Unifying Theme: Autism And Eating
While not all participants described having difficulties with eating, they did feel that autism had some kind of impact on their eating. All participants described a degree of selectivity around their eating and food choices: this included avoiding certain foods and eating from only a specific range of food or meals. Autism was also felt to impact their eating in other ways, including leading to difficulties with aspects such as cooking and eating in communal environments. A number of factors associated with participants autism were found to contribute towards these behaviours, which are presented below as sub-themes.
Sub-theme: Medical issues
Participants described avoiding certain foods, or in one case seeking out specific foods, in order to manage their sensory input. For some, this was avoiding certain foods due to hypersensitivities to aspects like taste, texture, smell, and temperature. While some participants described this in terms of dislikes- if the texture is off, that food can be just fantastic and I’ll still loathe it , for others this sensitivity was so extreme it caused pain, gagging, or a meltdown . While most participants described aversion to specific sensory experiences, such as certain textures, one participant actively used food to increase their sensory stimulation by actively seeking out strong flavours.
Sub-theme: Executive functioning
Sub-theme: Rigidity and routines
Feeding Problems In Children With Autism
Children with autism spectrum disorder may have restrictive and ritualistic behaviors that affect their eating habits. Some of them limit what they eat, in some instances so severely that it results in nutritional deficiencies1 that lead to weight loss, malnutrition and inadequate growth, said Melissa Olive Ph.D., a psychologist who treats children with ASD with feeding disorders at her practice in New Haven, Connecticut.
Research differs on how prevalent picky eating is in children with autism, but says that children with autism are much more likely than typically-developing children to be selective with food1,2.
Why Do So Many Children With Asd Suffer From Feeding Problems
There are many qualities of children with ASD that could cause feeding problems, including: sensory impairments restricted interests and insistence on sameness anxiety about changes to routines or novel situations ritualized behavior increased focus on details of food presentation impulsivity and challenging behavior challenges with social skills and decreased responsiveness to the social rewards of eating oral-motor skill deficits, biologic food intolerances or history of gastrointestinal discomfort disrupted eating patterns responding to internal states of hunger and/or aversive learning events paired with eating, such as gagging, choking or vomiting episodes.
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How These Behaviors Escalate
Often parents who have children with autism are focused on a number of different needs at the same time and many of those speech issues, toileting, school placement, overall compliance take precedence over the variety of foods a child is accepting. Feeding issues get back-burnered until either they become untenable or parents are able to focus on them.
If the child eats 10 foods and those 10 foods are keeping them alive and safe and fine, then parents will default to those foods, says Dr. Lee. But ignoring these issues tends to make them tougher to solve. The longer these negative mealtime behaviors go on, the more ingrained they become and the longer they take to treat successfully. That doesnt mean parents should give up, just that the process is probably going to take longer and require more persistence and patience on everyones part.
How Can Pediatricians Appease Families Anguish When Their Children Dont Eat Well
Families can, occasionally, overestimate food allergies or intolerances as contributors to feeding problems or a reason to restrict their childs diet. In these cases, we suggest pediatricians pursue high quality testing and discuss objective data with the family. Providers might also consider screening for celiac and nutritional deficiencies. If nothing else, these actions can be reassuring to families who are stressed by their childs diet.
Providers should assess for constipation and treat it aggressively. In our clinic, approximately 88% of our children are chronically constipated and may not have regular treatment. Children with ASD may require more intensive treatment than the typical child.
We recommend pediatricians engage in conversations with parents who are pursuing elimination diets as a treatment for ASD. They should provide education to the families about the insufficient empirical support for these interventions and the potential harmful consequences of pursuing these diets in children with significant nutritionally deficits.
Families should be encouraged to continue serving a variety of foods as much as possible, even if their child doesnt accept them. Families can approach this by offering their child a choice around food types versus insisting they eat the one you are offering. If the child wont tolerate the new food on his plate, find an acceptable middle ground .
How To Handle Fussy Eating And Encourage Varied Diets For Autistic Children
Try not be discouraged if you dont see improvements in your childs fussy eating habits or diet at first. Finding new foods that work for your child can take time. Also, your childs preferences might change and they might be more willing to try different foods as they get older.
Here are some ways you can encourage your child to start trying new foods.
