child requires for
meeting his/her daily nutrient requirements.
Possible outcomes #1 : Over-eating and stress at mealtimes; remain at the table
Sam could be over-eating in the long-term, particularly if meal portions are misjudged and
over-estimated.
Stress introduced at mealtimes could provoke a negative association with foods and
mealtimes.
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Parent’s suggestion #2: Allow Sam to include his favourite sauce when a new food is being
introduced
Professionals’ suggestions: Limit seasonings/ sauces to no more than one (1) tablespoon per
meals
Seasonings/sauces are commonly high in salt content. Try low salt varieties of seasonings/
sauces. Children should be encouraged to drink at least 6 – 8 glasses of water daily to help in
excreting excess salt.
Keep a food record of the foods eaten and not eaten by your child could help to determine
his/her food preferences. Such a food record can be used to decide which of the child’s
preferred foods could be replaced without compromising nutrition; while at the same time,
gradually decreasing any dependence on seasonings/ sauces at each meal.
Possible outcomes #2: Excessive salt intake
Sam might regard the sauce as a reward food; whilst the new food could be perceived by
Sam as a punishment at mealtimes, especially when the new food is not within the
acceptable range of Sam’s food preferences.
Sam might excessively use the sauces/ seasonings in his meals so that the taste of the new
food offered could be masked. Thus, a dependence on the use of sauces during the
introduction of new food could lead to an excessive salt intake by Sam’s through his diet.
Parent’s suggestion #3: Only allow Sam to reject a food after he has tried it (at least with a bite)
Professionals’ suggestions: Expect rejection, accept disappointment
Your child is still learning to eat different foods and is developing eating skills. Here, a
learning plate could be offered next to his/ her usual eating plate. Ask your child to place
their customary food on his/ her learning plate when s/he refuses to try a bit. If s/he refuses to
do this, you can help to place the customary food on his/her learning plate. Although your
child is not eating it, s/he can become familiar with the look and smell of the new food on the
eating plate and to tolerate its presence.
You could invite your child along on food shopping trips. Next, allow them to hold, smell
and touch new foods. In addition, you need to be aware of their food preferences. Touching
and playing with the food is part of the learning stage of food acceptance.
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Possible outcomes #3: Battles at family mealtimes when the caregiver and the child refuse to
listen to one another
Disputes that happen around mealtime increase everyone’s frustration, with negative
experiences being associated with the offering of new foods.
Children might feel their food preferences are not being understood and respected by their
parents, if they were required to take at least a bite of the new food.
Additional suggestions:
If your child by the age of 5 only eats one food texture, especially for a food requiring less
chewing (soft/ mince/ meltable), you should consider seeking professional advice.
Children with AS are commonly reported to have highly selective food preference that relate
to texture. If your child makes unhealthy food choices (e.g. fried fish finger, deep-fried
potato chips), you may wish to provide healthier choices (keeping in mind their texture
preferences, e.g. grilled crumbed fish, oven-baked potato wedges) – See “Food Selectivity by
Texture” and “Suggestion for texture/taste/ nutrition modification” handouts.
You may consider the use of a divider (e.g. silicon cups) in your child’s lunch box when
foods need to be separated from another food – See “Creative lunchbox ideas” handout.
What have you learned
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Case study # 2: Tom, aged 12
Physical status: Tom’s weight and height are within the acceptable healthy range. Tom
experienced an average growth of 3 cm and 2 kg over a period of three months (which is normal
average).
Clinical: Diagnosed with ADHD in addition to AS
Common eating behaviours:
- Repetitive and rigid eating patterns in a cyclic pattern;
- Same meals and snacks offered daily lasting for 3 – 6 months;
- Consumed less than ten food items over the past few years;
- Changed only one food in his limited food repertoire;
- Lack of vegetable, fruit and meat intake in his diet;
- The only vegetable eaten is hot chips;
- Had strong preference for salty, vinegary and plain foods;
- From his room, he can smell cooking in an open kitchen, particularly the odours of garlic,
onion, and spices.
Possible nutritional risk(s):
- At risk of inadequate fibre, vitamins and minerals intake due to low vegetable and fruit
intake;
- At risk of low iron intake since his meat intake was lacking;
- Might consume excessive salt intake from his strong preference for salty foods.
How did the parent and professional manage Tom’s eating pattern:
Parent’s suggestion #1: Let Tom decide what he eats; let Tom have a separate meal from the rest
of the family.
Professionals’ suggestions: Respect Tom’s food preferences if nutrition is not compromised
To do this, draw up a weekly meal planner for Tom by ensuring he eats daily at least one
type of food item from each food group.
Use the “Daily serving checklist for children” handout when planning Tom’s weekly meal.
It assures his nutrition intake is adequate yet meeting his food preferences.
Encourage Tom to sit at the table with the rest of the family at mealtimes, so that he is
exposed to the daily foods eaten by other family members, while learning to accept the
foods through role modelling.
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Possible outcomes #1: A reduction in stress at family mealtimes; a risk of poor food choices when
made by child; additional time in food preparation.
Most children have limited nutritional knowledge about foods. They often choose the food
based on their preferences, especially the taste and texture of food. As a consequence, their
nutritional intake could be compromised when poor food choices (i.e. those high in
calories/salt/fat and low in good nutritional values) are made.
Parents who offer foods that are acceptable to their children reduce the battles at family
mealtimes, when compared to parents who try to persuade and negotiate with their children
about trying those foods they dislike.
Parent’s suggestion #2: Accept the stereotyped behaviours of Tom.
“After Tom was diagnosed with Asperger Syndrome, we knew he was different and we learnt to
accept how he behaves and what he eats,” Mum.
Professionals’ suggestions: Do not treat your child with AS too differently from your other child
Listen to your children’s opinion/ interest.
Respect their food and sensory preferences.
Set up a positive mealtime environment that is acceptable to your child. This is essential to
encourage their food acceptances. See “Ideal mealtime practices” handout for more
information.
Possible outcomes #2: Allows parents to have an open, optimistic mind
Children with AS have little ability to manage their stress. Thus, for avoiding possible
unexpected events (e.g. choking from foods, disgust of the food taste), they may prefer to
eat familiar meals. Thus, a repetitive, rigid eating pattern is displayed. However, that could
also be explained by their stereotypical behaviours of disliking change.
Accepting and understanding a child with AS gives parents an optimistic mindset in guiding
the child throughout his/her challenging daily environments.
Parent’s suggestion #3: Involve Tom in meal preparation; avoid cooking garlic/onion/spices at
home when Tom is around
Professionals’ suggestions: Making mealtime fun by involving your child
Plain, bland foods are usually preferred by children with AS.
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Keep every meal easy and simple. Involving your child in simple meal preparation can be
fun.
Wrap-up foods are often popular dishes as children get to choose their own fillings and wrap
their own foods. For examples, sushi, tortilla, burritos, rice paper rolls, wraps and crepes.
Getting ideas from children’s cooking recipes allows your child to learn about foods by
cooking them; consequently, this increases their food acceptances when they know more
about the food they eat.
Growing and eating herbs/ vegetables in your garden can be fun!
Possible outcomes #3: Increase the food exposure to your child; encourage a positive mealtime
environment
The involvement of your child in the kitchen allows them to learn about food properties and
it preparation. In addition, this gives your child more knowledge about the foods that he/she
eats, such as knowing the type and quantity of ingredients used in a mixed dish.
Children with AS are commonly experience difficulties in sensory processing. Sensory
sensitivities for smell and taste could influence his/her food acceptances. Children with a
high sensitivity to smell are more readily able to accept food served at the dining table when
they are not distracted by an intolerable smell from the kitchen.
Additional suggestions:
Introducing fruits as desserts. For example, frozen fruit cup (prepare using fresh mango,
yoghurt and lemon juice - can add passionfruit pulp if your child likes more texture in food),
stewed/ grilled/ caramelized fresh fruits or fruit kebabs.
Try expanding your child’s vegetable intake. Slowly replace some of your child’s mashed
potato with mashed broccoli, and followed by sweet potato (white flesh), mashed sweet
potato (orange flesh), pumpkin, and mashed carrot. Only introduce half a tablespoon of
“new” food at a time.
Avoid your child adding salt from the dinner table. Use salt sparingly in your child’s diet.
The higher salt intake in child’s diet, the higher risk of experiencing hypertension in
adulthood.
What have you learned
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Case study #3: Sue, aged 14
Physical status: Height and weight are in the healthy range.
Clinical: Generally well, with no special health concerns.
Common eating behaviours:
- Likes beige-coloured food (Sue commented she felt safe to eat them);
- Has a strong preference for sweet food;
- Only likes tuna in sushi, but she never ate fish on its own;
- Enjoys finger-foods (e.g. sushi, tortilla, enchilada), but not self-limited to;
- Skips her meals when she was obsessive in her present activity;
- Displays aggression and temper tantrum if being served meal that were outside her food
preferences;
- Dislikes fresh fruit due to its fibrous texture;
- Fruit juice is the main fruit source in her diet;
- Mum reports Sue’s food variety has expanded gradually.
Possible nutritional risk(s):
- At risk of inadequate fibre intake;
- Irregular mealtimes could affect Sue’s satiation and appetite level towards her next meal.
