Is your child with autism a picky eater? You’re certainly not alone. A healthy, varied diet is essential for development. However, many families face challenges at mealtime, where picky eating can become an ongoing struggle. These challenges make meals stressful and limit access to a balanced diet.
By understanding the connection between nutrition and development—and learning practical strategies to expand your child’s food choices—you can support their health and help create more positive mealtime experiences.
The Importance of Nutrition for Development
Nutrition plays a key role in many aspects of a child’s growth and development. A balanced diet can impact physical health, cognitive functioning, and behavior. Adequate nutrition provides vital nutrients that support a growing child’s brain development, learning, and emotional regulation–each of which is critical for reaching developmental milestones.
In a perfect world, to achieve optimal development, children would consume all essential nutrients, such as protein, fats, carbohydrates, vitamins, minerals, and micronutrients, like iron, zinc, folate, and choline (Roberts et al., 2022). The foods and beverages a child drinks can positively or negatively impact their day-to-day functioning. In behavioral terms, one’s diet can be a setting event for various challenges, such as difficulty focusing or behavioral issues. Conversely, a balanced diet may help improve mood, increase energy, and support one’s ability to engage and learn (Jacka et al., 2010).
Common Eating Challenges for Children with Autism
While a healthy, well-balanced diet is important, families of children with autism often find this easier said than done. Research suggests over 70% of children with autism experience eating challenges, such as limited food preferences and hypersensitivity to food textures (Mayes & Zickgraf, 2019). This is a stark contrast to the general population, with only 4.8% of neurotypical children experiencing atypical eating habits.
Children with autism may struggle with eating for a number of potential reasons, such as a need for routine and predictability, sensory sensitivities, or even gastrointestinal (GI) issues. GI problems, including constipation, bloating, and abdominal pain, are more prevalent among children with autism than the general population (Lasheras et al., 2023). These discomforts can lead to food avoidance and reinforce sticking with “safe” foods.
A few of the most common eating challenges that children with autism experience include:
- Limited food preferences–Eating only a select few food items. This reduced food repertoire can impact nutritional intake. Chicken nuggets are one of the most commonly preferred foods for children who have limited preferences (Mayes & Zickgraf, 2019).
- Eating only one brand of food–Some children exhibit fixated preferences for a specific brand of food, such as only eating Tyson chicken nuggets and refusing other similar brands.
- Hypersensitivity to food textures–Hypersensitivity (or hyposensitivity) to sensory input is one of the main characteristics of autism spectrum disorder (ASD), per the Diagnostic and Statistical Manual of Mental Disorder, 5th edition (DSM-5) (American Psychiatric Association, 2013). These sensory differences often result in children with autism refusing foods with certain textures and having restricted preferences for foods with a particular texture.
- Pocketing food without swallowing–Holding food in the mouth without swallowing for extended periods of time sometimes occurs due to sensory processing challenges or motor difficulties. This behavior can significantly reduce the amount of food the child actually consumes. Speech-language pathologists (SLPs) and occupational therapists (OTs) can assess why the child is pocketing food and recommend strategies.
- Rumination–Repeatedly swallowing food then regurgitating it and chewing it again before swallowing it again or spitting it out.
- PICA–Consuming non-food items, such as rocks, dirt, or paper, can be particularly concerning, not only because the child is consuming less nutrients by eating fewer food items, but also because of the immense safety risks associated with this behavior (Mayes & Zickgraf, 2019).
Strategies to Expand Your Child’s Food Preferences
If your child engages in behaviors that limit their ability to consume a well-rounded diet, there are many approaches you can try to encourage more variation. Here are a few strategies to consider.
Rule out medical conditions–Before making changes, consider whether physical discomfort or medical conditions could cause or worsen your child’s picky eating. Treating GI problems and other medical conditions could potentially improve the child’s food selectivity (Zickgraf & Mayes, 2019).
Start small–Introduce new foods in small, manageable portions alongside familiar and preferred items. Offering a small portion to try without pressure may make the idea of tasting new foods less intimidating.
Add structure to mealtimes–Predictable mealtimes can help your child know what to expect, reducing anxiety and resistance. Try using a visual schedule to communicate your snack and meal routines and stick to them as closely as possible.
