Many children are picky eaters, developing strong preferences for some foods and strong rejections of other foods. However, children with autism are even more likely than their neurotypical peers to develop feeding problems, including food refusal.
Understanding food refusal can help you manage this condition, introduce new foods to your child’s diet, and ensure they get balanced nutrition.
The best methods to deal with food refusal in autistic children involve working with doctors to eliminate medical causes, a nutritionist to develop a meal plan, and behavior therapists to promote positive behaviors around eating.
An Autism Diagnosis
Children begin to show signs of autism around 2 years old, on average. These signs include changes in socializing, communication skills, and learning. Young children may stop making eye contact, lose interest in speaking or interacting with others, and develop trouble with motor skills.
Your child’s pediatrician can help you understand the different stages of childhood development. If symptoms of autism appear, they can diagnose the condition so you can get treatment for your child as soon as possible. Oftentimes, a pediatrician will refer you to a specialist, like a developmental pediatrician or a pediatric neurologist, for an official diagnosis.
There is no cure for autism, but symptoms are treatable. Working with a behavior therapist as early as possible can help your child manage behavioral struggles so they can be healthy and happy as they grow up.
What Is Food Refusal?
Food refusal is a specific feeding problem that is common among children with autism.
Children on the autism spectrum show more food refusal than their neurotypical peers. One study found that children with autism refused about 47% of food offered, while the control group refused almost 19% of food offered.
A 2019 study from Penn State found that 70% of children with autism reported some form of atypical eating behavior. This makes feeding problems, including food refusal, 15 times more common in children with autism compared to neurotypical children.
Children begin transitioning away from breastfeeding, bottle feeding, and specific, soft baby foods early in childhood. If there are issues related to this transition, it could be an early sign of autism. Food-related indicators of potential autism include:
- Resistance to weaning off bottles, the breast, and baby foods.
- Extreme food preferences.
- Struggles with textures and temperatures of certain foods.
With feeding problems appearing sooner than some other early signs of autism, medical researchers suggest adding food and eating issues to the list of diagnostic criteria.
What Are the Potential Underlying Causes in Children With Autism?
There may be several underlying causes for refusing certain foods. Causes are often linked to motor control problems, behavioral changes, and digestive issues.
Here are some of the most common causes of food refusal in children with autism:
- Repetitive or ritualistic behaviors: Children with autism develop obsessions, rituals, and repetitive behaviors around play and learning. They may also develop these behaviors around eating, mealtimes, and specific foods. This may manifest as eating only a few types of food and refusing to try new foods.
- Texture and temperature preferences: There is some evidence that people with autism experience sensory input differently, especially around taste and smell. For example, children with autism may not have a strong sense of smell, so they may not taste extreme flavors like sour, sweet, and bitter as distinctly as neurotypical children. This can mean that they are more sensitive to texture and temperature differences, and they may develop food aversions to certain combinations.
- Need for consistency: People on the autism spectrum struggle with changes, and this might include changes in what and when they eat. In extreme instances, the child may struggle to move away from canned baby food or even bottle feeding to eating solid foods. In less extreme cases, children may learn to eat one or two types of food,= and not understand that there are variations in these foods. For example, they may always prefer one type of cereal, even though there are other types of cereal that are similar.
- Motor control: Some research shows that people with autism have difficulty with motor control and coordination, which often manifests as trouble with posture, balance, and muscle strength. Chewing and swallowing are also complex activities for motor control. Problems coordinating these muscle movements might lead to preferences for specific types of food and rejection of other types, especially foods that are harder to chew.
- Gastrointestinal disorders: People with autism have a higher rate of gastrointestinal problems, including bloating, constipation, and diarrhea. This may be associated with certain foods. Some medical research suggests that people with autism have higher levels of gluten intolerance and, potentially, higher levels of dairy intolerance. Other foods with a lot of fiber, like raw fruits and vegetables, can be difficult to digest. These problems could lead to specific food refusals, with the child preferring food they know they can eat without discomfort.
It is important for children with autism to maintain a balanced diet because malnutrition can increase developmental challenges in the brain and body. Weak muscles and bones can increase poor posture and balance, and slowed brain development will increase the risk of cognitive difficulties.
Managing food refusal and other feeding problems requires a multifaceted approach from parents and the child’s treatment team.
Get Medical Help to Support Your Child as They Overcome Food Refusal
To help your child overcome food refusal and maintain a balanced diet, there are several steps to take.
- Talk to your child’s pediatrician or other specialist about referrals for a nutritional therapist and a behavior therapist.
- Work with a behavior therapist, like an applied behavior analysis (ABA) therapist, to reduce maladaptive behaviors like repetitive behaviors and communication issues. When your child can communicate better, they are better able to express issues with food so you can find solutions. Speech therapy will also help with this.
- Get other exams for your child, like a dental exam. Underlying pain and discomfort may cause some food refusal and behavioral trouble, especially if your child cannot communicate this pain to you very well.
- Get a medical assessment of oral motor function. Your child may be unable to easily chew and swallow certain foods, and this might be the driver behind their food refusal. This assessment can help you determine how to prepare foods so your child can eat and enjoy them, while ensuring they have a balanced diet.
- Have an occupational therapist or speech-language pathologist take an eating history. This may include questions about whether your child chokes or gags while eating, and if they have recurring respiratory issues that may indicate they are not swallowing correctly.
- Work with a nutritional therapist to determine if any foods should be eliminated from your child’s diet because they upset their gastrointestinal system. The therapist can help you find suitable, healthy replacement foods. Since autistic children often suffer from nutritional deficiencies, this step is important.
- Get an assessment from a psychologist or your pediatrician in regard to pica, a condition in which non-food items like rocks or dirt are consumed. This may be another cause of feeding problems in autistic children.
- Work with a behavior therapist on a treatment plan to manage various behaviors, including food refusal. A long-term, objective behavioral plan can improve your child’s ability to socialize and communicate. This can improve mealtimes, food refusal, and other eating issues.
While you may end up working with several medical professionals, start with your child’s pediatrician to get referrals to specialists. If you are already working with an ABA therapist, you can also ask them for help finding specialists, such as a nutritional therapist, to support your child’s eating habits.
Don’t expect immediate results. Your child’s therapist will set a goal and then break that goal down into very small steps. The progress generally takes time, but it’s worth the effort as you see your child’s diet expand and behaviors around eating improve.
- What Is Autism? Autism Speaks.
- Unusual Eating Behaviors May Be a New Diagnostic Indicator for Autism. (June 2019). Penn State.
- Mealtime and Children on the Autism Spectrum: Beyond Picky, Fussy, and Fads. Indiana Resource Center for Autism, Indiana University Bloomington.
- Food Selectivity in Children With Autism Spectrum Disorders and Typically Developing Children. (March 2010). The Journal of Pediatrics.
- Problem Eating Behaviors in Autism Spectrum Disorder Are Associated With Suboptimal Daily Nutrient Intake and Taste/Smell Sensitivity. (June 2014). Infant, Child, & Adolescent Nutrition.
- Motor Coordination Issues in Autism Are Caused by Abnormal Neural Connections. (November 2014). University of Chicago Medical Center.
- Gastrointestinal Symptoms and Autism Spectrum Disorder: Links and Risks — A Possible New Overlap Syndrome. (September 2015). Pediatric Health, Medicine and Therapeutics.
- Speech Therapy. Autism Speaks.
- Nutrition and Autism. Autism Speaks.
- The Pica-Autism Connection: Help & Perspective. (September 2018). Autism Speaks.