How did the parent and professional manage Sue’s eating pattern:
Parent’s suggestion #1: Never give up introducing food variety at each meal; includes at least one
acceptable food in the meal
Professionals’ suggestions: Introduce new foods by expanding one food item at a time
For example, if your child likes eating pasta, introduce cooked carrot or cooked pumpkin
into the pasta to expand his/her vegetable intake.
Start introducing foods, that are generally eaten by your family throughout the year, and
which share similar food properties with your child’s preferred foods.
Gradually increase the amount of “new” foods on your child’s plate by half a teaspoon at a
time.
Only introduce another “new” food when some improvement was shown during the
previous mealtime offer.
Be persistent! You are not the only parent who is struggling with feeding your child. If you
need to talk to other parents, see the “Helpline” handout.
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Possible outcomes #1: Increase the chances of a new food being accepted by Sue in long term
Studies have found that children learn to accept one new food after at least 10 – 15 times of
exposure. When your child is learning about new foods, s/he could be sensitive towards
certain food properties. In addition, remember your child is still learning to eat different
foods and is developing eating skills.
Including familiar foods in each meal, together with the new foods, helps to ensure your
child eats something from the plate. However, you may be placing your child’s food
repertoire at risk by removing familiar foods with new foods. This is because your child may
feel ‘threatened’ by the unexpected changes in his/her usual preferred diet. Remember most
children with AS prefer routine, and such as similar meals.
Parent’s suggestion #2: Invite Sue to take part in a school camp, community event or family day
where food is eaten.
Professionals’ suggestions: When eating out, bring your own food while still offering the food at
the table to your child
Offer the same foods to your child as what his/her peers (or other guests) have.
Contact the school before the camping/ travelling events to inform them of your child’s
eating patterns, so that alternative meals can be pre-arranged for your child when required.
Possible outcomes #2: Increased or reduced chance of new food acceptance
Social events with peers may help to promote variety in your child’s food intake through
role modelling. As an example, encouraging participation at birthday parties when invited,
may allow your child to learn from what others do or eat (i.e. outside of the family).
However, new social events may increase social anxiety and lead to reduce your child’s
food intake.
Parent’s suggestion #3: Communicate often; have a cooling period when child/ parent is distressed
Professionals’ suggestions: Stay calm and be honest with your child
Avoid showing your anger and fear.
Communicate with your child when your mind is ready to listen and accept/negotiate in a
calm manner.
Use a negotiation chart to jot down what you and your child think before making any
further comments/ decisions about foods.
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Avoid empty promises that lead to mistrust.
Possible outcomes #3: Improved understanding between parent and child; avoid confrontation
Communication is the best tool to understand your children better. Parents know their
children best; however, a lot of effort is required to assist his/her.
Allow time for a person to calm down and think while speaking out their thoughts and
perceptions towards a situation.
Additional suggestions:
Try offering Sue fruit with less fibrous texture. For example, canned fruit, stewed banana,
and guava. The stringy fibrous material can be removed once fruits are cooked. Try stewed
peaches, banana, and nectarines, which are sweet (i.e. meeting the child’s sweet preference).
If forgetting meal is an issue, set an alarm (e.g. using a digital watch or a desk alarm clock)
to alert Sue of her mealtimes.
Try expanding Sue’s food variety based on her preference for beige-coloured food – See the
“Food Selectivity by Colour” handout.
What have you learned
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Case study #4: Ben, aged 9
Physical status: Ben is overweight. He is experiencing an average weight gained of 2 kg per month,
and grew taller by 0.5 cm per month.
Clinical: Taking medication that hidden the possible adverse effect of weight gain to control his
behaviour; Experiencing diarrhoea 3 times per day
Common eating behaviours:
- Enjoys eating his food in large portions and in a repetitive manner;
- Frequently complains of hunger;
- Ben has access to food at all times when there is no supervision and raids the cupboard;
- The main fluid source is milk;
- Likes strong flavoured foods, e.g. curry chicken rice;
- Prefers foods that require minimal chewing, e.g. white bread, biscuits, yoghurts;
- Lacks vegetables and meat in his diet.
Possible nutritional risk(s):
- At risk of excessive calorie intake from his daily estimated needs;
- At risk of inadequate fibre intake;
- At risk of low iron intake since meat intake was low.
How did the parent and professional manage Ben’s eating pattern:
Parent’s suggestion #1: Lock the food cabinet and fridge
Professionals’ suggestions: Draw a weekly family activity schedule, including work, school,
mealtimes, sport and household chores
Listing of the schedule provides a routine schedule for your child/family to ensure a healthy
lifestyle is adopted.
Setting a regular routine at mealtimes and snack times allows your child to control their food
intakes by reducing its frequency to 3 main meals and 2 snacks per day. In addition, it
allows your child to learn the cues of hunger, so that she/he eats regularly at 3 – 4 hours
intervals only.
When his/her time is being occupied with other activities (e.g. cleaning own room,
homework, sports), excessive snacking at home can be avoided.
See the “Physical Activity” handout for ideas about the alternative activities in which your
child might be able to get involved.
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Providing a healthy snack food range in the food cabinet or fridge can prevent your child’s
from eating high calorie, empty nutrient foods often (i.e. remove the temptations from the
home). This can be difficult, since the whole family must cooperate.
Possible outcomes #1: Eliminates direct food access for children without supervision
Ben’s meal and snack patterns can be controlled.
Supervising Ben’s food intakes avoid over-eating (of junk or large quantity foods), and thus
prevents excessive weight gain.
Preventing food access by Ben at home reduces his exposure to foods to those of the
families’ common food items.
Parent’s suggestion #2: Introduce fortified food into Ben’s diet since he is not eating enough diet
variety
Professionals’ suggestions: Offer food that is higher in nutrient value
Replacing your child’s food choice with another food, that shares similar textures/tastes but
with a higher nutrient value, can be helpful to improve your child’s nutritional intake.
Ensure adequate fluid is consumed daily (i.e. at least 6 – 8 glasses of water per day)
See the “Foods & Nutrition” handout to gain ideas about the nutrient content in food sources.
See also the “Does Your Child Needs Nutrient Supplementation” handout to judge the need
for nutrient supplementation in your child’s diet.
See the “Reading Food Label” handout to guide you in shopping for more nutritious foods
for your child.
Possible outcomes #2: Nutrient overload; reduced willingness to be involved in food expansion
When a child eats a large portion of fortified foods daily, she/he may experience nutrient
overload at a higher risk than a child who does not consume fortified foods. This is because
fortification in food promotes a higher nutrient absorption rate in the digestive system than a
natural food. Some nutrients are stored and not excreted from the body when excessively
consumed. For example, a high iron store in child’s body promotes constipation, particularly
when his/ her fluid intake is inadequate.
Dependence on fortified food in the long term may encourage repetitive eating patterns in
children with AS, if parents assumed the adequacy of their child’s nutritional intake was
reached by using fortified diets.
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Goal Checklist:
Is the goal achievable?
Is the goal realistic?
What is the degree of difficulty to achieve the goal?
What are the barriers to achieving the goal?
How might you manage/ solve those barriers?
What help/ support can assist you?
Yet, the use of fortified foods can ensure that those children with a limited food repertoire
are obtaining an optimum nutritional intake to meet their growth status.
Parent’s suggestion #3: Visit health professionals to managing Ben’s eating behaviours and
gastrointestinal illness
Professionals’ suggestions: Discuss your goals and priorities for your child with your health
professional
List out your primary concerns with your child’s eating behaviours.
Prioritise goals for your child in the life context of the needs of your whole family.
Attempt one modification in your child’s life at a time. Ensure that you and your child are
involved in the setting of goals related to eating behaviour.
Draw out a reasonable timeline in achieving the goals listed. For example, one goal could
be to learn to accept yoghurt in the next six months.
Refer to the checklist below to guide you and your child in goal setting.
Possible outcomes #3: Such a visit may help Ben’s parents understand his needs from his
perspective (such as behavioural, clinical and psychological)
Clarifications from health professionals means parents understand their children better,
which can eliminate those unnecessary stresses in parents.
When a child experiences medical complications in eating, (i.e. diarrhoea in Ben’s case),
appropriate intervention guided by health professionals will improve Ben’s eating
behaviours, and therefore his/her overall nutritional status.
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Additional suggestions:
Try to encourage your child’s fluid intake to be at least 6 – 8 glasses of water per day. If
your child dislikes water, try to place lemon wedges, mint leaves, or strawberries for flavour
infusion into his/her drinking water. Alternatively, on summer days, prepare ice-blocks
using fruit juice/frozen berries and place them into their drinking water.
If your child likes spices, try to introduce new foods that sparingly use those types of spices
preferred by your child. For example, when child loves curry, try to cook a vegetarian curry
using tofu (i.e. white, soft, smooth) instead of chicken (i.e. white, soft, stringy). You may try
slowly changing the food texture in your child’s diet one food item at a time.
Some ideas to start with:
1. Set good mealtime practices in your family
2. Know your child’s food preferences
3. Communicate with your child often with regards to food
4. Draw a daily schedule, e.g. meal planner and activities
5. List out goals to be achieved in improving your child’s food intake
What have you learned
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Meal Portions
Children’s food intake is hard to judge when they keep growing each day. Each child requires
different energy requirements based on his/her gender, age and activity level. The Australian
Dietary Recommended Guidelines for Children and Adolescents (NHMRC 2003) are designed to
meet their general requirements. They can be used as a basic guide for judging the meal portions for
children. However, regular monitoring of your children’s meal portions and food choices is
essential to ensure your child’s appetite and nutritional needs are met.
