Autism and Food Aversions: Help for a Picky Eater and Their Family.

Eating disorders are complex and have been studied and researched at length. Autism often goes hand in hand with food aversions, picky eating, temper tantrums and behaviour associated with eating and mealtimes.  A picky eater who displays some behavioural issues associated with eating can be managed with some patience and guidance from health professionals for the child and their family. However, some other behaviours such as a failure to thrive, rumination, (Persistant regurgitation, re-chewing, & re-swallowing) obesity or pica eating (the ingestion of non-nutritional food, eg paper, dirt, chewing plaster or wood) can leave children in a significant risk of serious health and growth problems that can plague them right up to and beyond adulthood.

The four most common reasons for a child to be a picky eater:

  1. They are Filled-up on food with “empty” calories – junk food, fizzy drinks, highly sugared, processed foods
  2. Constipation – the tummy is full of faeces and there is no room left for food. Constipation is a common problem seen amongst autistic children
  3. Behavioural – toddlers are busy people and do not see the value in stopping their play just to sit down and finish a meal
  4. Lacking nutrients – a healthy appetite needs essential vitamins and minerals – zinc, B12 and Iron

If you have a picky eater with autism, know that you’re not alone. Recent scientific research identified autistic children are five times more likely to exhibit adverse behaviour around mealtimes and eating. Difficult behaviour at mealtimes may include any of the following.

  • Refusal of new foods
  • Unable to or refusing the use of cutlery – eating food with fingers only.
  • Ritualistic behaviour – exclusively specifically coloured foods, no food touching another on the plate.
  • Not wishing to sit at the table, walks around eating or goes to another room away from family, or “grazes’ all day with no recognisable mealtimes –   no social eating experiences.
  • Vomiting food they don’t like, or gagging on food
  • Holding food in their mouth in the buccal spaces – they prevents the child from tasting the food; they either spit it out or swallow it without tasting. This does not develop the child’s palate for different food.
  • Taking food from another person’s plate +

The goal with children and their ritualistic eating behaviour is to enable the child to eat from a broad palate and through a healthy range of food that is consistent with their family’s culture and tradition. Along with these goals it is mindful to achieve this without household conflict and maintaining good communication and strategies for the child and their family.

It is also comforting to remember that this behaviour is likely to be transient and normal eating habits will develop with time & maturity.

A child’s rate of growth slows between 18 months and three years of age and as a result their need for food decreases. This may explain a rather sudden loss of interest in food.

Furthermore, a limited diet with a narrow range of foods does not necessarily mean that the child is failing to thrive. If there is a balance of food groups – protein, fats and carbohydrates, and essential vitamins and minerals, the child will thrive.

Before initiating strategies to help with the problem it is best to also consider other reasons why the child is so averse to eating your family’s offered diet

Consult your doctor or specialist to consider any Gastro-intestinal (GIT) problems like reflux, constipation or food intolerances that could be fuelling the child’s food related behaviour. Gastrointestinal problems are not uncommon amongst autistic children, and as a result of their autism, they may be unable to verbalise the discomfort they are feeling and how this may be turning them off their food. They may not even recognise that this feeling in their tummy is not normal, they have always had it.

A dental exam is also necessary here to check teeth and gums for infection and other abnormalities. Due to the sensory issues that some autistic children exhibit, regular teeth brushing and oral care may be difficult. Going to the dentist may exacerbate these issues. A paediatric dentist who specialises in sensory sensitivities in children can help in this case.

Stay Calm

When developing a strategy for expanding the variety of foods that a child will eat or reducing adverse behavioural issues, it is most important to remain calm and not controlling. Don’t let mealtimes become a battleground of tantrums and less-than-ideal outcomes. Many children will need to “taste” a food for a dozen times before they can become accustomed to it and be able to eat it without fuss. Some children do not recognise feelings of hunger, or satiation. Children experiencing sensory issues will take longer. Its important also to remember that a child’s taste buds are so much more sensitive to tastes and textures than an adult. Get creative!

Take Steps Toward Tasting.

  • Look at ways of introducing new foods. Ensure the child sees other adults in the family enjoying the new food (even over dramatically!) then encourage the child to try the new food from a parent’s plate.
  • Allow your child to play with food. Paint faces with pasta sauce, allow them to cut shapes into their sandwiches, makes veggie faces on pizza bases or on the plate. Let your child see you eating and enjoying the food.
  • Involve the child in the preparation of the food. Let them touch, feel and smell the food. Let them explore this as much as possible. Suggest they take a lick of it first, give it a “kiss”. before expecting them to put the whole item into their mouth, chew it and swallow it.  Don’t react in a negative manner if it is spat out, there are gagging noises or it is vomited back up again. It may take several episodes like this before acceptance is any way near. Be patient and consistent.
  • Set a timer for an acceptable time to be seated at the table and stick to it. Have dinner ready when the child arrives at the table and gently explain the time limit. Offer some non-food reward if the child eats a good amount by the time limit. maybe a special story before bed, or a favourite TV show for 30 minutes, or a game of basketball in the back garden after dinner. Make the experience non-stressful, non-reactionary and easy to do for the child.
  • Make sure there is no expectation attached for the food to be eaten or liked. Asking a sibling, or another adult in the family to try the food at the same time can make it easier for the child to try tasting it.  
  • A social narrative to the food may also be helpful. Explain how it is grown or where it comes from. Food is providing us with fuel for energy and allows us to play, run and jump. There are some children’s’ storybooks written about eating good food – see reference list.  For older children, a proposed menu for the week ahead, displaying the next meal available and the invitation to help prepare the meal may help too.  
  • Combining the new food alternating or mixed with a favourite food is another option. Make this a pleasant and stress-free as possible to ensure it does not become a battle.
  • Hiding a portion of food in amongst other liked foods can also be successful. However, if it fails, it can reduce the foods eaten because the child becomes suspicious about the previously liked food. Be cautious using this strategy.
  • The environment for eating may also be a trigger for poor eating behaviour. Overload of sensory input may be a problem for some children. Turn off the TV, or any music, and make mealtimes conversational, relaxed and in line with the child’s sensory capabilities.

