Choosing what to eat is easy for most of us. But what if we had to eat whatever was put in front of us, whether we liked it or not?

For years, this was the situation for many schoolchildren with severe and complex special needs, many of whom either cannot, or do not, speak. But the introduction of pictorial menus - large cards containing photographs, words and symbols to represent each meal - has revolutionised their lunch and learning habits.

The menus were introduced to primary schools in West Dunbartonshire a couple of years ago and are now widely used to help children with speech and language difficulties, visual impairments, dyslexia and autism spectrum disorders.

Children are presented with the pictorial menus for each day of the week and must match them with corresponding Velcro-backed symbols. They then attach the symbols to a board, which is given to the dinner ladies.

At Kilpatrick School in West Dunbartonshire, headteacher Debbie Queen tells TESS: “We have 145 children here with a wide range of additional support needs. At the severe and complex end, many are non-vocal.

“Until recently, they couldn’t choose what they wanted for lunch. If one of us picked something for them, they’d often get frustrated and there would be difficult behaviour. It’s understandable. You’d be the same if someone was trying to make you eat food you didn’t like.

“This takes all the stress away. Lunch is bustling, confusing and noisy. Children’s minds are trying to process everything - go up, stand in a queue, take a tray, wait their turn, decide what they want. It used to be hard for them. But now they’ve made their choices. They go prepared.”

Using the pictorial menus to help children choose their food fits well into morning lessons, says teacher Barbara Keita in the school’s secondary support base. It also has significant benefits for their learning.

“It helps them become more independent and to learn to communicate, using something that motivates most of them - food,” she says. “Each day of the week has a different menu and the system operates on a four-week cycle. So children get to know what’s on offer and what their favourites are. It’s now part of our morning routine. Students often initiate the learning themselves.”

Sitting with the children as they study the pictorial menus is enlightening. Mark, 15, has learned to turn the menu pages to display the correct day of the week. Declan, also 15, will turn it to the day he wants it to be - Monday of week 2, the one that features his favourite menu option: steak pie. If it is not a pastry day, he will choose yogurt and toast.

On the day of my visit, the main meals offered are chicken fajitas, cheesy macaroni, cheese and ham panini, and chicken burger in a bun. Children can also choose a soup starter, select their own vegetables or salads and opt for one of three desserts. They also choose their own drinks - all by looking at the pictures.

“Ben has made great progress since we started using the menus,” says Ms Keita, indicating the 15-year-old at her side. “He even speaks a little now, which he never did before. Ben, what day is this?” she asks the teenager.

“Tuesday,” he answers, before pointing to a picture of a burger when asked which meal he wants.

“Lovely,” Ms Keita says. “What about potatoes - mash or croquettes?”

“Mash,” he responds.

“And green beans, broccoli or salad?”

“Beans,” Ben replies.

Ms Keita says this structured learning is very different from the days when the children would go to the servery and simply point at the food, when they often ended up with something they did not want.

The menus are designed to be student-friendly, with colour coding for different courses and a Comic Sans font, which resembles the handwriting that is taught in schools.

“Many are at the early stages of reading and writing, so consistency with what they’re learning is important,” Ms Keita adds. “The pictorial menus are a great way to practise total communication. Children look at a photo, a symbol and a set of words, which all represent the same thing.

“You get them to do the Makaton sign for `milk’, for example. You say the words. It all improves their understanding, their language and their learning.”

Once at the canteen, the children present their symbol pads to the dinner ladies, who respond, patient and smiling. At the dinner table, virtually everything is eaten.

That is unusual for young people with additional needs, catering manager Jeanette McDonald says. “If food is just put down to them, a lot gets wasted. That doesn’t happen now. They are happier since they’re choosing what they want. They are eating nutritious, healthy, balanced meals.”

It seems a simple solution. But it is one less obstacle for children who can physically struggle to eat their lunch. Some may not be able to grip a spoon or bring it to their mouths. Others have difficulty chewing and swallowing.

Ms Queen says the new school curriculum is about student choice and personalisation. And the pictorial menus are a natural extension of that. “There are huge educational benefits to these pictorial menus,” she says. “They improve (the students’) learning and communication skills. The dinner hall is much easier to manage because the children are happier there. And they reduce challenging behaviour right through the school.”

West Dunbartonshire’s pictorial menus initiative won the 2013 Convention of Scottish Local Authorities Excellence Award for tackling inequalities and improving health. bit.lyXZg44W.

Photo credit: west-dunbarton.gov.uk