Children and teens with autism spectrum disorder (ASD) have the same nutritional needs as all children and teens. Children with ASD may be picky eaters, so parents might worry they are not getting the nutrients they need. For example, if children do not get enough dairy (milk or cheese) because they do not want it or because of a special diet, they may not get enough calcium and vitamin D. If children do not eat enough foods made from grains, they may not get enough fiber and B vitamins. Some children with ASD are such picky eaters that they are at risk for nutritional disorders. They may also be at risk for low iron.
Eating problems are common in children. In children with ASD, the problems may be more serious and last longer because of problems with taste, texture, or smell. They may be the result of learned behaviors. Up to 3 of 4 children with ASD may have problems with eating behaviors, food choice, and/or delayed feeding skills. These problems include
Smaller range of food texture, color, taste, or temperature
Not wanting to try new foods
Demanding to eat in one way, or eat one thing, and not being flexible
Eating or mouthing things that are not food (pica)
Packing their mouth with food
Throwing up, gagging, and chewing or rechewing food for a long time
Slowed feeding skills as part of overall developmental delays or delays in caring for themselves
Not eating enough of fiber-rich foods, like vegetables and fruits
Acid reflux may lead to the child not wanting to eat. Distractions around a child may cause troubles with eating. For example, the school cafeteria is loud, bright, distracting, and disorganized, with multiple smells, which can be overwhelming to the child. Medication side effects, such as higher or reduced appetite, may also cause issues. Children with ASD may have a hard time knowing when they are full, when they are hungry, and how long they have been sitting at the table. The child might think he is “all done” after a bite or two of food or continue eating long after he is full. If your child has felt sick after eating a certain food, he may not want to eat that food again. This may happen even if the food was not what made your child sick. Your child might also eat only a few foods or not want to eat what has been a favorite food in the past. This may be related to anxiety, obsessions, not being flexible, or sensory problems.
If your child has difficulties with eating, think about all medical, sensory, environmental, and other behavioral causes so you can work on these problems with your child’s pediatrician and therapists. Different members of the team may have creative solutions.
A great way to work on eating and nutrition issues is to set up a regular structure for mealtimes. Offer your child meals and snacks at about the same times each day. Keep mealtime calm and remove distractions. Sit down with your child and eat the same foods. Your child should feed herself if she can. Do not ask your child to come to the dinner table until you are done preparing the food and are ready to sit down and eat.
At each meal, be sure to serve at least one food that your child has eaten and liked in the past.
Remember that a food often has to be offered multiple times before a child will eat it. Offer the new food on many days in a row with food your child likes to eat. This way, your child has something she is likely to eat. As much as you can, try to feed your children as many of the same foods as the rest of the family. Ask your child to eat, but do not beg or threaten. Once your child leaves the table, the meal is finished. To encourage eating at scheduled meals and snacks, do not give your child food or drink other than water until the next meal or snack. Use a visual schedule so that your child knows the time and place of each meal. She will learn to eat what the rest of the family eats and follow everyone else’s mealtime behaviors. So, the rest of the family will need to show good mealtime behaviors, eat fruits and vegetables, and avoid snacking. Your child will learn the eating habits of other family members.
You can help your child learn about mealtime routines by telling and retelling a social story, which is a story in pictures or words about what you hope mealtimes will look like. Telling social stories about what should happen at mealtimes can help your child know what to expect at home, at school, and in the community. To deal with special feeding problems such as mouth packing, rechewing of food, and very limited diets, you will likely need help from experts. Talking with a registered dietitian may help too.
Talk to your child’s therapists about how they can help him learn feeding skills and improve variety in his diet.
Your child’s pediatrician will review your child’s diet at health checkups. Let her know if your child has a very limited diet or if you have placed your child on a special diet. The doctor will ask you some questions and do a physical examination to see if medical problems are causing eating problems. Tell your doctor if you notice burping, gagging, difficulty sleeping at night, or any other concerning symptoms. Also, tell your child’s doctor if you are giving any vitamins, supplements, or over-the-counter medications.
Keep in mind that what you think children need to eat may actually be too much. Your child’s pediatrician will be able to tell you the portion sizes that are best for your child’s age and weight. Also, remember that a balanced diet takes into account what she eats over the whole week, not in one meal. Eating problems do not go away overnight. You will need to keep teaching your child the rules for eating. Ask your child’s pediatrician about the “Behavior Challenges” handout for more information.