Many problems of picky eating and mealtimes are resolved with a little guidance and some patience. However, parents of children on the autism spectrum often seek further guidance and support for what are frequently much more severe eating problems. In part, this is simply due to the limited number of specialists dealing with eating and feeding disorders. Furthermore, within this limited number of specialists few have much understanding and experience with children who have autism spectrum disorders.
A frequently suggested strategy for many children with eating and feeding disorders involves withholding food until the child is hungry enough to eat. This approach has been shown to be dangerous and not appropriate for a child on the autism spectrum. Though no reliable statistics are available on feeding and eating disorders of children on the autism spectrum, it does appear to be relatively common. Families of these children may end up struggling on their own with little understanding from family, friends and the professional community.
One British mom, out of loneliness and frustration, attempted a survey that resulted in a sample of 89 questionnaires being filled out and returned. Though each child is unique, information gathered from her survey shows the need for further research on this issue and serves to educate families about some common eating issues. Medical, behavioral, and environmental factors, including sensory difficulties, must be considered when feeding and eating problems occur.
Within the scope of this article, medical and behavioral factors will be addressed briefly. Medical issues and frequently, behavioral issues, need to be assessed and addressed by working with the appropriate professionals. The environmental and sensory related issues will be discussed and outlined in more depth. After medical problems have been examined, and plans are in place to address these problems, then the behavioral problems, if any remain, are important to address and treat.
Occasionally behavioral issues are so severe that medical intervention is needed for these issues also. Environmental issues including sensory difficulties can be considered after medical and behavioral issues have been treated. These sometimes hidden problems may be causing a child pain and lead to eating and feeding difficulties. Due to sensory sensitivities regular teeth brushing and oral care may be difficult for children on the autism spectrum. Going to the dentist may also be difficult due to these oral sensitivities and fear of unfamiliar people and places.
Working with an experienced pediatric dentist can help if this is the case with your child. An eating history should be taken.
The eating history should include gathering the following information:. An occupational therapist, speech and language pathologist, and nutritionist or dietician along with a doctor and a nurse are all involved when a team approach is used for a feeding assessment.
Frequently a social worker or child psychologist is also part of a feeding team. An additional aspect of medical assessments for children with autism spectrum disorders related to eating and feeding issues has been suggested. Since the late s, abnormal gastrointestinal functioning of many individuals with autism spectrum disorders has gained increasing recognition and concern. Research by pediatric gastroenterologist Tim Buie and gastroenterologist Arthur Krigsman suggest that at least half of all children with autism spectrum disorders have clinically significant gastrointestinal symptoms.
These researchers have conducted intestinal biopsies and other assessments and have found unique forms of inflammatory bowel disease including enterocolitis, esophagitis, and gastritis in children with autism spectrum disorders. Buie, along with others suggest evaluation for abdominal pain, GERD, and chronic constipation might be important for some children with autism Buie et.
For some individuals, treatments of these digestive system abnormalities have led to varying degrees of improvements in the core symptoms of autism spectrum disorders, including behavior, communication and social skills. The main treatments for this abnormal inflammatory bowel disease include diet, treatment of gut yeast, and supplemental enzymes.
More information can be found about biomedical treatments related to gastrointestinal problems and autism spectrum disorders in books by Martha Herbert and a few others. These books are listed at the end of this article. In , the Autism Research Institute ARI established a forum for researchers to share information on various medical and neurological comorbidities they were finding in children with autism. Currently, ARI offers Continuing Medical Education webinars that can be reviewed by professionals as well as families and all other interested individuals.
Different diets seem to help some people with autism spectrum disorders. The Specific Carbohydrate Diet Gottschall, is also of interest among families of children with autism spectrum disorders. This approach certainly does not work for everyone, is very individualized and is a substantial commitment to most families if or when they begin. When a child is continually refusing food or having other feeding or eating difficulties, it is important to evaluate any possible medical problems and determine factors to be addressed medically that will maximize feeding and eating success.