As a general rule:
Use your child’s palm size to measure a serve of meat
For children under 5 years, one tablespoon of vegetables is approximately equal to
one serve of vegetable
The more active the child is, the more energy is required to meet their demands
Let your children serve themselves and allow them to judge their fullness. It is not
essential to require your children to empty their plates
Set regular meals and snack times in order to monitor the type and quantity of food
intake of your children consistently
Approximate average proportion of food groups served in a healthy lunch
box:
1 bottle
Water
Dairy
(1 serve)
Fruit
(1 serve)
Meat/ meat
alternative
(1 serve)
Bread/rice/
pasta/
couscous/
noodle
(2 serves)
Vegetables
(2 serves)
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Recommended daily intake for children
Food groups
1 serve equals
Number of servings/day
Children aged
4 – 7 years 8 – 11 years 12 – 18 years
Cereals, bread,
rice, pasta,
noodles
1 slice bread,
½ bread roll/ bagel,
1 crumpet/ English muffin,
2 Weet-Bix,
¾ cup hi-fibre breakfast cereal,
¼ cup untoasted muesli/oats, OR
½ cup cooked rice/ porridge/
pasta/ noodles/ couscous
5 – 7
6 – 9
5 – 11
Vegetable ½ cup cooked vegetable,
1 cup salad vegetable,
½ cup cooked legumes, OR
1 small potato
2
3
4
Fruit 1 medium piece of fruit,
2 small pieces of fruit,
1 cup canned fruit,
1.5 tablespoons dried fruit, OR
½ cup fruit juice
1
1
3
Dairy 1 cup milk / calcium-enriched
dairy alternatives,
200 g yoghurt/ custard, OR
40 g cheese
2
2
3
Meat, fish,
poultry, eggs
or alternatives
65 g cooked meat,
1/3 cup lean mince,
2 slices roast meat/ ham,
80 g cooked fish,
½ cup cooked legumes,
1 egg, OR
10 nuts
½
1
1
Extra
(Sometimes)
foods
2 sweet/ savoury biscuits,
1 scoop ice-cream,
1 small packet potato crisps,
1 ‘fun-size- chocolate bar, OR
200 ml fruit juice/ soft drink
1
1
1
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Creative Lunch Box Ideas
Simple yet creative healthy lunch box ideas can be a struggle for fussy eaters. Two common
questions are: “What can I provide in my child’s lunch box when their food choices are so
limited?” “How can I encourage my child to eat more foods from the lunchbox?” Hence, our
objective is to share some ideas in preparing lunches.
We aim to:
Encourage your child to eat the food prepared in the lunch box;
Encourage your child (and not the bin) to gain the good nutrients offered by
the food you prepare;
Promote safe and healthy eating at school.
Three (3) points to keep in mind when preparing a lunch box for children are:
1. Food safety
2. Food preference and nutrition
3. Quick food presentation in a hurry
1. Food safety tips
Practice good hygiene during food preparation/ handling
Wash hands before handling food. Avoid touching food directly with bare
hands, but use gloves or utensils if necessary.
Ensure clean utensils and food containers are used.
Use separate cutting boards for raw meat and fruit/ vegetables.
Do not prepare raw meat together with ready-to-eat salad/ fruits to prevent
cross-contamination.
Clean the kitchen before and after food preparation.
Cover the cooked hot dishes with muslin clothes or net to prevent the bacteria
contamination from insects, especially during hot weather, while cooling
down the dishes before storing into lunchbox.
Food temperature check
Store the cool food below 5oC and the warm food above 40
oC. Temperature
between 5oC and 40
oC is the most desirable environment for the growth of
bacteria. Use insulated flask or one with freezer pack to store those foods that
required safety attention.
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Try to eat perishable food items, such as dairy products, egg and meat, within
about 4 hours of preparation.
Cool down cooked food completely before packing into a lunch box to reduce
the condensation and thus the moisture content in the lunch box. Alternatively,
fridge the food overnight before packing into the lunch box for next day.
Foods that should be avoided from lunch box are:
Raw fish/ seafood
Undercooked meat
Half-boiled or runny poached egg
Leftovers that appear to be a bit stale
Egg-based/ cream-based dressings, e.g. mayonnaise, ranch, Thousand Island
dressings, unless keep it very cool
Tofu
2. Food preference and nutrition
Lunch box planner (as designed by Makiko Itoh: http://www.justbento.com/)
Encourage your child to get involved in the preparation of the lunch box, such as choosing
and packing the foods into the lunch box. You should set a role model by preparing yourself a
healthy lunch box.
Discuss with your child about his/her food preferences in the lunch box
Ensure your child chooses one food item from each food group based on his/ her preferences.
For example, if s/he prefers eating white-coloured foods, pick one white-coloured food from
each food groups, so that a balanced nutritious lunchbox is warranted. Refer to ‘Food and
Senses’ handout for more ideas.
Most importantly and definitely, the lunch box has to be tasty as well!
The secret of making a tasty lunch box is by keeping the ingredients as simple as possible. As
long as the ingredients used are fresh and good in quality, the simple cooking method, such as
grill, roast, or steam, can bring up the natural flavour of the cooked ingredients fantastically
(maybe a light shake with salt/ pepper as an indulge). This is particularly applicable to a child
who is a sensitive towards smell and taste of food.
Nutritious
Have the checklist of food groups handy. Tick the number of servings and type of foods
offered to and eaten by your child in the lunch box-of-the day. Offer the rest of the lacking
19
food group intake in the later meals of the day, or make up those inadequacy intake to the
meal next day. Make every mouthful count!
3. Quick food presentation in a hurry
Essential tools in decoration/ arrangement
Silicon cups: Place loose/ small foods, e.g.
cherry tomato, grated carrot, minced meat
Baking paper cups/ foils: non-reusable, more
hygiene; suitable for dry foods
Picks: For finger foods or as decoration Plastic grass divider: “Baran”- separate the
food from touching
Cookies cutter: Shape vegetable Bread shaper: Remove crust & shape bread
Rice shaper Mould/ Divider: Place loose food items
Accessories: Mini sauce bottles , Plastic cutlery
Speedy lunch box preparation tips
Prepare as much as possible the night before.
Cut up vegetables the day before and refrigerate overnight for use in assembling
the lunch box.
Cut up fruit at night and store in fridge after squeezing some lemon juice over the
fruits to reduce the browning reaction on the fruits.
If possible, cook the meat for lunch box at night and refrigerate overnight, unless
the meat has to be crunchy. That not only ensure the meat is cooled when packing
in the lunch box, but also save the time in cooking.
Set aside some left-over for the lunch box.
Get ready with carbohydrate foods, such as bread, cooked pasta, cooked rice,
cooked cous cous, and biscuits, the night before.
Set up all utensils and accessories required for the assembly and preparation of
the lunch box in advance
Don’t spend too much time on fancy decorations by shaping every foods offered.
Offering tidy arrangement, safe and nutritious food is more important in assuring a
healthy appetite of your children than a fancy lunch box. Keep the craft work in
preparing lunch boxes for family picnics or camping when more time is allowed to
do so.
References:
1. Itoh, M. (2010), “The Just Bento Cookbook: Everyday lunches to go”, Kodansha International, Japan.
2. CSIRO. (2009), “The CSIRO wellbeing plan for kids”, Penguin Group, Australia.
20
Food and the Senses
Understanding senses
Our senses are: hearing, smelling, seeing, touching, and feeling movement. These senses
affect how we, as individuals, respond to the world around us. Different individuals have
different sensitivities to various sensory inputs. For some children, only a small amount of
sensory input is needed to obtain a response (hyper sensitive or over responsive); while for
others a lot of input is needed (hypo sensitive or under responsive). For example, a child can
be over sensitive to the fluorescent lighting in the dining room and complain of glare. For
some children, the smell of donuts cooking at the shopping centre (a distance away) may be
experienced as unpleasant and intolerable; however another child might only smell the donuts
cooking when s/he is close by.
How the brain makes sense of incoming sensory input is known as sensory processing.
Children learn to associate certain types of sensory input with pleasant or unpleasant
experiences based on learning from past experiences. This could be affected by past family,
social and cultural experiences. For example, if a child is forced to eat lumpy food while
being spoon fed by an adult as a toddler, s/he might remember this as unpleasant; hence avoid
any type of spoon feeding in future or avoid similar lumpy food.
In general, our senses help us to be aware of, attuned to and engaged with the world around
us. Each individual’s sensory preferences shape his/her level of alertness or arousal, and the
brain’s readiness for learning.
Mealtimes and Senses
Not only do an individual’s food preferences influence what s/he eats, but also the
environment at mealtimes influences a child’s eating behaviours. Parents and caregivers need
to be alert to children’s food preferences in order to offer nutritious food choices and promote
successful eating and mealtimes. In addition, understanding the sensitivities of individual
children related to smell, taste and touch can also help to build a positive mealtime
environment – See Ideal mealtime practices handout. Some suggestions for managing
sensory issues at mealtimes are listed below:
Set up a mealtime environment that is practical for your family and acceptable for your
child. For examples, check the child’s seating position (i.e. chair at appropriate height
21
for table using booster seat); consider the lighting, noise level (reduced background
noise from radio/TV) and smells. Some children dislike the smell of certain foods
cooking and will not come into the room. You may need to cook these foods earlier in
the day.