Offer foods that are similar to their preferred foods–While you may be eager to get some nutrient-dense foods in your child, a slow and systematic process is often needed to encourage variation in their diet. This may involve offering foods that have similar textures, colors, and smells as their preferred ones. It could even involve offering the same foods but a different variation or brand of them.
Gradually try new foods–Allow your child to acclimate to new foods at their own pace. Have them work on trying one new food at a time. If they’re not ready to immediately eat the food, that’s okay. Have them simply touch it and smell it. As they feel more comfortable, encourage them to bring it up to their lips. Next, have them lick the food. Eventually, as they progress through each of these baby steps, they’ll make it to the point of taking a bite.
Allow choices–Encourage your child to make choices to foster independence and offer a sense of control. Even choices that aren’t directly related to the food, like choosing which plate to use, can help reduce mealtime anxiety.
Keep trying–While it can be discouraging to see your child repeatedly refuse healthy and varied food options, it is important to avoid getting into the habit of only presenting their preferred options. Research has shown that repeated exposure to foods increases the likelihood of children accepting them. One research review found that children were more likely to consume fruits and vegetables when a single item was presented once per day for 8-10 days (Spill et al., 2019).
Steer clear of power struggles–Avoid mealtime power struggles. These could make your child’s selective eating worse and create new undesired behaviors.
Consult professionals–Eating challenges often require a multidisciplinary team of professionals to support, including OTs, SLPs, and sometimes BCBAs who are trained in feeding therapies. If your child engages in food behaviors that limit their nutrient intake, it’s best to consult professionals to provide individualized assessment and treatment.
When to Seek Professional Help for Eating Challenges
Many kids are known to be picky eaters–but how picky is too picky? A good rule of thumb is if their eating habits are enough to cause you concern, it’s best to have it evaluated by a professional.
Here are a few signs that your child should have an assessment with an SLP and/or OT for their feeding and eating challenges:
- Extremely limited food preferences that restrict or could potentially restrict nutrient intake
- Strong tendency to prefer or avoid specific textures, colors, or types of foods
- Mealtime anxiety or distress
- Frequent gagging
- Pocketing food
- Eating inedible items
The CompleatKidz team of multidisciplinary clinicians, including Speech Therapists and Occupational Therapists, are here to guide you and your child through mealtime challenges. Contact us today to schedule an initial evaluation.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Jacka, F. N., Kremer, P. J., Leslie, E. R., Berk, M., Patton, G. C., Toumbourou, J. W., & Williams, J. W. (2010). Associations between diet quality and depressed mood in adolescents: results from the Australian Healthy Neighbourhoods Study. The Australian and New Zealand journal of psychiatry, 44(5), 435–442. https://doi.org/10.3109/00048670903571598
Lasheras, I., Real-López, M., & Santabárbara, J. (2023). Prevalence of gastrointestinal symptoms in autism spectrum disorder: A meta-analysis. Anales de pediatria, 99(2), 102–110. https://doi.org/10.1016/j.anpede.2023.07.003
Mayes, S. D., & Zickgraf, H. (2019). Atypical eating behaviors in children and adolescents with autism, ADHD, other disorders, and typical development. Research in Autism Spectrum Disorders, 64, 76-83. https://doi.org/10.1016/j.rasd.2019.04.002
Roberts, M., Tolar-Peterson, T., Reynolds, A., Wall, C., Reeder, N., & Rico Mendez, G. (2022). The Effects of Nutritional Interventions on the Cognitive Development of Preschool-Age Children: A Systematic Review. Nutrients, 14(3), 532. https://doi.org/10.3390/nu14030532
Spill, M., Callahan, E., Johns, K., et al. (2019, April). Repeated exposure to foods and early food acceptance: A systematic review. USDA Nutrition Evidence Systematic Review. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK582166/
Zickgraf, H., & Mayes, S. D. (2019). Psychological, health, and demographic correlates of atypical eating behaviors in children with autism. Journal of Developmental and Physical Disabilities, 31(3), 399-418. doi:https://doi.org/10.1007/s10882-018-9645-6