Unfortunately, some children do not seem to have much appetite at all. They may not have the ability to feel or interpret the feeling of hunger. Food allergies and food intolerance should also be considered as part of medical testing. Eating disorders are complex and continue to be studied among various populations.
Eating disorders such as failure to thrive, rumination, pica, obesity and anorexia nervosa can affect children with autism spectrum disorders. Children experiencing these problems are at risk for serious health and growth problems that can lead to life threatening consequences.
Pica, the ingesting of non-nutritious substances, is a behavior that can start at any point in life under various circumstances. Obviously the child should be closely supervised and kept away from substances related to this pica behavior.
There are multiple causes and treatments for pica. A knowledgeable professional can assess and address pica. Nutritional deficiencies, sensory stimulation, lack of ability to discriminate non-edible items, and relief of anxiety are all possible factors that can lead to pica.
Rumination is the persistent regurgitation, re-chewing, re-swallowing, or occasionally vomiting of previously eaten foods and is a second behavioral problem of eating that can have serious health consequences. The causes of rumination are not clear but are thought to begin due to gastro-intestinal disorders and continue due to the self-stimulatory rewards the individual experiences.
Rumination is a relatively rare disorder; the best course of action is an appropriate medical assessment and treatment. Behavioral interventions may be appropriately designed and implemented once medical issues have been thoroughly addressed. Behavioral issues, when severe, will also need to be assessed and treated medically. Children with extreme food selectivity issues are frequently dealing with many environmental factors related to sensory modulation and regulation.
Selective eating can have significant developmental and health consequences. Extreme selective eating problems are often seen paired with strong negative reactions to the introduction of new foods. Mild selective eating is common in all toddlers and young children according to a variety of studies. It cannot be emphasized enough that the issue of concern for a significant number of children on the autism spectrum is extreme food selectivity.
Try putting the new food near the food that they like. You could also let your child sniff or lick the broccoli to get used to the look, feel and smell of it. You might have to do this over several meals before your child is willing to even take a bite of the new food. Keep to a routine Offer your child meals and snacks at regular times.
This encourages a better appetite at mealtimes. Change how you present food Making small changes to the way you present food might encourage your child to try new and more foods over time. For example, you could try:. Getting comfortable with new food outside meal times If you can introduce new foods away from the kitchen or the family table, it can reduce the pressure your child might feel about having to try new foods. As your child becomes more comfortable with new foods in these contexts, you can start introducing new foods at the table.
Limit milk drinks Some autistic children have a habit of drinking milk from a bottle rather than eating food. Remember that children with autism tend to do best with clear routines. Post this in her room, in the kitchen and other places where she spends time. You can use a timer to let her gauge that mealtime is approaching. The idea is to give your daughter as much preparation time as possible prior to meals. This has the added advantage of helping her manage food-related anxiety.
Try some movement before meals. You may find that it helps to have a little physical exercise — if only marching around the table to music — before sitting down to a meal.
Remember to make it fun. Take the mood out of the food. I think this is a useful mantra for parents. Try to consciously reduce your anxiety or other negative emotions. Try to maintain a positive atmosphere around meals. Believe that your child will eat and celebrate every success! Try serving food family style. Put foods on serving plates, and let your child serve herself. If your daughter is able, ask her to pass the plate on to the next family member. The idea is to give her as much control as possible over her eating.
Allow her to sit at the table while the rest of you eat. As I mentioned earlier, the look, smell and proximity of the food can help her make progress to eating more foods in the future. Find the ATN center nearest you. Advocacy News. House-passed bill calls for greater autism research investment to address disparities, lifespan issues and co-occurring health conditions. Gnome Surf: creating a wave of inclusivity and kindness for autism families. Tool kit. Telehealth Tool Kit for Families and Providers.
Science News. Study finds higher rates of gender diversity among autistic individuals. Autism Speaks hosts experts and advocates to address health disparities in autism. Expert Opinion. Suicide risk in autism.
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