7 Parental Solutions for Feeding Children with Autism
Feeding problems in autistic children is very common and a source of frustration for parents. Elizabeth Strickland MS RD LD, author of Eating for Autism, offers advice for families struggling with difficulties around mealtime to ensure children will gain the nutrition they need for optimal growth.
Research from the Marcus Autism Center and the Department of Pediatrics at Emory University School of Medicine have found that chronic feeding problems increase a child’s risk for poor medical and developmental outcomes, including malnutrition, growth retardation, social deficits, and poor academic achievement. Children with autism that have chronic feeding problems are at long-term risk for poor bone growth, obesity, and other diet-related diseases such as cardiovascular diseases.
Parents should first understand that children with autism are not the stereotypical “picky eater.” Picky eating is a normal part of childhood development. Approximately 50% of young children are identified as picky eaters, says Ms. Strickland. These are children who eat fewer than 30 different types of food, focusing on certain favorites, but will ultimately try something new and expand their diet.
Feeding problems are much more complex. These children eat fewer than 20 foods and may even begin to whittle those few down to 5 or 10, placing them at risk for nutritional deficiencies. Problem feeders will sometimes refuse entire categories of foods because of texture or other reasons. They will eat the same foods over and over and cry or throw a tantrum when offered something new.
There are many potential causes of feeding problems, including oral-motor dysfunction, sensory integration dysfunction, environmental factors, and behavioral problems. Medical conditions, such as digestive trouble which can be common in children with autism, may also play a role.
It is important for families with autistic children that have feeding problems to sit down with their healthcare team to work out a Feeding Intervention Plan. The pediatrician should first offer a full medical examination to identify or rule out conditions that contribute to problem eating. These include Gastroesophageal Reflux Disease (GERD), Eosinophilic Gastrointestinal Disorders (EGID), and chronic constipation. The physician should also review all medications for side effects such as altered taste, decreased appetite, abdominal pain, or dry mouth.
One of the leading contributors to feeding problems in autistic children is sensory integration dysfunction, also known as sensory processing disorder. These children experienced a disruption of the intake and organization of sensory information within the brain, causing them to have trouble responding appropriately. As eating is a complex act that requires all five of the senses, sensory integration dysfunction can certainly contribute to problem eating.
Remember that structure plays a big part in an autistic child’s life. He or she probably craves sameness and ritual during mealtimes. Distractions can overload the senses, causing him to lose interest in eating. Offer your child consistency and structure during meals with minimal distraction. Do not overly focus on your worries about his diet, as this struggle will likely only worsen the problem.
Although it is tradition to sit down as a family to enjoy a meal, your autistic child may have other thoughts on the matter. He or she may like to stand while eating, use a certain chair or certain dishes, or may not like being at the table at all. Work with your child’s needs and remember that certain issues aren’t worth the struggle. Nothing bad will happen if he or she eats while standing, for example.
Ms. Strickland offers the following at-home strategies to improve your child’s feeding problems:
• Use positive reinforcement. Praise your child when he or she does something appropriate at mealtime. Do your best just to ignore problem behaviors such as spitting out food.
• Model good behavior. The rest of the family should model good eating and social behavior during mealtime, such as sitting at the table and making a plate of food. Over time, your autistic child will see this as a structured norm.
• Stick to a schedule. Offer meals at the same time and place each day. Limit meals to no more than thirty minutes to discourage lingering and playing with food.
• Don’t let your child graze. Eating small amounts of food all day will diminish his or her appetite at mealtime. Offer three meals and two to three small snacks during the day. Limit caloric beverages, such as juice, that might fill him up and discourage regular foods. Offer water in-between meals.
• Avoid food-burnout. If your child eats the same food, the same way each and every day, he will eventually “burn out” and eliminate that food from his diet. And once an autistic child refuses a food, he is unlikely to accept it again in the future. Slightly change the presentation of the food. For example, make a pancake oblong instead of round. Within a pancake, add two eggs instead of one which will only slightly change the flavor.
It will take time and effort to improve feeding problems in an autistic child, but it will be well worth it.
References: Information adapted from "Eating for Autism: The 10-Step Nutritional Plan to Help Treat Your Child's Autism, Asperger's, or ADHD" by Elizabeth Strickland MS RD LD. 2009 Da Capo Press
Emory University, Children with autism at risk for feeding problems, nutritional deficits, Feb. 6, 2013
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