Autism nutrition

Autism and Picky Eating

Many parents are familiar with picky eating.  As a parent of a child with autism, you may be  familiar with it on a whole new level. You are not alone.  It is not uncommon for children with autism to also have extremely restrictive eating, preferring specific colors, textures or even brands of a specific item.

Caregivers often struggle to know what to offer and keep plenty of the preferred foods on hand.  Going out to eat, family gatherings, vacations and holidays are difficult to navigate. You may also worry about the child’s nutrition and health. On the other hand, the child is also worried and anxious when faced with a new and different food. Mealtimes are often a source of stress for caregivers and children alike. 

Why does the picky eating matter?

Proper nutrition supports growth, development and long term health. A balanced diet includes a variety of foods including fruits, vegetables and whole grains. Many of the foods preferred by children with autism are highly processed or do not provide a wide range of nutrients. They also may be high in calories, sugar and fat. Each of these foods can lead to excess weight gain. As a result, a child with extremely picking eating may still be growing and at the top of the growth charts, yet deficient in key nutrients.  Children and adults with autism are at greater risk for malnutrition, obesity and chronic disease. While there are a few reasons for this, restricted eating patterns play a role. 

Why is picky eating so common in Autism?

The most common reasons are sensory aversion and anxiety. Other reasons include difficulty with swallowing or chewing,  pain related to heartburn and gastrointestinal discomfort, food intolerances or allergies. Imagine not being able to communicate that a particular food was causing pain, or that the texture or color was like fingernails on a chalkboard? Mealtimes would be dreaded.

It is important to rule out physical pain from food allergies or intolerance, gastrointestinal conditions or a swallowing disorder.  These conditions are common in children and adults with ASD. Having a mutli-disciplinary healthcare team to evaluate and assess each individual case is recommended. This team may include a medical doctor, dietitian, speech language pathologist, occupational or feeding therapist. Treatment approaches often include speech, feeding and occupational therapies. If a food allergy or medical condition is diagnosed that it can also be addressed.

What can a caregiver or parent do to help food acceptance along?

There are ways to make the process of food acceptance a little less stressful. When a child is refusing a food, there is a reason that makes sense to them. We may not see it, but something about that food causes pain, anxiety or aversion. So it’s a gradual process of helping them be more comfortable with their non-preferred foods. This takes exposure to the food in a no pressure way. Here are three steps for working towards acceptance.

Step 1: Keep mealtimes relaxed

Meet the child where they are at; accept the preferred foods are what they will eat at mealtimes (at least for now). Take the focus off of the food the child will or won’t eat and focus on mealtimes as a way to spend time together. Offering the preferred foods, while the rest of the family enjoys the regularly scheduled meal. Note that it is still important that the child be exposed to those foods without the pressure of being asked to eat it, try it or taste it.  The goal is to not just foster acceptance but enjoyment of a wider variety of foods. Allowing the child to be relaxed at mealtimes will pave the way.

Step 2: Provide exposure in baby steps

Embrace the concept of baby steps. This process might take a while.  In order for the child to become more comfortable with foods, they need to explore and experience the food without the initial pressure of “try-it”.  Cooking activities, farmer’s markets and meal planning are a great way to do this. For example, in a cooking activity the child will be able to experience the food by touch and smell. At the Farmer’s Markets, allow them to look at all the foods offered and choose one for the family.  They may not try the food the first time and that is okay. The exposure to the food is the important part. This is where progress happens.

Step 3: Allow for and praise tiny bites

Think “tiny bites”!  Typically when we offer new foods it is big spoonfuls of new food at the dinner table! Or we hide the new food IN something that they like. This may be stressful or overwhelming to the child. So, make it small and make it fun!  Snack times are an ideal time. Offer both the new food and a familiar food and yield control to the child. One way to do this is to place a small pea sized amount on a spoon and place it on the child’s plate. Another way is to ask them to sandwich the tiny bite inside their favorite food.  Give them permission to spit it out if they don’t like it. This gives them a sense of control and confidence. Praise them if they try it! No bribing or coercing if they don’t. 

Encouraging relaxing mealtimes and allowing the child to explore new foods stress free will foster an acceptance and enjoyment of food.  Keep in mind, that this is more of a marathon than a sprint. Work with your healthcare team to identify any physical or medical reasons for food refusal. Consult with a registered dietitian to identify and address any immediate nutritional concerns.

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