Use crockery and cutlery that are appropriate cutlery for your child’s age/size and the
development of their eating skills.
Consider where they are best seated (e.g. next to parent or an older sibling who can role
model appropriate eating behaviours) at the dinner table.
Establish a regular routine around mealtimes (e.g. sitting at table for certain period of
time) rather than eating on the run or watching TV.
Be aware of any preferred and non-preferred food properties (such as crispy food vs.
lumpy food) experienced by your child and also the child’s sensory style (neutral, over
or under sensitive to certain types of sensory input).
Help your child to understand and manage his/her senses. Discuss with an occupational
therapist if you feel your child is having certain sensory difficulties when responding to
his/her daily home or learning environment. Ensure mealtimes are calm and relaxed to
promote a positive social and sensory experience for your child.
Avoid force feeding under any circumstances, as this may worsen children’s eating
experiences.
Use visual supports or social stories when introducing new foods.
By respecting and accepting individual preferences, parents/carers can gradually shape
children’s food preferences and food choices. As a simple and quick reference in finding food
alternatives for your child based on individual’s food preferences, see Food Selection by
Colours, Food Selection by Textures and Suggestions for Textures/ Colours/ Nutrition
Modification handouts.
Please contact your local dietitian or occupational therapist for further advice when
mealtimes, food and sensory issues are concerns for your child.
References:
1. Myles, BS, Cook, KT, Miller, NE, Rinner, L & Robbins, LA (2000), Asperger Syndrome and sensory
issues: Practical solutions for making sense of the world, Autism Asperger Publishing Co., USA.
2. Bogdashina, O. (2003), Sensory perceptual issues in autism and Asperger Syndrome: different sensory
experiences, different perceptual worlds, Jessica-Kingsley, London.
22
Food Selection by Colour
This table is for reference purposes only. It aims to provide food ideas for children based on colour selection. As an example, if you notice that your child has
strong preferences towards white foods, then to expand the diet variety of your child, you could try to slowly introduce alternative white foods. To start with,
try other white foods that have similar smells and tastes to his/her current food liking, such as replacing plain popcorn with rice cake. Increased food exposure
might help to expand the familiarity of ‘new’ foods for your child. However, never give up on introducing new foods!
Food Colour Food Group
Bread & Cereal Vegetable Fruit Meat/Fish/Poultry/Legumes Dairy
White Barley
Quinoa
Rice
Rice paper
Rice noodle
Udon noodle
Mung bean (glass)
noodles
Oats
Amaranth
Rice cakes
Plain popcorn
Sago
Pearl cous cous
White bread (crust left)
Flat bread
White asparagus
Peeled aubergines (Eggplant)
Bamboo shoots
Bean sprouts
Cauliflowers
Stem of Bok Choy
Stem of Chinese cabbage
Tapioca
Chicory
White corn
White button mushroom
Oyster mushroom (Grey
white)
White potato
White radish
White turnip
Parsnip
Lotus root
Taro
Peeled banana
Peeled lychee
Peeled longan
Peeled rambutan
Peeled mangosteen
Peeled pomelo
Peeled guava
White currants
White mulberry
Nashi pear
White peach
White nectarine
Water chestnut
Butter beans
Cannellini
Large white kidney beans
Macadamia nut
Raw/canned peanut
Skinless brazil nuts
Lotus seed
Lily bulb
Octopus/ squid
Oyster
Tofu
Pork
White fish
Chicken
Quail
Turkey
Egg white
Chicken/ Pork sausages
Milk
Soy milk
Yoghurt
Vanilla ice-cream
Milk pudding
Feta cheese
Mozzarella cheese
Notes:
23
Food Colour Food Group
Bread & Cereal Vegetable Fruit Meat/Fish/Poultry/Legumes Dairy
Beige/
Brown
Buckwheat noodle
Whole-wheat spaghetti
Brown rice
Pappadum
Wholemeal bread
Rye bread
Whole-grain bread
Pita bread
Fruit loaf
Carrot cake
Melba toast
Bran
Chestnut cap mushroom
Brown mushroom
Brown pear Chestnut
Brown lentils
Roasted cashew nuts
Roasted peanuts
Walnuts
Almonds
Hazelnuts
Chocolate flavoured
dairy products
Orange Orange cake Carrot
Orange sweet potato
Pumpkin
Orange pepper
Butternut squash
Papaya/ Papaw
Orange
Mandarin
Rockmelon
Persimmon
Cooked salmon Cheshire cheese
Swiss cheese
Red Beetroot Tagliatelle
Thai red rice
Tomato
Red capsicum
Red pepper
Red radishes
Cherry
Strawberry
Cranberry
Raspberry
Ruby/red grapefruit
Watermelon
Red Williams pear
Red plum
Red apple
Adzuki bean
Red kidney bean
Beef
Veal
Mutton
Lamb
Offal
Game meat
Red meat sausages
Berry flavoured
dairy products
Notes:
24
Food colour Food Group Bread & Cereal Vegetable Fruit Meat/Fish/Poultry/Legumes Dairy
Green Spinach pasta Choko
Cucumber
Asparagus
Broccoli
Celery
Pea
Snap beans
Snake beans
Leek
Iceberg lettuce
Oak leaf
Cos lettuce
Little gem
Okra
Green pepper
Snow pea sprout
Spinach
Watercress
Ripe green tomato
Green cherry tomato
Asian green vegetables
Wakame
Brussel Sprouts
Green olives
Alfalfa
Kiwi
Honeydew
Green pear
Avocado
Granny Smith apple
Pistachio nuts
Green Mung beans
Pistachio flavoured
dairy products
Green tea flavoured
dairy products
Notes:
25
Food colour Food Group
Bread & Cereal Vegetable Fruit Meat/Fish/Poultry/Legumes Dairy
Black/Purple Squid ink taglioni
Black glutinous rice
Wild rice
Nori
Wood ear (Judas’s ear)
Black truffle
Shitake mushroom
Black radish
Black olives
Beetroot
Purple-tipped asparagus
Purple cauliflower (Green
after cooked)
Red cabbage
Red oak leaf
Lollo rossa
Purple sweet potato
Purple/black pepper
Yam
Blackberry
Blackcurrant
Black mulberry
Dried prune
Purple plum
Black pudding
Black pea
Taro flavoured
dairy products
Violet/ Lavender
flavoured dairy
products
Notes:
26
Food Selection by Texture
This table is for reference purposes only. It aims to provide food ideas for children based on texture selection. As an example, if you notice that your
child only eats foods that require less chewing, such as crispy and/or soft-textured food, then you could try to slowly introduce alternatives. To start
with, try alternative foods that have similar smells and tastes to his/her current food liking, such as replacing potato crisps with rice chips. Increased
food exposure might help to expand the familiarity of ‘new’ foods for your child. However, never give up on introducing new foods!
Food Texture
Food Group
Bread & Cereal Vegetable/ Legumes Fruit Meat/ Fish/Poultry Dairy Miscellaneous
Crispy
Thin pizza base
Wafer
Water cracker
Rice cracker/chip
Rice bubbles
Baked filo pastry
Pappadam
Iceberg lettuce
Celery
Fruit crisps Grilled bacon Potato crisps
Crunchy
Hard
Breakfast bar with
nuts
Nacho
Dried bread
Carrot
Corn on cob
Apple
Green pear
Guava
Dried nuts Hard boiled lollies
Soy crisps
Taro/ Jackfruit chips
Plain sweet biscuits
Pretzels (snacked)
Soft Waffle
Fruit-filled breakfast
bar
Rice cakes
Corn thins
Puffed grains
Blanched broccoli/
asparagus
Raw button
mushroom
Rosti
Baked potato wedges
Nectarine Popcorns
27
Food Texture
Food Group
Bread & Cereal Vegetable/ Legumes Fruit Meat/ Fish/Poultry Dairy Miscellaneous
Chewy
Bread
Thick pizza base
Pretzel
Muesli bar
Yoghurt-coated
breakfast bar
Pasta
Cooked mushroom Fruit rolls
Dried fruits
(e.g. apple
rings/ apricot)
Beef steak
Pork/ lamp chop
Salami/ pepperoni
stick
Prosciutto
Beef jerky
Cheese sticks
Grilled Haloumi
cheese
Gummy candy
Liquorice
Glutinous rice balls
Sago
Mochi
Soft
Smooth
Pancake/ pikelet/
crepe
Mashed and meshed
vegetables (i.e.
boiled, mashed and
filtered the fibrous
using a sieve)
Fruit Jelly Silken tofu Plain yoghurt
Dairy milk drinks
Custard/ Puddings
Cheese fondue
Smooth ricotta
Jelly
Chocolate fondue
Marshmallow
Puree Oat porridge
Rice bubbles
soaked with added
milk
Cooked semolina
Mashed pumpkin/
sweet potato/ potato
Mashed cauliflower/
broccoli/ pea
Bean dipping sauce
(e.g. Hummus)
Fruit puree
Avocado
Mashed
pawpaw/
banana
Puree scrambled eggs
Meat blended with gravy/
sauce
Smoothies
Ice-cream
Sorbet/ Gelato
Fibrous Boiled couscous/
Barley/ rice/
amaranth
Baked beans
Tomato
Boiled okra
Cooked yam/ taro
All soft fruits
(e.g. mango,
nectarine,
peach)
Stewed/ Minced meat
Canned fish
Fish fillet
Sausages
Yoghurt with real
fruit pieces
28
Suggestions for Texture/ Taste/ Nutrition Modification This table is for reference purposes only. It provides a few examples of food items according to their food groups. It also constructs the possible experiences of
child when consuming those foods. The last column of the table suggests some ideas aimed at increasing food acceptability amongst children. Such suggestions
also aim to improve the nutritional intake of children. If you notice your child experiencing any of the issues noted in the table, you could try to slowly
implement changes in your child’s diet. Always check your child’s tolerance level and acceptability. For example, if skim milk is not accepted by your child,
you could try to introduce semi-skim milk into your child’s diet to replace full-cream milk. Again, examine what is the priority for your child before
implementing changes in his/her diet – such as, the nutrition of your child, or for ease of convenience during outings.
