At 5, Safin Rubin - who has autism - was the ultimate picky eater. But he wasn't just choosy, he was in pain. Safin is one of 25 to 35 percent of children with autism spectrum disorders who have feeding problems.
In Safin's case, he was down to eating only one food - a type of cereal. That's when his mother turned to the feeding experts at Children's Healthcare of Atlanta's Marcus Autism Center for help.
Zoe Hawthorne is doing something that used be almost impossible: making lunch for her 5 year old, Safin Rubin. She says, "We've got the yogurt, and he has pear. These are carrots, but I put sauce on it. He likes it."
She lays out four foods, all pureed, so the texture is perfect. And when she and Safin sit down, success.
He allows her to feed him, smiling, raising his hands above his head and cheering.
A year ago, eating was tricky. Hawthorne says, "I would try different things, every different food."
As a toddler, Safin started rejecting baby food. By two, he wouldn't take a spoon or accept a sippy cup.
And by four - diagnosed with Autism - Safin was down to one "safe" food. Hawthorne says, "So, he never ate anything besides porridge, which he ate probably for the first four years of his life, every day, for every meal."
He'd starve himself at school, only allowing Zoe to feed him. Worried he was underweight and becoming malnourished, Zoe brought Safin to Children's Healthcare of Atlanta's Marcus Autism Center for a feeding evaluation with registered dietitian Rashelle Berry and her team.
Right away, they spotted a problem. Berry remembers, "I found that the strongest thing going on with him is that he was incredibly constipated."
Berry says about a third of children on the autism spectrum have gastrointestinal issues. And many are incredibly selective about what they'll eat - preferring processed foods - like cereal and crackers - that always have the same taste and texture. Berry says children can become so rigid and selective, they reject whole food groups, like fruits and vegetables.
In May, Safin joined Marcus' 8-week day treatment program, Berry says, "So, the first thing we do is remove the parent from the eating situation."
Safin started working with an oral motor therapist, who started at square one, reintroducing Safin to eating. Berry says, "We do things very, very slowly."
The oral motor therapist taught Safin to get comfortable with taking food from a spoon, He learned how to swallow and chew. Berry says, "Maybe the child will just take an empty spoon into their mouth. And then they might have a rice-size or a pea-size of food."
Zoe Hawthorne says, "The first two weeks, he would put up a fight." But, gradually, Safin began accepting pureed foods. He's now moved on to chewing very small bites. Today they're working with animal crackers. The therapist rewards him with Matchbox cars each time he chews 10 bites. He's smiling throughout the session.
Safin is now eating 14 different foods, and drinking a milk drink. Zoe says he's making huge progress, and will now allow his teachers to feed him at school.
Safin still has some catching up to do, but Zoe says her little man - is getting there, one bite at a time.