How to help a child with ASD to eat a variety of foods

If your child with ASD is a fussy eater, it is quite likely you have tried everything to get them to eat. This post provides a better understanding as to what may be impacting your child’s refusal to eat a wide variety of food, as well some practical tips to encourage your child to expand their food choices.

Your child  with ASD is unlike any other child with ASD. However, when it comes to fussy eating behaviours and fussy eating causes there are quite a few common traits.

A narrow range of food

A child with ASD is more likely to be a fussy eater than their neurotypical peers. It is estimated that 72% of children with ASD eat a narrow range of foods[1].  These children may present with difficulties from the time solids are introduced, for example, they may show strong preferences for certain foods, as well as a ‘stubborn’ refusal to sample others. For example, they may struggle to move on from purees and have a hard time with lumps.

Challenging and concerning  behaviours at mealtimes

As parents seek to introduce new foods, their child with ASD may present challenging behaviours at mealtimes[2], for example, they may run away from the table or have a complete meltdown before or during a meal. Some children also display concerning behaviours, indeed they may overeat or eat non-edible items (PICA).

Parents often find themselves isolated. They worry about growth, nutritional, and safety outcomes for their children. The dinner table becomes a constant battlefield. Anxiety levels are heightened for all involved.

The problem is that those difficulties are likely to persist in adulthood: among adults with intellectual disabilities, those with autism have more severe feeding and mealtime challenges such as food selectivity and refusal than those without autism[4].

Potential nutritional deficiencies

Children are at risk of nutritional deficiencies when they drop entire food groups. Studies find that children with ASD are more likely to lack:

• iron,
• folate,
• b12,
• zinc,
• lithium,
• calcium,
• magnesium,
• DHA
• specific amino-acids [3] .

Organic causes behind a child with ASD limiting their food choices

There are a variety of causes that will impact an ASD child’s capacity and desire to develop a varied food repertoire.

Medical

ASD children may be unwell. They may experience discomfort yet may not be able to express it. The signs can be minuscule but behaviour can be a tale-tell. For example, parents need to check for constipation and wind, because gastrointestinal discomfort is quite common among children with ASD. Moreover, children are more likely to suffer from food intolerance and allergies than their peers.[5] If in doubt it is best to get a referral to an allergist or a gastroenterologist.

Eating skills

They may lack the skills they need to eat. For example, they may have low muscle tone and therefore a lack of oral motor skills to eat challenging foods and textures. When there is delayed speech, it is worth checking with a Speech-Language Pathologist and get them to perform an oral-motor examination of your child. 

Anxiety, medication, and nutrition

Adults with ASD often say that anxiety is worse than ASD itself. Anxiety, stress and medication can all impact appetite. Nutrition once impacted, may, in turn, affect appetite.

Environmental challenges

Children’s eating environment may impact their ability to relax, they react to noise and lights. They may be fidgety and struggle to sit for a while, especially if their seat does not provide good ergonomics.

Sensory sensitivities and rigidity

It is likely that children with ASD struggle with a range of sensory sensitivities. Eating food is a multi-sensory experience: food has smells, textures, colours, and tastes as well as different temperatures.

For example, parents often mention their child’s rigidity: they may balk at food touching each other. They may recognise the aspect, the smell or the taste of a branded product and refuse an equivalent. As a result, they may request the same food day after day. They may refuse mushy textures, favour crunchy sensations and develop strong food aversions. Parents may also observe that their child covers a food with sauce, or salt to neutralise or tone down a particular flavour, or their child may run away from a smell in the kitchen as a result of sensory challenges.

Children may avoid using their back molars to reduce the sensation of the food in their mouth creates.

Since children are diagnosed with ASD on average at the age of 4, parents have often already adapted the best they can to their child’s food refusals or rigidity. It is worth revisiting this relationship and exploring options to improve the range of accepted foods.

Reasons to be optimistic for your child with ASD

It is an interesting observation that family food cultures have a significant impact on children’s capacity to eat certain foods. For instance, a child with ASD in an Indian family may eat dahl and rice, when an Aussie family may have a child who is stuck with pasta and chips. French children here eat casseroles.

Selective eating in children with ASD’s selective eating is a manifestation of their restricted interests and activities[6], so parents may have a special role to play in opening up those possibilities.

Here are my top ten tips to help a child with ASD to eat a variety of foods

1. Always check for underlying causes that may trigger pain or difficulties. Misbehaviour is often rooted in physical pain so it is important to eliminate any Gastro-Intestinal (GI) issues, chewing and swallowing difficulties.

2. Trust your child’s appetite: making sure that meals are offered when your child is hungry is important, as well as making sure that medication is adapted and given at optimal times.

3. Reduce anxiety by offering certainty, use cards or charts to spell out the routine. What is the routine before the meal, during the meal, after the meal? What is on the menu?  I have observed the capacity that children have to increase their accepted range when a routine is present and stress is reduced.

4. Use a French style of family meals by serving the food on platters in the middle of the table. Your child can choose what they want to eat from your nutritious, wholesome offerings.

5. Present new foods on the table, move them closer to your child as time goes by to increase familiarity.

6. Integrate a new food to a liked food, slowly change the texture, the taste, or the colour, depending on what the refusal is about.

7. Avoid ruling foods out, keep offering what forms the basis of your family food culture.

8. Improve familiarity with food by having non-eating activities that involve preparing and cooking food.

9. Identify your stress levels associated with feeding your ASD child on a scale of 1 to 10. If your stress level is too high, who can help you? Who is in your support system?

10. If your child avoids entire food groups or has meltdowns at mealtimes professional support may be warranted.

Remember we normally eat 3-5 times a day, so this activity can become normal and pleasant for all ASD children and their families.

Fussy Eater Solutions offers a range of in-home and online services to families who self-manage their NDIS to improve the lives of their ASD fussy eater child. Call Marie-France, the Fussy Eater Specialist, for more information or book a free 15-minute assessment here.