Food Group Examples of Food Possible issue(s) experienced by child Suggestions/ Strategies
Bread/ Cereal:
Bread
White bread
Wholemeal/
wholegrain bread
Tortilla
Taco shell
Crust on bread
Foods sticks to teeth during chewing
Grain in bread causes discomfort during
chewing if your child is orally sensitive
to tactile sensations
Poor nutritional value if white bread
(i.e. low in fibre) is only eaten
Remove the crust from bread
Toast bread or use flat bread
Use taco shells or thin crispy-crust pizza bases if stickiness is an
issue
Use high fibre white bread
Offer highly nutritious fillings
Cereal
Rice
Pasta
Noodle
Breakfast cereals
Basmati/ Jasmine
rice
Spaghetti
Egg noodles
Mushy texture
Chewy texture
Difficulty in chewing long foods (e.g.
spaghetti, fettuccine) with a firm texture
(? Oral motor skills)
Add dried/fresh crispy fruit to reduce the mushiness in oat
porridge
Add seeds/nuts to oat porridge, when no food allergies are
involved
Eat the cereal shortly after milk is added
Replace milk with yoghurt on cereal to better maintain the
crispiness of cereal/muesli
Cook pasta longer to provide a softer texture
Provide a smaller form of pasta, e.g. penne/macaroni
Offer couscous to replace rice/pasta
29
Food Group Examples of Food Possible issue(s) experienced by child Suggestions/ Strategies
Vegetable/ Legumes
Green
Coloured
Celery
Asian greens
Capsicum
Carrot
Tough fibrous texture, e.g. celery and
vegetable stalks
Hard crunchy texture, e.g. carrots
Bitterness in some vegetables, e.g.
brussel sprouts and dark green
vegetables
Hot sensation during the chewing of
some vegetables, e.g. capsicum and
onion
Cut stalk vegetables into smaller pieces in order to break their
fibrous texture leading to improved chewing
Grate the carrot finely if raw is offered in sandwiches or salads
Cook the vegetable until soft, if chewing is an issue
Remove vegetables with a bitter taste or hot sensation from your
child’s diet, if s/he is not ready to accept them, but replace with
other various vegetables
Fruit
Orange
Yellow
Red
Green
Grapefruit
Peach
Cherry
Kiwi
Tangy or sour tastes of citrus fruits
Waxy/hairy skin of the fruits (produces
a hard to chew/greasy-like/irritating
texture)
Pulp in fruits (can’t handle surprise
popping sensation/course texture)
Seeds in fruits may cause choking if the
child does not know to remove them
Edible small seeds in fruit that gives a
course texture, e.g. kiwi/dragon fruit
Avoid sour lemons/grapefruits/oranges if the child finds them
distasteful
Choose Valencia or Sunkist oranges that are commonly sweet
Offer peeled fruits
Avoid fruit that contains pulp, such as citrus fruit and
pomegranate
Remove all inedible seeds from fruits before offering them to
your child
Avoid fruits containing edible small seeds, if they are
unacceptable to your child.
Meat/ Fish/ Poultry
Red
Pink
White
Beef steak
Pork chop
Fish
Tough, chewy texture from red
meat/skin of meat
Fishy smell from seafood
Bony fish may choke your child
Afraid of blood stain on meat
If the child has difficulty in chewing:
o Remove all skin/fat from meat
o Stew/casserole meat dishes
o Offer lean mince meat or home-made patties
If the child dislikes fishy smells:
o Cook fish with strong herbs , e.g. basil, thymes, rosemary,
garlic, if a fishy smell is an issue
o Offer fish as a mixed cooked dish, e.g. seafood pot/pie
o Offer canned fish with marinates
Offer fish fillets to prevent choking on bones
Offer well-cooked meat, especially if cooking meat with the
bones attached; OR remove the bone prior to cooking
30
Food Group Examples of Food Possible issue(s) experienced by child Suggestions/ Strategies
Dairy:
Liquid
Plain/ flavoured milk
Malted milk drink
Milkshake
Too much sugar/fat in commercial
beverages
Dislikes the creamy/‘cowy’ taste of
milk
Offer home-made milk beverages
Include low-fat yoghurt when preparing cold milk drinks
Offer low-fat milk or calcium-fortified soy milk that gives a less
milky taste (as long as your child is above 2 years)
Add malt or chocolate powder (liquid) to the milk drink
Puree Yoghurt
Thick shake
Cheese spread
Dislikes the waxy coating left on their
tongue after eating
Difficulty in swallowing food with a
puree consistency
Offer a milkshake that is prepared using low-fat yoghurt and
low-fat milk
Offer a cheese slice on sandwiches or crackers
Semi-
viscous
solid
Ice-cream
Custard
Panna cotta
Can’t handle ‘surprises’ in oral texture
Orally sensitive to cold temperatures
Dislikes a ‘mushy’ texture in the mouth
Over-consumption may lead to high
sugar/fat intake
Avoid those dairy foods that are not tolerated well by your
child. Find alternative dairy sources!
Keep this food category as occasional food
Prepare home-made low-fat milk ice-blocks as an alternative to
commercial ice-cream during hot weather. Additional fruit
blended into the milk ice-blocks may increase its acceptance.
Solid Cheddar cheese
Ricotta cheese
Cheese slice
Can’t handle the strong taste of certain
cheeses, e.g. veined or goat’s milk
cheeses
Dislikes the chalky taste of some cheese
Over-consumption may lead to a high
salt/fat intake
Avoid strong cheese
Try processed cheese, e.g. cheddar or Cheshire, which has a
mild flavour
Try low-fat cheese options
Offer no more than two serves (40 g/serve) of cheese per day
Notes:
31
Food and Nutrition
Background
If your child selects foods based on colour and texture, trying to include certain foods that are higher in
nutrient values can assure the optimum nutritional intake. Acceptance of a variety of food is a common
problem among the children with AS. Thus, including one or more of the excellent food sources for
certain nutrients in your child’s diet can help to replenish their nutrient stores.
Finding alternatives is one aim to promote healthy eating for selective eaters. This is because we need to
respect children’s food preferences, yet help them to make wiser choices from their limited food
repertoire. Good communication between parents and children can build a stronger bond, and that may
enhance the process of food acceptance in children. Respect and communicate about your child’s food
preferences while offering higher nutrient value foods promote healthier eating patterns.
Three main nutrients, calcium, iron and fibre, are highlighted in our diet sheets as these are the common
nutrients found to be lacking in children. They are needed as they play a significant role in assuring your
child’s growth and development. See tables below that depict the nutrient content in each 100 gram of
edible portion for comparisons to be made between each food groups. The nutrient values listed in the
chart are based on NUTTAB 2006.
How to use the charts:
Foods that are closely related to the food listed (e.g. strawberry yoghurt instead of vanilla yoghurt) can be
offered to your child. In addition, certain foods may appear to provide high nutrient content; however it
may only be eaten in a minute quantity (e.g. sesame seed and blackberry). Select your child’s food by
considering their sensory preferences. Use the food group checklist to keep track the daily food consumed
by your child. Always try offering food sources from the highest nutrient content, whenever possible, in
each food groups. Reminder for vegans or those who dislike eating meat: legumes and nuts are good food
sources to replace meat.
Iron
Iron is important for our blood in replenishment and tissue cells. There are two types of iron in our diet:
haem-iron and non-haem iron. Haem-iron is found rich in animal foods; whilst non-haem iron from plant
foods. A child requires eating more quantity of plant foods to meet an equivalent amount of iron intake
from animal foods, as haem-iron offers a better absorption rate in human body than non-haem iron.
32
Besides, foods with a high phytate, oxalates and tannins (found in black tea, whole grain and legumes)
could reduce iron absorption; whilst foods with a high vitamin C (such as citrus food) could enhance iron
absorption. Inadequacy of iron intake leads to lethargy. Iron overload from dietary intake is unlikely,
except for children with metabolism disorder who failed to ingest iron promptly, or those who have
frequent blood infusion or long-term ingestion of large amounts of iron.
Alert: Having frequent, large portion of iron-fortified foods can cause excessive iron intake, particularly
for those children who include meat and vitamin supplement in their daily meal patterns. Ensuring
adequate fluid and fibre intake daily is important to prevent hard passing stools.