When you share regular meals and snacks with your child, you model healthy eating habits and a varied diet for your child. You also avoid rewarding fussy eating behaviour with separate or special meals. When youre using this approach, give your child food that you know theyll eat as well as new foods, and let your child decide whether they want to try the new food.
Introduce new foods that are similar to familiar foodsIf your child finds change difficult, your child might take a while to get comfortable with new foods.
You can help your child to accept new foods by introducing foods that have a similar texture, colour or smell to other foods that you know your child enjoys. Try putting the new food near the food that they like. For example, if your child wont try broccoli, you could try putting the broccoli near some cauliflower. You could also let your child sniff or lick the broccoli to get used to the look, feel and smell of it. Just let your child know that they dont have to eat the broccoli.
You might have to do this over several meals before your child is willing to even take a bite of the new food.
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Feeding Issues Related To Autistic Behavior Patterns
Like many children, kids with autism would usually prefer chicken nuggets and pizza to salads and fruit. Unlike many children, however, kids with autism can get absolutely stuck on very few food choices and absolutely refuse to make even the slightest change. If required to eat a carrot stick, an autistic child may melt down like a nuclear power plant!
While it is possible that these extreme preferences are sensory , it’s also possible that your child has developed a routine that is extremely difficult to change. People with autism, in general, prefer sameness and function well with routines, but sometimes a strong need for sameness can get in the way of proper nutrition.
If you’re struggling with an autistic child’s need to eat the same things, in the same order, day in and day out, start by checking to see if there is a real nutritional problem. If your child eats a limited but complete diet it may, in fact, be the case that he’s not in nutritional trouble. If you’re worried, you might just supplement his diet with a multi-vitamin. Next, rule out and/or address sensory or physiological problems .
Assuming that your child’s diet is really poor, and you’ve already addressed any sensory or physical issues, you’ll need to address the behavior. There are several approaches you can take, and you can mix and match:
Autism & Dietary Struggles
Why is autism often tied to dietary struggles? People on the autism spectrum have a developmental condition that manifests in a range of behavioral differences and struggles. These behavioral struggles can sometimes become evident as feeding problems. An autistic persons issues with food may manifest as:
- Rituals around eating.
- Pocketing food in their cheeks or sucking on food instead of chewing it.
- Strongly preferring certain foods.
- Avoiding certain foods.
People with autism are also at higher risk for gastrointestinal problems. Autistic children may avoid certain foods or develop strong texture or temperature aversions because of the physical discomfort they associate with those sensations. In frustration, parents of autistic children may limit their childs foods to only those they know will be accepted. However, this is not a sustainable model to develop healthy eating and nutrition habits. It is important to work with your pediatrician and potentially a nutritionist to expand your childs diet. Over time, you and your childs treatment team can develop a list of optimal foods that your child enjoys as well as a list of foods to avoid that often result in digestive issues.
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What We Know About Diet And Asd
While we dont know a lot about autism and its connection to diet, some studies identify relationships. Its been reported that gastrointestinal disorders are nearly eight times more common among children with autism than other children. Many children with ASD suffer from issues like chronic constipation, diarrhea, and frequent abdominal pain more often than their peers. Studies have shown these chronic digestive issues can translate into increased behavioral challenges.
Also, we know that childrenwhether or not they have a diagnosis of autismbenefit from a healthy diet. The USDA recommends that all children consume multiple servings of vegetables every day in their ChooseMyPlate.gov recommendations. Depending on the age of a child and their activity level, its recommended that they consume 1-3 cups of vegetables each day. But what about the specific benefits of cruciferous plants and children with ASD?
What Not To Do
Dont force them to eat things they dont want to eat.
Dont let people judge you for your kids diet. Theyre kids and youre doing your best to help them out.
About the writer
Im a writer, artist, and advocate who loves living in Maine among the trees and oceanside villages. Im also autistic, ADHD, and PTSD. My education, both academic and personal, has centered around mental health and neurodevelopmental disabilities, as well as discrimination and the socioeconomic consequences of living disabled in America. I work to plant seeds and spread ideas through my writing and will be among the autistic adults helping you understand your autistic kids better on Spectroomz Ask An Autistic.
You can find me on Twitter .
