First Bite: How We Learn to Eat by Bee Wilson

children to have a wide range of problems with food. It’s been estimated that 75 percent of children diagnosed with autism have severe feeding difficulties. They may demand exclusively “yellow” food (chips, corn, biscuits, popcorn, fried chicken), or refuse to eat a meal unless none of the components are touching. Above all, autistic children are likely to have a very narrow range of foods that they find acceptable.
    Jim, a age three and a half, was an autistic boy with serious eating problems by the time he arrived at the Penn State Hershey Medical Center. He ate only two foods, toasted cheese sandwiches and hotdogs,supplemented with frequent glasses of milk. In addition, Jim tended to be disruptive at mealtimes: he had tantrums, cried, acted out, and refused food from even his limited repertoire.
    But Jim was doing well compared to Kim, a five-year-old autistic girl referred to the same clinic. For a while, Kim, too, had eaten a limited diet of hotdogs, peanut butter, bacon, chocolate, eggs, and toast. She, too, would cry, tantrum, and throw food at mealtimes. After an illness, though, she stopped eating altogether, and for six months she had been completely dependent on feeding through a gastrostomy tube.
    Most parents would feel overwhelmed at the thought of feeding these children and somehow broadening their horizons. I know I would. Food refusal is demoralizing at the best of times; all the more so when you are dealing with the other challenges of caring for an autistic child. If a child dislikes most foods to the point that they provoke tears and rage, it is very hard to bring yourself to do anything other than sigh and make another toasted cheese sandwich.
    Jim and Kim sound like two hopeless cases. But they weren’t. Within two weeks of intensive treatment at the center, Jim’s repertoire of foods had increased from three to sixty-five. Kim, meanwhile, would now eat forty-nine different foods and no longer needed the feeding tube. This huge increase in “likes” (and decrease in “dislikes”) was achieved not through any magic, but simply through a more systematic and intensive version of Lucy Cooke’s “Tiny Tastes” system.
    Therapists at the clinic engaged the children in many repeated taste sessions to expose them to pea-sized amounts of novel foods in the course of each day. Unlike with “Tiny Tastes,” the therapists added in an “escape prevention” element: the child was told “when you take your bite, you can go and play,” and was not allowed to leave the room until the bite was taken. If a child screamed or cried, this was ignored, but a child who ate the pea-sized bite was praised. There were also “probe meals” at which larger quantities of the new foods were offered—three tablespoons of three different foods—with a ten-minute time limit and no requirement to eat the food.
    The results of this experiment have been astonishing. To go from being fed by a tube to being able to eat forty-nine different foods is life changing for the whole family. A three-month follow-up showed thatJim and Kim had not lost the majority of their new likes at home. They had not slipped into the old unhappy mealtimes of before. Food was no longer a trauma to them. Both sets of parents were continuing to offer the children taste sessions outside of mealtimes. Jim’s range of foods was now fifty-three. This large repertoire was all the more impressive considering that Jim’s parents had decided to become vegetarian since the start of the intervention, the sort of change that autistic children often find unsettling. Kim’s range of foods was still forty-seven. In place of a tube, she was now enjoying many different flavors and textures, without tears or rage. Autism goes along with restricted social interaction. Yet Kim’s new likes placed her back in the social world of the family dinner table.
    Similar work is being done by therapists at specialist feeding clinics across the world, although Keith