The general iron requirements for children are:
Children Recommended iron intake per day (mg/d)
4 – 8 years 10
9 – 13 years 8
14 – 18 years Boys: 11 ; Girls: 15
Food groups
Foods
1 Sample serve
Iron content
(mg) per serve
Bread & Cereal White bread, iron increased, toasted 1 slice, 30 g 2.1
Mixed grain bread roll, toasted 1 slice, 33 g 1.9
Breakfast cereal, mixed grain,
extruded shapes
¾ c , 22.5 g 4.3
Breakfast cereal, wheat bran flakes ¾ c , 30 g 5.1
Breakfast cereal, puffed/ popped rice ¾ c , 22.5 g 2.3
Meat/
Fish/Poultry/
Seafood
Smoked oyster, canned in oil, drained 2 pieces, 24 g 4.0
Green mussel, steamed/ boiled 2 pieces, 16 g 1.7
Fish paste/ spread 1 tsp, 5 g 0.45
Lean mutton, casserole 65 g 3.4
Dry fried mince lamb 65 g 3.3
Chicken egg yolk, hard-boiled 65 g 2.4
Grilled kangaroo loin fillet 65 g 2.7
Grilled lean, round beef steak 65 g 2.2
Stir-fried, lean beef strips 65 g 1.8
Baked, lean duck 65 g 1.7
Stir-fried, lean veal 65 g 1.4
Pan fried, trimmed pork fillet 65 g 0.9
Vegetable/
Legume
Tempeh, fried in sunflower oil ½ c , 90 g 8.3
Sundried tomato 1 piece, approx. 5 g 0.3
Smoked tofu 1 piece (6.3 x 2.9 x
2.5 cm), 120 g
4.8
English spinach, boiled ½ c , 95 g 3.7
33
Food groups
Foods
1 Sample serve
Iron content
(mg) per serve
Vegetable/
Legume
Canned baked bean in tomato sauce,
salt reduced
½ c , 138 g 2.2
Canned red kidney bean, drained ½ c , 95 g 2.0
Silverbeet, boiled ½ c , 58 g 1.6
Bok Choy, stir-fry ½ c , 80 g 1.7
Canned mixed bean, drained ½ c , 100 g 2.0
Canned cannellini bean, drained ½ c , 90 g 1.5
Roasted cashew, salted 10 nuts, 15 g 1.0
Nut White sesame seed ½ tsp , 1.4 g 0.07
Tahini, sesame seed pulp ½ tsp , 2.5 g 0.1
Sunflower seed ¼ c , 38 g 1.8
Almond with skin 10 nuts, 12 g 0.5
Liquorice 30 g 2.6
Snack
Cereal & nut breakfast bar 1 bar, 30 g 1.7
Air-popped, popcorn, no added fat,
unsalted
1 c, 8.5 g 0.3
Soy crisps or chip 1 small packet, 30 g 0.8
Calcium
Calcium is the building block for our bones. Calcium stores happen during childhood to adolescence and
ceases when we reach adulthood. Adequate calcium not only assures healthy growth development, but
also the reach of peak calcium storage. Building up a strong bone foundation can help prevent
osteoporosis and bone fractures in later life. The general requirement for children aged 4 - 7 is 700 mg/d,
which is equivalent to 3 cups of milk, children aged 8 - 12 is 1000 mg/d, which is equivalent to 4 cups of
milk, and children aged 13 – 18 is 1300 mg/d. Substitution of dairy to other calcium food sources (e.g.
bony fish and nuts) is wise when your child does not like dairy products. Refer to the chart below to give
you some ideas about the calcium food sources.
34
Food Groups
Foods
1 Sample Serve
Calcium
content
(mg)per
serve
Bread &
Cereal
White bread, calcium increased 1 slice, 30 g 70.8
Mixed grain bread roll ½ roll, 25 g 40.0
Pancake, prepared from commercial
dry mix
2 small (7.5 cm), 26 g 38.7
Muffin, English Style, white, toasted 1 muffin, 58 g 78.3
Breakfast cereal, oat bran ¾ c , 30 g 32.1
Fruit Dried fig 1 ½ Tb, 25 g 50.4
Dried fruit scone, home-made 1 regular scone, 85 g 82.5
Pikelet, home-made 2 pikelets, 40 g 40.7
Wholemeal bread roll ½ roll, 40 g 34.4
Dried apricot 1 ½ Tb, 16 g 11.5
Dried currant 1 ½ Tb, 18 g 15.9
Vegetable Firm tofu 1 piece (6.3 x 2.9 x
2.5 cm), 120 g
384.0
Soy-beverage, flavoured, calcium
fortified
1 c, 250 ml 340.0
Boiled frozen spinach, drained ½ c, 95 g 161.5
Sundried tomato 1 piece, aprrox.5 g 4.8
Bok Choy, stir-fried ½ c , 80 g 98.4
Nut Tahini, sesame seed pulp ½ tsp, 1.5 g 4.6
Almond with skin 10 nuts, 12 g 30.0
Brazil nut, raw/ blanched 10 nuts, 35 g 52.5
Sunflower seed ¼ c, 38 g 38.0
Pistachio nut, unsalted 10 nuts, 7 g 6.3
Seafood
Sardine, canned in water, no added
salt, drained
80 g 432.0
Fish paste/ spread 1 tsp, 5 g 22.0
Sardine, canned in tomato sauce,
undrained
80 g 344.0
Salmon, Australian, canned in water 80 g 267.2
Green mussel, steamed or boiled 2 pieces, 16 g 55.4
Anchovy, canned in oil, drained 40 g 66.8
Dairy
Skim milk powder ¼ c, 25 g 312.5
Yoghurt, unflavoured (natural) low fat 200 g 470.0
35
Yoghurt, vanilla flavour, low fat
(<0.5% fat)
200 g 336.0
Reduced fat milk, fluid 1 c, 250 ml 352.5
Dairy custard, vanilla, reduced fat
(1%), commercial
200 g 260.0
Fibre
Fibre is a ‘cleaner’ in our body system. It helps to remove the ‘unwanted’ residue from our ingested food.
Fibre intake is commonly eaten inadequately in children, when grain and vegetables are not part of their
food intake. Fibre requirements for your children increases parallel to their age. When your child’s age is
1 – 3 years, his/her fibre requirement is recommended to be 14 g/d. When your child’s age is 4 years, 18
g/d of fibre is recommended. And that is followed by an additional of approximate 1 g/d of fibre tops up
for each year until they reach 18 years of age (i.e. 25 g/d of fibre is recommended for women, 30 g/d for
men).
Fresh fruits should be offered all the time over fruit juices, in order to increase the overall fibre and
vitamins intake. Fruits, carrot, tomato, celery, cucumber, broccoli and seeds can be the good snack
options for your children. Alternatively, psyllum husk or chai seeds can be used as a fibre supplement to
add into their cereal, soup or smoothies drink.
When introduction of vegetables is difficult for your child, try to initiate your offer with food that
contains higher fibre and that also complies with their sensory preferences (such as colour and smell).
Refer to the chart below and also the handout for food selection by senses as guides to promote fibre
intake in your child’s food intake.
Alert: Having excessive fibre intake and inadequate fluid intake can cause hard passing stools. Ensure
your child drinks at least 6 glasses of water not only can replenish their ‘dehydrated’ body from their
daily active lifestyle, but also promotes a good cleansing.
Food Groups
Foods
1 Sample Serve
Calcium
content (mg)
per serve
36
Food groups
Food
1 Sample serve
Fibre content (g)
per serve
Bread & Cereal
Rye crisp bread 3 crispbread, 30 g 4.3
Wholemeal wheat crisp bread 3 crispbread, 18 g 2.3
Pumpernickel bread, toasted 1 slice, 100 g 10.8
Wholemeal, fibre increased bread, toasted 1 slice, 30 g 2.6
Dark rye bread, toasted 1 slice, 30 g 2.6
Chapatti bread, no added fat 1 slice, 35 g 2.6
Mixed grain bread roll, toasted 1 slice, 33 g 2.2
Wholemeal bread, toasted ½ roll, 40 g 2.6
Wheat bran pellets cereal ¾ c, 50 g 15.0
Wheat bran flakes cereal ¾ c, 30 g 4.9
Whole wheat and other cereals, added dried
fruits & nuts
¾ c, 45 g 6.4
Oat bran cereal ¾ c, 30 g 3.7
Puffed whole wheat cereal ¾ c, 9 g 0.9
Fruit Dried apple 1 ½ Tb, 23 g 1.8
Dried fig 1 ½ Tb, 16 g 3.6
Dried date 1 ½ Tb, 23 g 2.2
Dried apricot 1 ½ Tb, 16 g 1.3
Passionfruit pulp, raw/ canned 1 fruit, 18 g 2.5
Pomegranate, raw, peeled ½ fruit, 120 g 7.7
Guava, Hawaiian, raw ½ fruit, 45 g 2.4
Vegetable
Sundried tomato 1 piece, approx. 5
g
0.7
Artichoke, globe, boiled ½ c, 45 g 4.2
Fresh red bean, boiled, drained 75 g 7.4
Frozen green pea, boiled 75 g 5.6
Frozen mixed vegetable, boiled ½ c, 70 g 4.7
Nut Desiccated coconut, grated 1 Tb, 6 g 0.9
Tahini, sesame seed pulp ½ tsp, 2.5 g 0.3
Raw hazelnut 10 nuts, 15 g 1.6
Sunflower seed ¼ c, 38 g 4.1
Sesame seed, white ½ tsp, 1.4 g 0.1
Pistachio nut, unsalted 10 nuts, 7 g 0.6
Almond, blanched 10 nuts, 12 g 1.1
Brazil nut, raw/ blanched 10 nuts, 35 g 3.0
37
Does Your Child Need Nutrient Supplementation?