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Allow Hunger To Motivate Eating:
We generally recommend five opportunities to eat in 24 hours. This includes three regular meals and two snacks. There isnt a problem adding more opportunities, as long as they follow a regular pattern and some rules. What you want to avoid is eating whenever your child feels like it, especially if he/she has a constant grazing type pattern. If you have more meal/snack opportunities regularly expected in the routine, then your child wont have to wait too long for another opportunity.
Do Children With Feeding Problems Need To See A Specialist What Should Families Do If One Is Not Available
It is important that feeding issues in children with ASD are addressed by a specialist. These problems dont resolve on their own over time and may get worse. The recommendation to let them get hungry and wait until they eat does not work and can result in serious harm. Providers should refrain from this recommendation and instead get the children and family to the right intervention specialist.
Behavioral interventions provided by an interdisciplinary team are currently the only empirically supported treatment for pediatric feeding disorders in children with ASD. Unfortunately, few of these interdisciplinary programs exist, which results in a huge barrier to accessing care. We have one such program at Childrens Autism Center, however families often encounter long wait times because there are limited providers trained in working with this complex population.
While families are waiting, providers should help parents find resources and put together their own care team, including:
Together, this team can craft a plan addressing why a child might be refusing to eat.
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What Is The Relation Between Sensory Processing Disorder And Food
Sensory processing issues are common in individuals with autism. Due to the disorder, autistic individuals are impacted negatively in terms of their daily routines.
One of the major parts of a daily routine for an individual is naturally eating.
Eating is known to be frequently impaired in children with autism. Studies showed significant correlation between sensory processing disorders and eating problems for these children.
Since hyper- or hypo-sensitivity to stimuli such as textures, smells, temperatures or colors greatly impacts the decision of a child to eat or not, food aversion can occur.
Children with autism are really selective and strict with what they eat.
This picky eating behavior creates major problems in the childs diet.
A child with autism, who has sensory issues, does not process the sensory input in the same manner as a typically developing child.
Studies conducted with children with ASD showed that there is a strong correlation between eating problems and sensory issues.
What Are The Common Feeding Challenges In Children With Asd And Are There Typical Ages When They Occur
Parents also describe increased refusal of foods, insistence on particular preparation of foods, demands for specific utensils, consumption of a limited range of foods and preference for lower textured foods.
There is no specific evidence on the typical ages when feeding challenges peak. However, it is common for parents to report an emergence of food refusal during the transition to solid food or shortly thereafter . Additionally, parents often report changes in their childrens eating habits just before the emergence of symptoms of ASD.
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My Experience Of Autism & Food
This is my little boy Finn. Finn is 5 years old and he loves trains, jumping on the trampoline and ice cream . Finn was diagnosed with autism in June 2017 and since then Ive been trying to learning more about the link between autism, fussy eating and food anxiety.
Every child with autism has different experiences and issues surrounding food, some mild and some much more severe. For a long time Ive shied away from talking too much about this topic, unsure if my experience with just my child was enough to be able to give any meaningful advice. But if I can help just one family then it will be worth it.
Something Theyve Eaten Somewhere Else
Picture the scene: You arrive to collect your fruit-and-vegetable-hating child from his grandparents house, only to be told that he always eats his greens for Nanny. Delighted, you secure the recipe and excitedly make the same dish at home, only to have it unceremoniously thrown across the room at you. Clearly youre just completely rubbish at this parenting lark there can be no other possible explanation.Except that there can. Phew!The answer to this particular mystery lies with our old friend SPD. You see, your childs senses are busy taking in information from their surroundings all the time, and because this information is different when theyre at someone elses house, it can make the same food, prepared in exactly the same way, taste very different indeed depending on where they are when they eat it. I know: strange, but true.
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Eating Optimal Foods: Autistic Children & Problems With Food
Children with autism often have inadequate nutrition, partly due to food avoidances and aversions. Poor nutrition increases the risk of later chronic illnesses, like diabetes and heart disease. Children who grow up with poor diets are more likely to be obese, which is associated with several chronic illnesses. Children with autism are more likely to have low calcium and protein, which can reduce brain development, bone growth, and muscle strength. These issues may be correlated with problems with cognition, balance, physical strength, and other aspects of physical development. Feeding issues can be a major problem for autistic children, and the consequences can be serious if the child ends up with nutritional deficiencies. Parents can help by employing various strategies to get their children to eat a more diverse diet. Doctors and therapists are often involved in this process.