Picky Eating Risks Autistic Kids

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Two new studies out this year have focused on the nutritional adequacy of diet in children with autism, particularly those who are selective about what they eat. Many children are picky eaters as they go through the more independent stages of toddlerhood and school-age years, but the trait is more common in children diagnosed with autistic spectrum disorders (ASD).

Autistic children have limitations or difficulties in several key areas of development, including language, communication, social interaction, and rigid or repetitive behavior. “Selective eating”, the clinical term for a picky eater, can be a component of the desire to have a more structured environment. While most children outgrow their tendency to be picky about what they eat, children with ASD often carry the trait into adulthood.

Dr. Linda Bandini, of the EK Shriver Center, University of Massachusetts Medical School and Boston University says that children “not eating foods from each of the food groups in sufficient amounts…may be at risk for nutrient deficiency.” Her research is published in the April issue of the Journal of Pediatrics.

To study eating habits, Dr. Bandini and colleagues used data from the Children’s Activity and Meal Patterns Study (CHAMPS) which included 111 children between the ages of 3 and 11, 53 of which had diagnosed autism. Parents were asked about their child’s eating habits and patterns and then kept a food diary for three days.

Selective eating practices were found in both groups of children; however those with ASD “displayed more food refusal and exhibited a more limited food repertoire.” When reviewing the food diaries, the autistic children in the study were more likely not to meet requirements for vitamins A, C, D and minerals zinc and calcium. Fiber was also lower than compared to the group of typically developing children.

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The February 2010 issue of the Journal of the American Dietetic Association also highlights research over the past 25 years on “food selectivity” and nutritional adequacy of children with autistic spectrum disorders. The introductory paragraph of the article contributes this to sensory sensitivity factors often seen in ASD children, such as the smell, texture, color or temperature of food.

Almost all of the studies available for review were based on food records, questionnaires, or interviews with the parents instead of observation of actual food intake. This type of study, as the study above, can be limiting in information as the data is very subjective and reliant on parent memory. Many of the studies were also small or had very limited useful data, such as the inability to compare autistic children to healthy controls.

Some of the data from the studies selected by the researchers found:
• 59% of children in small UK study limited their intake to fewer than 20 different foods.
• Another small study found that 53% of the participants were reluctant to try new foods.
• In a survey of 100 parents of children with autism, 67% reported their children as being “picky eaters” despite also reporting that their child had a good appetite.
• One study found that food presentation may also be a factor, such as when foods touch each other on a plate or the child having a desire for a specific eating utensil.
• Some children have particular rituals or behaviors associated with mealtime.

Only a few studies selected by the researchers focused on the correlation between food selectivity and nutritional adequacy, rather than on the behaviors themselves. The first study of 40 children with ASD and 34 typically developing children, did not find any significant difference in nutrient intake. In contrast, another small study of only 17 children, nine of which had autism, had an intake that was below the recommended levels for one or more nutrients, most notably iron, vitamin D, vitamin C, niacin, riboflavin, and zinc.

The foods most likely to be eaten in amounts lower than recommended were fruits and vegetables. Those that selectively ate foods on a daily basis were from the “fatty” and “sugary” food groups, suggesting that ASD children are not always as different as their “healthy” counterparts, but may need more direction or structure toward adding new foods to their daily diets.

Because feeding problems are often complex and multi-factorial, parents are urged to seek the help of a physician, registered dietitian, or occupational therapist in helping to plan meals, interventions, or other techniques that can help bring an autistic child’s diet within the recommended nutrient levels for optimal growth and development.

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