Nowadays, it is common to observe parents introducing a multi-vitamin tablet. A frequent
and high dosage of nutrient supplement can cause harm to your child if s/he is overloaded
with certain nutrients that are indigestible and stored permanently in the body. As an example,
iron is the common nutrient taken above the upper safety limit intake set by the food safety
standard amongst the children. The consequences of iron overload include constipation and
proneness to infections and illness.
Below is a quick checklist to determine the need of nutrient supplementation for your child:
In general, my child:
Loses weight gradually for no obvious reason?
Experiences no growth in height in the past three months?
Experiences poor skin conditions (e.g. dry, flaky, rough)?
Experiences gum bleeding easily?
Experiences poor hair conditions (e.g. thin, sparse, easily plucked)?
East less than two serves of bread/cereal/rice/noodle/pasta/grain per day?
Eats less than one cup of meat per week?
Eats less than one cup of vegetable per day?
Eats less than one cup of dairy per day?
Eats less than one fruit per day?
Often (i.e. more than 3 times/week) replaces his/her regular meal with those high
fat/ sugary snack foods?
Often skips meal (i.e. breakfast, lunch or dinner)?
Eats more than four servings of high fat/ sugary foods (e.g. 1 serve = 1 slice cake,
2 butter/cream cookies, 1 small packet potato crisps, and 2 scoops ice-cream) per
day?
If your child experiences one or more of the conditions listed above, you should consult a
health professional, such as paediatrician or dietitian, to gain further advice on the appropriate
type of nutrient supplementation for your child.
38
Healthy Snack Ideas for Children Ensure food labels are checked in order to provide your children with better nutritious food
options. Fresh foods, such as vegetable, fruit and dairy food, are always the best snack
options. Try to avoid those foods that are high in sodium, fat and sugar if possible. See
Reading The Food Label for further explanations.
Sweet snacks
Bread & cereal
1 Breakfast bar: Fruit bar, nut bar, muesli bar
½ cup breakfast cereal
2 Pikelets
1 Crumpet
1 slice fruit loaf/ raisin toast
1 fruit scone
1 small slice (35 g) fruit cake
2 fruit slice biscuits/ pillows
2 plain sweet biscuits
½ cup creamed rice
Fruit
1 medium fresh fruit
2 small fresh fruit
1 cup fresh fruit salad
½ cup tinned fruit
1 tub (60 g) fruit tub
1 tub (140g) fruit puree
1 box (40g) sultanas
5 dried prunes
10 dried apricots
1 glass fruit smoothies
1 fruit ice popper
Vegetable & Legumes
Carrot/ cucumber sticks
Peanut butter with celery sticks
1 small roasted sweet potato/ tapioca
½ cup red bean paste as topping on ice-cream
½ cup roasted chestnut
39
Dairy
1 glass (200mL) low fat milk
1 glass (200mL) low fat milk + 1 Tb Nestle Milo™
1 tub (60g – 200g) low fat plain/ fruit yoghurt
1 tub (200g) diet yoghurt
1 tub (100g) custard
1 individual tub (125g) frÚche
1 individual bottle (65mL – 150mL) yoghurt drink
1 tub (60g) mousse
1 tub (125g) diet mousse
1 scoop (100g) low-fat ice-cream
1 milk popper
Savoury snacks
Bread & cereal
1 cup pretzels/ corn chips
10 rice crackers
1 mini pack (20g) Vita-wheats™
2 Ryvitas™
1 toasted pita bread triangles
1 small savoury muffins
1 mini pizza
Vegetable
1.5 cups plain popcorn / 20g individual popcorn
½ cup baked bean
½ cup bean dipping, e.g. hummus, garbanzo dip, black bean dip for vegetable
sticks/ grain savoury crackers
½ cup salsa dip
Dairy
1 slice low-fat cheese
1 individual pack cheese + cracker snack
1 cup Greek style yoghurt
Protein alternatives
½ cup plain nuts, e.g. walnuts, cashew nuts, pepitas, pine nuts, roasted chickpeas
Recommended website: www.choicefoodforkids.com.au
40
NUTRITION INFORMATION
SERVINGS PER PACKAGE: 16
SERVING SIZE: 45g
Qty per
serving
Qty per
100g
Energy 878kJ 1950kJ
Protein 5.9g 13g
Fat, total 10.2g 22.7g
- saturated 1.1g 2.4g
Carbohydrate, total 20.1g 46.6g
- Sugar 3g 6.6g
Dietary fibre 5.4g 12.1g
Sodium 18mg 40mg
Per 100g
Use this column to compare between products. Choose
the one with lower fat, sugar and so-
dium, but with higher fibre.
Fat
- Total
Choose a product contains less than
10g fat per 100g. Aim for less than
2g fat per 100g of liquid food prod-ucts.
- Saturated
Aim for less than 3g saturated fat per 100g.
Sugar
Choose the lowest sugar content in the product range. If
possible, choose one contains less than
10g sugar per 100g. If a product contains fruit ingredients, try
to choose one has less than 30g sugar
per 100g.
Dietary Fibre
Aim for a product contains more than 3g fibre per
100g. Always pick one with
higher fibre.
Sodium (Salt)
Choose a product con-tains less than 300mg sodium per 100g,
except bakery prod-ucts. A low sodium
product contains less than 120mg per 100g.
Serving Size
Use this as a serving reference. This is not a must-follow
metric measure for quantity of intake.
Decide individual need wisely.
Reading the Food Label Check on nutrition information panel for investigating which product is a healthier option.
Note: Colour-coding is used to refer the label on the nutrition information panel to its
respective explanation.
Reminder: Check the serving portion. Having low-fat food can be the same as having high-
fat food. If your child has excessive intake of low-fat food, it amounts to the same thing.
For your reference, you may cut the below and keep it with you as a quick and handy
reference during your grocery shopping.
Nutrition information panel:
Per 100g
Total fat < 10g (Solid food) ; < 2g (Liquid food)
Saturated fat < 3g
Sugar < 10g (Except fruit products)
Sodium < 120 – 300mg
Fibre >3g
41
Ideal Mealtime Practices
As caregivers, we decide what to offer children and they decide what to eat. Children with AS
tend to make their food choices based on their sensory preferences and past experiences. Food
properties, such as texture, colour, shape, taste and smell, related to your child’s preference
need to be closely monitored in order to offer better choices in their food intake. Although
every mouthful of food taken by your children is important, we should not neglect the
importance of a healthy mealtime practices. Mealtimes play a relatively important role in
encouraging your child’s food intake. We should promote a mealtime environment that is
enjoyable and relaxed for your children together with the whole family if possible. A quick
checklist for positive mealtime practices is listed as below:
Have meals together with family where possible
Sit on chair with good posture to eat at meal and snack times
Set a regular and predictable routine for meal and snack times
Draw a menu weekly or daily to inform/ negotiate with your child what foods are
being offered in each meal
Offer food in a suitable serving size for your child
Provide an appropriate set of utensils for the use in accord with their eating skills, age
and size
Involve your child in food preparation or mealtime setting as children tend to accept
more food from their own preparation
Provide a sociable and calm mealtime environment
Check if the mealtime environment suits your child’s sensory preferences. Examples:
the lighting, the smell presented and the noise level
Remove radio, T.V or games from the dining area
Expect some mess when children are learning to eat independently; the younger the
children the more likely the mess
Always clarify with your child and provide alternatives in a calm tone. Shouting does
not help you to understand your child better
Encourage your child to try all food presented by using positive statements. Example:
“I know YOU CAN take a bite of this carrot.”
Never force feed or pressure your child to eat
Talk about food and nutrition at mealtime to share knowledge about healthy eating
Talk about likes and dislikes with your child so that you learn about your child’s food
preference
42
Food and Growth
Understanding growth in children Many caregivers are anxious about their children’s growth and weight gain. Children grow
differently at different stages in terms of their statue and physiology. In addition, girls and
boys experience different growth spurt at different ages. Girls tend to experience their growth
spurts in the early adolescence stage; whilst the boys in the later stage. Hence, the food and
nutrition demands for boys and girls are different under the same age group. Refer to the
‘Meal portions’ handout to give you some ideas about the daily recommended dietary
requirements of your children.
During the toddler stage, children gain approximately 2.5 kg per year in weight and a further
12 cm per year in length. Their growth continues at an average rate of approximately 2 kg per
year and 10 cm per year, and a steady decline to 6 cm per year until the growth spurt at
puberty (Shaw & Lawson, 2007). Remember parental statue, not only the children’s
nutritional intakes, influences children’s height and weight.
How to monitor growth in children
To monitor the growth status in your children at home, ensure the measurements of
height and weight of your children are taken using the same equipment/ method
respectively so that the readings are consistent and reliable.
Record the measurements and plot them into the growth chart provided in their Health
Record Card according to their age measurement taken.
Measure up your child’s height and weight monthly or regularly.
Calculate your child’s body mass index (BMI) a.
