Shawn wasn’t your typical four year old. Extremely thin and unable to communicate verbally, his entire diet consisted of infant oatmeal cereal with pureed fruit mixed in. For three meals a day, that was it. No meats, no vegetables, no solid food whatsoever. During his first visit to the feeding clinic, staffed by a registered dietitian, occupational therapist, and speech language pathologist, Shawn screamed and banged his head on the floor when chicken nuggets were simply brought into the same room. Beyond simple picky eating, this type of response can be common among children on the Autism Spectrum.
It’s now believed that 1 in every 68 children meets the criteria for autism spectrum disorder. Common behaviors include problems interpreting social interaction cues, repetitive patterns of behavior, and interests. Gastrointestinal difficulties are common, but the cause and preferred treatment for issues such as constipation, diarrhea and reflux disease hasn’t been fully determined. Problems with communication skills can make it difficult for caregivers to interpret food preferences when attempting to feed, prepare or serve food to their child. Basically meals are a battle.
Call it what you will- Food selectivity, sensory integration with food, or problem feeding behaviors, children with ASD are five times more likely to have feeding behavioral issues. A child may refuse to accept certain textures — rejecting those that are more complex than a smooth, purée for instance or completely rejecting anything other than crunchy foods. Smooth vanilla yogurt may be accepted, but offer them a pink yogurt with tiny pieces of strawberry and suddenly that yogurt is a complete no go.
Children with sensory disorders often will not touch foods which are wet, slimy, sticky etc., and may adamantly refuse to have those types of foods on the same plate as their preferred food. In extreme cases, there may be only five items in a child’s entire food repertoire. New textures and tastes are often rejected, despite multiple attempts at positive reinforcement, encouragement and repeated introduction of the foods.
Preferred foods often lean towards snack foods, starches such as french fries, processed foods which consistently appear the same to the child’s sensitive perception, or easily chewed, processed meats such as chicken nuggets or hot dogs. Children, especially high functioning on the spectrum, may show significant brand specificity choosing only “nuggets from McDonalds” or certain types of crackers.
Despite the fact that there is help for problem feeding behaviors, it’s still common for pediatricians to offer the advice to worried parents such as “They’ll grow out of it,” or “They’ll eat when they get hungry,” Unfortunately variety is key when it comes to getting enough vitamins and minerals on a daily basis. Children with such limited palates may need key nutrients supplemented to ensure they receive sufficient building blocks for their immune system and growth.
But what can parents do? In the next few blogs we’ll be expanding on these tips with some great places to start.
Begin by avoiding forcing or fighting at meals. Expanding a child’s diet relies on careful exposure to new foods in a non-threatening way.
Work on establishing a meal time routine by eating at the same location, using the same plates and utensils.
Increase pleasant interaction with non-preferred foods by placing a disliked food on the table, on their tray or even on their plate if they will tolerate it, but avoid prompting them to eat it.
Seek out help from a registered dietitian nutritionist, qualified occupational therapist or speech language pathologist with experience in treating feeding disorders. Don’t worry- They won’t judge you! You’ll find a sympathetic ear from a trained practitioner who knows how to help.