Food Textures and their effects

It is common for autistic children to show a strong preference for a specific texture of food and can show a particular sensitivity to different textures of food. How the food feels in their mouth, rather than the flavour, can produce the food aversion.

Crunchy strong tasting food like tomatoes may need to be pureed into a pasta sauce, or smooth food like mashed potatoes may need to be the same consistency each time, for acceptance and enjoyment. Modifying the texture can be the answer here.

 

Allow Choice, Control and Autonomy.

Your child will not like everything you offer. There will be some foods that they just will not like. Accept this and move on. But continue to offer a broad range of foods and textures. Also offer a choice of foods that the child can pick which they would like – for example put out five varieties of vegetables and ask the child to pick three they would like to eat. Some children need the addition of topping, like tomato sauce or mayonnaise to enjoy their food. These toppings are fine, and it is helping the child to take in the nutrition that hey need. It’s a small price to pay.

Some things don’t work! Here are some examples:  

  • Coaxing and pleading with your child will fall on deaf ears.
  • Threats, punishment and anger usually makes the situation worse.
  • Force-feeding is dangerous and may stop the child eating at all.
  • refrain from making a separate meal for your child. It is not helpful for your child’s behaviour and it’s not fair on you either.
  • Ignoring the behaviour will not make it go away
  • Rewards – it is important to recognise and reinforce your child’s behaviour and their willingness for food flexibility and adventurism to try new foods. Be warned however that blatant bribes will backfire because the child does not learn to enjoy food and well-rounded diet that is important. While desserts and snacks can be a normal part of the diet, don’t make them part of a reward system.

IN CONCLUSION:

  • Eating & feeding problems can absolutely dominate family life. It is very easy to become overwhelmed when the nature of the problem is so closely related to your child’s progress and development.
  • Mealtimes occur three times a day, and it can often be difficult for the whole family to eat all together. This can add to the stress.
  • Seek out professional help to help you to navigate your way through this. Network with other families to share successes, recipes and failures, and gathering new tips and resources, can really make a difference.
  • Patience, creativity and consistency are the keys to success here.

Reference list

BOOKS ON EATING HEALTHILY FOR CHILDREN

Eating the Alphabet

by EHLERT LOIS | 1 May 2011

Plant, Cook, Eat!

by Joe Archer | 6 March 2018

The Vegetables We Eat

by Gail Gibons | 1 January 2008

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Since I was a young child I have always been interested in the human body, illness and disease and have always wanted to help people. I became a nurse as soon as I finished school, completed my general nurses' training and became a registered nurse, and went on to become a midwife as well. I spent the next 25 years looking after sick people. While I loved doing this, I came to realise that prevention was where I wanted to be. I also discovered that Natural Medicine was the avenue that I needed to travel. Now, having completed a Bachelor of Health Science in Naturopathy, and as a Naturopath, I believe I can help you achieve a better state of health that is sustainable and attainable. I have trained under Dr Natasha Campbell-McBride MD and became a certified GAPS (Gut And Psychology/ Physiology Syndrome), Practitioner. GAPS is explained as a condition, which establishes a connection between the functions of the digestive system, the brain and the immune system. So if you or any of your family members regularly experience common digestive complaints, for instance heartburn (reflux), indigestion, bloating, cramping, constipation, diarrhea or suffer from eczema, asthma, dyslexia, depression, autism, ADD, ADHD or autoimmune disorders, such as rheumatoid arthritis, osteoarthritis, fibromyalgia and if you are ready to make a life changing decision for your health (or your child’s health) then I can assist you. My special interest areas are in reproductive health, both male and female, Pre-conception, Pregnancy, post natal, reproductive and menopausal issues, Children’s health – babies young children and adolescents, Weight issues, stress management and Chronic fatigue syndromes, to mention just a few. As a mother to four children, I understand the challenges and obstacles in the raising of children in the 21st Century. It is both exhilarating and exhausting. Added to this, the modern day illnesses caused by Stress, fatigue, poor nutrition and sub-optimal health can affect our day to day living. As your Naturopath, I can develop a treatment strategy for you that will pave the way to a cleaner, healthier state of well-being and supporting your vital force. It can be as simple as a few minor dietary changes or as complex as a multi-faceted long term treatment plan. My clinical experience acquired during my nursing years has given me as solid backbone of understanding of the process of disease and my understanding of Natural Medicine has added a whole new dimension to my level of understanding. The philosophy of Natural Medicine underpins what I believe in – to treat the underlying cause of the illness, to treat the whole client, educate the client about their illness and how to take care of themselves and their health, rebalance your system and develop strategies for the prevention of reoccurrence of disease. All of these factors are at the forefront of any treatment strategy that I develop. I look forward to meeting you and your family. I hope that I can be of assistance to you. I am centrally located in Carindale. My home-based clinic is open Monday to Friday 10am till 6pm, and on Saturdays 9am till 2pm. However, as I am homebased, I can make myself available outside those hours quite easily. This helps to accommodate school children in the mornings before school, or adults in the evening after their work-day. My times can be a flexible as you need them to be! In my clinic I have a dispensary and can prescribe you herbs and nutrients to help you achieve optimal health.