If the records of your child’s BMI-for-age are below 3th
percentile or above 95th
percentile over an on-going period, you should seek further assistance from a health
professional in monitoring and improving the growth status of your child.
Note: a BMI is calculated by dividing height in meter squared (m
2) with body weight (kg).
Reference:
1. Shaw, V. & Lawson, M. (2007): “Nutritional assessment, dietary requirements, feed
supplementation,” In V, Shaw & M, Lawson (eds), Clinical paediatric dietetics, 3rd
edn,
Blackwell Publishing, UK.
43
Importance of Physical Activity
“Stay active” and “Be active” are the two common statements used in promoting the physical
activity to the current sedentary lifestyle of our community. We are responsible for encouraging and
keeping our children active. Activity such as: joining sport games, playing in playground/ courtyard,
helping out with house chores/ gardening, using active transport (e.g. walking to the station or shop),
playing with a family pet or building blocks, and volunteering in community works.
Keeping your children active is important in promoting healthy lifestyle from childhood through
adulthood. Active children tend to stay active as they grow. That is an essential way to keep your
children’s body fit and prevent them from being overweight/ obesity in their later life, which come
with many risk complications of health. Active body promotes an active brain - children learn
through play.
Leisure screening should be limited to no more than an hour per day. Choose the educational
programs that help in learning and improving children’s knowledge, and meet your child’s sensory
preferences (i.e. background noise for soothing and calming). Active games should be introduced to
your child to keep them moving (e.g. Twister TM
, Jumping Jack, Hopscotch).
Developing a daily routine for your child can help in setting and organizing their lifestyle, to assure
active learning is promoted at all time. This allows your children to enjoy activities they get
involved in, while helping them to sustain their interests. Refer to “Physical activity alternatives”
handout to give you some ideas about activities your children may be interested to get involved in
order to keep them physically active.
Websites for further readings:
1. Department of Health and Aging. Physical activity guidelines. Available [Online]:
http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-
act-guidelines. Last updated on 01 October 2010. Accessed on 9 February 2011.
2. Healthy kids: Eat well, get active. Available [Online]: http://www.healthykids.nsw.gov.au/
Accessed on 9 February 2001.
3. Raising children network. Encouraging kids to be active. Available [Online]:
http://raisingchildren.net.au/articles/encouraging_kids_to_be_active.html/context/227.
Accessed on 9 February 2011.
44
Physical Activity Alternatives
The alternatives here refer to physical activities that your children can get involved besides
participation in sport games. Our aim is to keep your children moving! This helps them spend
less time in sedentary behaviours, such as playing computer games and watching television.
Go through the list below and make a note next to the ones you think your children will be
capable of and interested to participate in. Discuss with your children about these alternatives
and draw out a weekly routine to ensure sufficient physical activity.
Join dancing classes
Action games and songs
Gardening (e.g. build a herb garden or flower garden, weeding, watering)
Tidy up own room/ play space
Set up table at mealtime
Simple food preparation tasks (e.g. mixing salad, rolling burritos, mashing potato)
Vacuuming/ sweeping floors
Dust the house
Empty filled garbage bag into the bin outside the house
Help with laundry (e.g. hanging, folding, collecting clothes)
Look after family pet (e.g. playing, feeding, brushing, cleaning the cat/ dog)
Jump on a trampoline/ ride a swing/ run around the blocks
Walk or Cycle to school/ shops/ station
Visit nearby beaches for a run/ play with sand in building castles etc
Play with a gym ball (e.g. bouncing or rolling). Choose one that suits their size
Play Hopscotch/ Climb tunnels or tyres/ Chase a friend or sibling in an open field
Involve in community works (e.g. visit retirement village, church, foster care)
Create new movements for stretching or balancing
Throw & fetch a billabong/ ball/ flying saucer
Collect newspaper/postage from mailbox
Run up and down the stairs
Dish washing
45
Activity Sheets
You may like to photocopy them for use
each time.
46
Daily Food Group Intake Checklist for Children: Is your child eating enough or too much?
Highlight the number serving eaten by your child in the respective food groups.
Fill up one column for each child. Make a note when certain food group is eaten in excessive or inadequate.
Food Group
Sample one serve
Recommended Daily Intake (Serves) for Children
Notes 3 – 7 years 8 – 18 years
Breads, cereals, rice,
pasta, noodles
1 cup cereal
¼ cup muesli
½ cup pasta/ rice/ noodle
1 slice bread
2 rice cakes/ Weet-bix
Vegetables 1 cup salad
½ cup cooked vegetable
½ cup beans
1 small potato
Fruit 1 medium fruit
2 small fruits
1 cup canned fruit
Dairy 1 cup milk/ soy milk
200g yoghurt
40g cheese
Meat, fish, poultry,
eggs, or alternatives
60g cooked meat
½ cup lentils
2 eggs
Extras 1 scoop ice-cream
20g potato crisps
2 sweet/savoury biscuits
Designed by Shu Ong (2011)
47
Meal planner: Week starting:
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Breakfast
Morning snack
Lunch
Noon snack
Dinner
Note:
Designed by Shu Ong (2011)
48
Negotiation Chart:
Completed by child/ parent Completed by opposition By both parties
Suggestion Reason Acceptance Solution if no deal
TO:
FROM:
DATE:
RECEIVED BY:
Deal No Deal
If no deal, reason(s):
Replace with:
On hold until:
Date: _______________
Other(s):
TO:
FROM:
DATE:
RECEIVED BY:
Deal No Deal
If no deal, reason(s):
Replace with:
On hold until:
Date: _______________
Other(s):
Designed by Shu Ong (2011)
49
Helpline: AS Support Group in Australia
State Organization Website Email Phone
All Autism Asperger Advocacy Australia [email protected] a4.org.au/a4/abouta4 n/a
VIC Autism Victoria www.autismvictoria.org.au [email protected] 1300 424 499/
(03) 9657 1600
Autism Help www.autismhelp.info/main.htm [email protected] (03) 5221 2984
Autism Plus www.autismplus.com.au [email protected] (03) 9782 1843
Aspergers Support Group Network Vic www.assnvic.org.au [email protected] (03) 9845 2766
NSW Aspect (Autism Spectrum Australia) www.autismspectrum.org.au [email protected] 1800 069 978
(02) 8977 8377
Autism & Aspergers Support Group www.autismsupport.org.au n/a 0425 380 575
0425 380 574
QLD Asperger Syndrome Support Network
(ASSN)
www.asperger.asn.au [email protected] (07) 3865 2911
Autism Queensland www.autismqld.com.au [email protected] (07) 3273 0000
1800 428 847
SA Autism Association of South Australia www.autismsa.org.au [email protected] 1300 288 476
(08) 8379 6976
WA Autism Association of Western
Australia
www.autism.org.au [email protected] (08) 9489 8900
1800 636 427
ACT Autism Aspergers ACT Inc. www.autismaspergeract.com.au [email protected] (02) 6140 1061
(02) 6176 0514
Autism ACT www.autism.anu.edu.au [email protected]
(Info for group meeting)
(02) 6290 1984
TAS Autism Tasmania www.autismtas.org.au [email protected] 1300 288 476
NT Autism NT www.autismnt.com.au [email protected] (08) 8984 4424
1300 288 476
50
Parenting Helpline in Australia
State Organization Website Phone
VIC Parentline n/a 13 22 89
NSW Tresillian Parent Help Line www.tresilian.net 1800 637 357
9787 0855(Sydney metro)
Karitane Care Line www.karitane.com.au/services/careline.php 1300 227 464
Parent Line www.parentline.org.au 1300 1300 52
QLD 13 Health www.health.qld.gov.au/13health/ 1300 30 1300
SA Children, Youth and Women’s Health Services www.cyh.com 1300 364 100
WA Parenting WA line www.communities.wa.gov.au/childrenandfamilies/ 1800 654 432
6279 1200 (metro)
ACT Tresilian Help Line www.tresilian.net 1800 637 357
TAS Parenting Line n/a 1300 808 178
NT Parentline www.parentline.org.au 1300 30 1300
51
Additional Reading Resources
Meal time/ eating behaviour management:
Autism Association of Western Australia (2011) Meal time management and overcoming restricted
diets in children with Autism.
Legge, B. (2008) Can’t eat, won’t eat: Dietary difficulties and Autistic Spectrum Disorders, Jessica-
Kingsley Publishers, London.
Ernsperger, L & Stegen-Hanson, T (2004) Just take a bite: easy, effective answers to food
aversions and eating challenges, Future Horizons, Arlington.
Raising children network 2011. [Online]: http://raisingchildren.net.au/
The National Autistic Society 2011, Dietary management for children and adolescents with ASDs:
restricted diet [Online]: http://www.autism.org.uk/living-with-autism/understanding-
behaviour/dietary-management-for-children-and-adolescents/dietary-management-restricted-
diet.aspx.
Meal ideas and food pictures book:
Williams, T. (2010) this = that child’s size: a life-size photo guide to kids’ food serves, Australia.
CSIRO (2009) The CSIRO wellbeing plan for kids, Penguin group, Australia.
Diet and Autism Spectrum Disorder:
Connor, Z. (2006) Diet and Autistic Spectrum Disorder [Online]
http://www.bda.uk.com/foodfacts/Autism.pdf.
Srinivasan, P. (2009) A review of dietary interventions in autism, Annals of clinical psychiatry,
21(4): 237-247.