Children with autism commonly have feeding problems, such as food avoidance, selectivity, or “pocketing” food rather than chewing and swallowing it.
If your child has feeding problems, a behavior therapist can work on these issues with your child. In therapy, your child can learn new behaviors related to food, how to try new foods, and how to avoid non-food items like dirt.
Digestive problems may also be part of your child’s feeding problems. Work with a nutritional therapist or physician to effectively address these underlying issues.
An Autism Diagnosis
Autism spectrum disorder (ASD) is a developmental disorder that manifests in a range of changes in communication, learning, and socializing, starting between 6 months and 4 years old. Children can be reliably diagnosed with autism around 2 years old.
If you notice changes in your child like reduced mobility, losing communication skills, less interest in playing with you, and more focus on a specific toy or type of play, talk to your pediatrician. They can provide information on autism and a referral to a specialist if autism is suspected.
If a specialist confirms the diagnosis, they can help you find a behavior therapist to help your child manage the symptoms of autism and improve behaviors. Applied behavior analysis (ABA) therapy is the leading treatment to manage symptoms of autism.
Feeding Problems Prevalent Among Children With Autism
Most symptoms associated with autism involve trouble with verbal and nonverbal communication, isolation and trouble socializing, and cognition issues.
Another common symptom for many people with autism is difficulty with food and eating. Unusual eating habits can involve:
- Eating a very select few foods.
- Avoiding specific foods, usually for texture or temperature reasons.
- Creating rituals around eating.
- “Pocketing” food in the cheek without swallowing it.
- Struggling with digestive problems like constipation or diarrhea.
- Eating non-food items like rocks or dirt (PICA).
Research conducted at Penn State College of Medicine and published in 2019 found that 70% of children with autism had atypical eating behaviors, like those listed above. This rate was 15 times higher than the rate of eating- and food-related issues among their neurotypical peers.
The study suggested that feeding problems are so common among autistic children, compared to neurotypical children, that these issues could become one of the diagnostic criteria of ASD.
Research on Feeding Problems in Children With Autism
Food aversions, preferences, and feeding problems appear around the time many children are diagnosed with autism. Parents may notice some subtle changes when the child is about 1 year old, and these become more pronounced as they age.
Early studies on children with autism found that diets could become very restricted by the time a child reached 24 months, or 2 years old. In one study, a group of 79 children with autism were compared to a control group of nearly 13,000 neurotypical children.
At 54 months (4.5 years old), without treatment, a child’s diet could become restricted to the point of being completely different from the rest of the family’s diets. The study also found that children with autism were more likely to have food allergies than neurotypical children.
Children with autism were found to consume less:
- Fresh fruit
- Carbonated drinks
Although there were extreme food restrictions, particularly in children who focused on processed foods or carbohydrates, there were no reported weight differences between the two groups of children in the study. Despite this finding, eating such a restricted diet might lead to developmental issues like lower bone mass. It could potentially trigger chronic illnesses like diabetes or hypertension later in life.
Pica is an eating disorder in which a person eats something not commonly thought of as food, which has no nutritional value. The study also found that pica occurred in children with autism more often than it did in the control group. This behavior usually became evident between 8 and 54 months of age.
Nutritional Issues Associated With Autism
Children on the autism spectrum may suffer from several nutritional issues, such as:
- Malnutrition, or lack of proper nutrition.
- Overnutrition, or excessive intake of some nutrients.
- Micronutrient deficiency.
- Toxicity from pica.
A study published in 2018 affirmed that young children with autism had much higher rates of feeding problems compared to a neurotypical control group. Speech therapists and psychologists detected feeding disorders in autistic children around 3 years old.
- Over 23% showed selectivity based on texture, compared to 7.1% of their peers.
- About 24.5% were selective about food based on type, compared to 11.8% of their peers.
- More than 10% percent increasingly refused food, with none of their peers reporting this issue.
- Over 14% ate until they were overstuffed with food, compared to 3.5% of their peers.
Feeding problems will become very apparent as children age. As neurotypical peers will slowly add new foods to their diets, some children with autism may focus on one specific type of food or texture of food, like pasta or chicken nuggets. Other children may refuse to stop eating baby food or even be unable to transition away from bottle feeding.
Many children on the autism spectrum have digestive discomfort, which can manifest as food avoidance or selectivity, temper tantrums related to food or meals, selecting only certain safe foods, or creating rituals around how the food is consumed.
Young children will not have the communication skills to express what they dislike about a food or how it makes them feel. Children with autism are at higher risk for being unable to communicate to their parents or caregivers, and this can compound food and eating issues.
How to Manage Feeding Problems in an Autistic Child
One approach to feeding issues is to work with a behavior therapist on the specific behaviors the child displays, rewarding them for trying new foods, branching out their diets, or changing rituals around eating.
There may be some underlying physical issues that need to be addressed, including digestive discomfort and food sensitivities. Physical issues must be addressed before the child can change their behaviors.
- ABA therapy: Applied behavior analysis (ABA) therapy is the most common treatment for autism. It aims to reduce negative behaviors by rewarding positive behaviors. Starting treatment with an ABA therapist as soon as possible will help your child make more permanent positive behavioral changes, including with food. When targeting food-related issues, ABA therapy works best when treatment begins around preschool or earlier. Once underlying physical problems have been addressed, the ABA therapist can focus on rewarding more adventurous eating and helping your child to develop healthier habits around food.
- Help from a specialist: A nutritional or gastrointestinal physician can identify underlying issues that may be contributing to your child’s distress or behavior. A physician can develop a prescriptive diet that will moderate your child’s gastrointestinal function, including alleviating constipation from the narrow diet your child maintained. Using this prescriptive diet, you and the physician can begin to add or remove foods that appear to be causing issues while offering a more balanced diet so your child does not suffer from nutritional deficiencies. This process can also screen for potential food allergies or other causes of discomfort. If certain foods cause discomfort, you can begin to understand this from a physiological perspective and help your child eat alternatives that will not cause digestive issues.
- Diet planning with a nutritionist: A physician may refer you to a nutritionist who can help to design an eating plan for your child. This nutrition expert will ensure your child is getting all needed nutrients and give advice on expanding your child’s palate.
A Multipart Approach to Getting Help for Your Autistic Child
Nutritional deficiencies can be detrimental to a child’s growth and development, and these problems can be magnified in a child who has autism. Talk to your child’s pediatrician and other specialists about the best ways to overcome feeding problems.
They can help you assemble a treatment team to address these issues. This team will generally involve an ABA therapist, nutritionist, and other physicians who specialize in this area.
- What Is Autism Spectrum Disorder? (March 2020). Centers for Disease Control and Prevention (CDC).
- Signs and Symptoms of Autism Spectrum Disorders. (August 2019). Centers for Disease Control and Prevention (CDC).
- Unusual Eating Behaviors May Be a New Diagnostic Indicator for Autism. (July 2019). ScienceDaily.
- Early Signs of Autism Spectrum Disorder. (December 2010). Psychiatric Times.
- PICA. (2018). National Eating Disorders Association (NEDA).
- Prevalence of Feeding Problems in Young Children With and Without Autism Spectrum Disorder: A Chart Review Study. (July 2018). Journal of Early Intervention.
- Understanding and Approaching Feeding Disorders in Children With Autism. (January 2020). Rx Nutrition: What Doctors Need to Know About Diet.
- Experts Release GI Symptom Management Guidelines for Children With Autism. (July 2015). Journal of the Academy of Nutrition and Dietetics.