HealthMatters
When it comes to kids who have autism, nutrition is one of the biggest concerns both parents and healthcare providers have. That’s because it’s common for children with autism to have feeding challenges or difficulties.
In fact, findings suggest that up to 75% of children diagnosed with autism will have some type of feeding difficulty. In some cases, feeding challenges can lead to nutritional deficiency, meaning the body is not getting enough of the nutrients it needs to stay healthy.
As a gastroenterologist, I often see children with autism who have symptoms related to feeding difficulties. These are some of the questions parents ask me most often and strategies you can try at home.
1. Why do kids with autism commonly have feeding challenges?
One of the most common reasons is related to sensory processing or behavioral concerns. This can include:
- Wanting only certain textures of foods
- Heightened oral and visual sensory processing — this can increase how intense flavors taste; it can also affect your child’s ability to tell apart minor changes in flavors or any change in the way a food looks
- A preference for repetitiveness or rituals — such as all meals needing to be the same, wanting foods to be in the same package, or concerns about adding new foods to the diet
Other reasons a feeding challenge might develop can be due to:
- Problems with a child’s oral functioning skills — such as the ability to chew food well or having an effective or safe swallow (this can occur when kids do not use these skills)
- Oral or dental problems — such as dental disease, cavities or a tooth abscess that creates a dislike of food
- Gastrointestinal (GI) symptoms — these can be related to feeding or nutrition problems, such as celiac disease, esophageal disease or inflammation in the intestines
2. What are the nutritional dangers related to kids having feeding issues?
Here are common nutritional deficiencies we see in children with autism, and how they can affect your child:
Iron – important for growth, energy level, brain development and cognition
Iron deficiency can cause anemia, fatigue, low energy and faltering on growth curves. It can also affect cognitive function in school and daily functioning, as well as pica (interest in eating non-food items).
Calcium – important for bone health and development
Calcium deficiency can lead to weak bones, bone fractures, and in extreme cases, rickets. During childhood, the teen years, and early adulthood, the body builds its calcium stores. With a calcium deficiency, we become concerned about the long-term effect and the possibility of bone problems later in life due to poor calcium stores.
Protein – critical building block for growth and overall health
Protein deficiency can lead to many and severe problems, including stunted growth, a weakened immune system, muscle loss, decreased bone development and malnutrition.
Vitamin C – important to the development, growth, and healing of the skin, bones and connective tissue
Vitamin C deficiency can lead to scurvy, which involves bleeding of gums, bruising of skin, bone pain and, rarely, pulmonary hypertension.
Vitamin A – important to vision health and the body’s immune system
Vitamin A deficiency can cause decreased immunity and vision problems, including permanent vision loss if it’s not managed.
Depending on their diet, children can also become deficient in other or multiple nutrients important to their growth and development. That’s why it’s so important to address feeding difficulties as early as possible.
3. What can families do at home to help a child who has feeding difficulties?
For children with severe, restrictive eating patterns, talk to your doctor about approaches that would be best for your child and family. For children with mild to moderate feeding challenges, the following strategies might help:
- Talk to your medical team about starting a daily multivitamin if your child is not taking in a good variety of foods.
- Offer a variety of foods from different food groups with each meal.
- Note that it can take up to 20 times or more for a child to accept new foods. You may need to start with “early exploration” of the foods where you have your child touch, smell, kiss or lick the food before even taking a bite.
- Offer a mix of both preferred and non-preferred foods at meals. You can offer a small amount of a new food with the preferred foods to increase exposure.
- Offer choices when you can, to let your child have some control over the situation. This might be a choice of two new foods, an option of how much, or even how the food is cut.
- Aim for family-centered meals where everyone eats the same foods. Consider offering 1-2 of the foods family style so your child can see the foods throughout the meal and place the foods on their plate.
- Limit snacking/grazing. Structured mealtimes help increase hunger so when foods are offered, your child may be more willing to try them.
- Limit sweetened beverages that contain “empty calories.” These can create a full feeling and limit the calories your child gets from healthy foods.
These approaches may not work for every family or child. If you’ve tried these and your child is still struggling, talk with your doctor about getting extra help with other services. These might include the following:
- Speech-Language Therapy – can help when there are concerns with oral motor skills
- Occupational Therapy – can help with sensory issues or the actual process of getting food to the mouth
- Psychology – can address behaviors around eating, such as fixations, fear of new foods, and anxiety
- Gastroenterology – can work to improve variety or volume of food and address symptoms such as constipation, diarrhea and vomiting that may be contributing to a limited intake
- Nutrition Therapy (dietitians) – can provide ideas to enrich the nutritional quality of foods that are being accepted, offer nutritional supplements, and discuss other approaches to nutritional supplementation
Some children might need all the above support, while some may need just one or two.
4. Are there any diets you recommend for treatment or management of symptoms and autism, such as gluten-free, dairy-free, or casein-free?
In general, I do not recommend starting one of these diets until after having a detailed conversation with your doctor and discussing all of the symptoms your child is experiencing. There are no data to support the use of such diets for limited intake, without an underlying diagnosis.
If you are interested in trying one of these types of diets, talk with your pediatrician first. They can help make sure it’s done in a safe way, taking into consideration any supplements that may be needed while your child is on a particular type of diet.
5. When should I call the doctor about my child’s eating habits?
Talk to your pediatrician if you notice any of the following symptoms in your child.
- Not gaining weight/weight loss
- Rashes, bleeding or bruising (outside of normal scrapes/bumps), including bleeding and swollen gums
- Leg/joint pain or refusing to walk
- Vision problems, problems with coordination or prior tasks easily completed
- Pica
- Blood in stool
- Choking with meals or vomiting frequently
Your doctor can help evaluate how serious the problem is and help you determine next steps. They may order additional testing or refer you to a specialist.
We recognize that managing feeding difficulties can be challenging for the entire family. The goal of our Nutrition Therapy and Advanced Nutrition teams is to make sure your child’s growth and nutritional well-being are sustained. We aim to help our patient families find strategies that work well and build on those for long-term success for your child.
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