Picky Eating Related to Autism

What Causes Picky Eating Behavior?

Children diagnosed with autism can become “picky eaters” for several reasons. Being a picky eater does not always imply stubbornness or bad temper. Some of the most common causes of picky eating include the following:

• Sensory Processing Issues with Food

  – This is one of the most common causes of picky eating. For example, a child diagnosed with autism may prefer the soft texture of yogurt or enjoy hearing the “crunch” sound of crackers and carrots. Inversely, a child may have an adverse reaction to soft foods or feel uncomfortable with the “scratchy” texture of harder foods. If a child consistently prefers or avoid a category of food, this can severely limit the range of meals that the child is willing to consume.

• Underdeveloped Oral-Motor Musculature

  – Some children with developmental disorders may simply lack the muscle strength needed to chew foods like pickles or steak. When this happens, mealtime becomes a fatiguing workout rather than a fun experience. Even worse, avoiding certain foods also means forfeiting the opportunity to strengthen oral-motor muscles and can worsen the problem in the long run.

• Discomfort with Remaining at the Table

  – Some children may have a “favorite spot” they prefer to eat instead of setting for an entire meal at the table. Others may find it hard to balance the act of eating versus engaging with siblings or companions at the table. Telltale signs of a child frustrated with sitting at the table include throwing food or utensils as well as constantly getting up to move a plate or bowl to a different location (such as the couch or floor).

How Can I Help a Picky Eater?

1. Rule Out Medical Problems

Some children come across as “picky eaters” due to an inability to express physical discomfort. For example, children who clamp their lips shut, shake their heads, or clasp their midsections may be trying to indicate gastrointestinal distress. The first step would be to visit a pediatric gastroenterologist who can test for GI disorders or other organic causes. While a child with autism may not be able to verbalize the problem now, a medical evaluation to help pinpoint the source of the issue. Common GI track problems among children may include the following:

• Acid Reflux. Also known as gastroesophageal reflux (GER), acid reflux occurs when the lower esophageal sphincter relaxes more than necessary, causing the contents of the stomach to flow back into the esophagus. Children with autism may attempt to express this discomfort by crying or jumping around.
• Constipation among children with autism can result from a limited diet (for example, decreased fiber or fluid intake due to weaker oral-motor skills) or delayed toileting (common for children with autism). These children may hold their stomachs to indicate that they still feel full or “stomped up.”
• This condition can cause discomfort in the intestines, as the stool has not had enough time to firm. As a result, a child may not feel up to eating anything else.
• Eosinophilic esophagitis (EoE). Eosinophilic esophagitis is an allergic swallowing disorder characterized by inflammation of the muscular tube that runs between throat and the stomach. When this area is inflamed, a child can feel as if he or she is choking. This can result in children avoiding meals until they have undergone adequate treatment.

2. Start Small

Once you have ruled out any medical issues, it is time to stay calm and start small. This can literally mean one or two small bites of a new type of food.  Retrieve a list of recommended healthy foods from your therapist or practitioner, and then start with one or two bites per meal. You can also permit the child to say, “No, thank you” after trying at least one bite. This allows the child to feel agency while helping them grow accustomed to new foods.

3. Be Consistent

Experts recommend trying a new food seven to 12 times before making it routine or eliminating it from a child’s foot list. For example, you might one or two small bites of a new food a lunchtime for a least a week (7 days).

4. Experiment with Textures

Sometimes the issue is texture (how the food feels in hand or mouth) rather than taste. For instance, a child may not want to eat tomatoes on a sandwich due to an aversion to the “slimy” texture or seeds. Chop the tomato into very small pieces and toss into a salad, dice the tomato into a child-friendly serving of pico de gallo, or cook them into a sauce to serve over dinnertime pasta.

5. Prepare Meals Together

For many children, nothing beats the pride of preparing meals themselves. Try to get on your child’s level (meaning set up a table and chairs at the child’s height) to make kid-friendly meals. Ideas include using vegetables to make faces on pasta (or fruit to make faces on pancakes) and using child-safe cookie cutters to make their own sandwiches. In this way, eating becomes the “reward” for a job well-done.

6. Create Choices

Another tip is to introduce two foods at a time to give your child a choice. For example, if you want your child to have at least one vegetable and one protein at dinner, present three options of each and allow you child to choose one. This process can also introduce your child to the formal dinner table (which typically has a range of dishes on display).

7. Plan Reactions to Tantrums

While the goal is to eventually eliminate tantrums, you can prepare for your child’s current stage through “planned ignoring” these episodes. This means that you can ignore small disruptions as long as it is safe. Shift gears by offering the child a different option that provides similar health benefits (for example, tiny orange slices instead of grapefruit).

8. Keep a Food Journal

Make sure parents, babysitters, and other caregivers write down the time, meal type, and food consumed on a daily basis. This helps everyone stay on track and can highlight potential problems (such as limited diet). It also creates an excellent record for future health checkups. If your child has constipation or other gastrointestinal problems, you should keep a toileting journal as well.

9. Provide Praise

Never discount the benefits of praise. General praise (“Yay!” “Way to go!” or “High five!”) should occur after every meal. Labeled praise (“Thank you for trying the [new food]”) provides positive reinforcement for your child’s effort. In addition, praise is also a great way to balance your child’s frustrations with corrections or reprimands. As a general rule, be sure to incorporate at least five praises for every correction or reprimand (5 to 1 ratio) to help your child associate the table with positive experiences.