When was the last time you took a bite of food and paid attention to the skills you used? You use your lips, tongue, and cheeks to move the food to your teeth, chew it, and move it back to swallow. If this was a difficult experience that made you feel unsafe – would you take another bite?
Autism and feeding difficulties are, unfortunately, a lot more common than you’d think. “Picky eating” is often used to describe children who are particular about their food. However, children diagnosed with ASD often present with symptoms more severe than the term suggests. Because of that, we need to understand the feeding difficulties kids on the spectrum often experience and learn how to help them.
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Overcome Picky Eating
Feeding challenges in autism
A large number of children diagnosed with autism present with feeding difficulties, which can look different for every child and can vary in severity.
Many children have a limited amount of foods they will eat and resist trying anything new. They may only eat particular brands of food, require their food to be presented or prepared in a certain way, and be unable to eat in environments outside of their home.
Although the term is often used for feeding difficulties in autism, it is important to distinguish the difference between “picky eating” and symptoms that indicate a more significant feeding disorder.
Is it picky eating or a feeding disorder?
“Picky eating” usually indicates that a child eats over 30 foods and will eat foods from various food groups. If “picky eaters” stop eating a certain food, they often will eat it again after a few weeks.
Though children struggling with picky eating may protest in response to a new food, they can usually be redirected and are able to continue eating.
On the other hand, children who have a feeding disorder may have extreme selectivity and a diet that consists of less than 20 foods. In many cases, they exclude entire food groups.
If these children cut out food, it often stays eliminated. Children with a potential feeding disorder often exhibit the following behaviors:
- have significant meltdowns in response to new food,
- can be incredibly disruptive during mealtimes,
- choose not to eat at all.
Common causes of feeding difficulties in autism
If medical issues are ruled out by your child’s medical team and your child continues to demonstrate feeding difficulties, other developmental skill deficits may be impacting your child’s ability to eat.
Sensory integration and motor coordination are two main developmental skill areas for successful eating.
Often, children diagnosed with ASD have both sensory processing and motor coordination deficits that impact their ability to complete eating easily and efficiently. Understanding and addressing these areas can impact your child’s eating.
Sensory processing issues
Children diagnosed with ASD are known to have difficulty processing the sensory information around them. Sounds can be louder, sights brighter, smells stronger and tastes bolder.
As an occupational therapist who works with children with autism, I’ve noticed many children have a preference for foods that are easiest for their sensory system to tolerate.
A child with sensory processing deficits may have no problem holding a hard tan pretzel but may gag when looking at a green vegetable or when their fingers touch a wet fruit.
Negative sensory responses to food texture are physiological and often outside the child’s control. It does not feel good to have a surge in stress and overwhelm in response to food.
It is very difficult to overcome such a bodily feeling. For them, it is much easier to stick to safe and predictable foods, steer clear from those that look different, and avoid eating experiences that make them uncomfortable.
This is how food selectivity and rigidity can start. Each child is different, but their reasoning is often the same. They stick to the foods that are familiar and that they know are safe for their body and refuse the others.
Motor coordination issues
In addition to tolerating the sensory experience of eating, you also have to master the motor component of the task.
The fine movements required to lateralize food to your teeth, keep it there for chewing, and move it back once it’s ready for a swallow can be challenging for children with motor coordination deficits.
When a child has difficulty with oral motor coordination, food can get “lost” in their mouth, end up on the back of their tongue, and result in a gag.
Gagging does not only happen in response to the sensory properties of food. It is a protective response and can result when a child has oral motor deficits.
Other behaviors that can result from a child’s difficulty with the motor coordination side of eating are:
- spitting foods out,
- using their fingers in their mouth when eating,
- stuffing a lot of food in at once,
- frequently coughing/gagging/choking.
If you often gagged, felt unsafe, and were unable to control a bite of food in your mouth, would you find eating enjoyable?
Managing feeding difficulties in autistic children
Eating is often a negative experience for children with autism. Because of that, these negative experiences are the main source of behaviors that they exhibit during mealtime or when they try new foods.
On top of that, many of these children struggle with anxiety and regulating their emotions. When your body feels physiological anxiety and stress, your body shuts down your appetite.
Even if the eating situation doesn’t seem stressful to others, children with autism may perceive it differently. This often leads to intense behavioral reactions like outbursts, running away, or shutting down completely.
So, how can we support children on the spectrum and deal with their feeding difficulties? Let’s consider some strategies.
Make sure medical issues are not the cause of feeding difficulties
Before delving into the specific skills needed for eating and how to improve them, parents should first explore any possible medical issues that might be causing their child’s feeding challenges.
Some examples of this are, but are not limited to:
- allergies,
- respiratory involvement,
- tethered oral tissues,
- dysphagia or swallowing disorders,
- Reflux/GERD,
- chronic constipation,
- other upper and lower GI issues.
Discuss your concerns with your child’s pediatrician or medical team, as they can guide you in obtaining a comprehensive medical evaluation for your child based on their specific symptoms.
Establish a routine
Since eating can be such a problematic and unpredictable experience for children with autism, it is helpful to establish a mealtime routine.
When mealtimes become predictable, and the routine is structured and consistent, a lot of stress is taken away from a child at the dinner table so they can better focus on the difficult task of eating.
I always recommend that families have a schedule with set times for meals and snacks. All meals and snacks should happen at the same place, such as a family table.
This can take some time and hard work to establish. With consistency, however, it will quickly become a new norm.
Strategies such as visual schedules and timers, and positive reinforcement can help establish a mealtime routine.
Offer a variety of foods, both new and old
When serving food to your child, one method that can be used is the Satter Division of Responsibility in Feeding, which states that parents take leadership with the what, when, and where of feeding and let their child determine how much and whether to eat what they provide.
There are some exceptions to this theory for severe feeding disorders, as some children are unable to eat without external and sometimes medical assistance.
However, it is a good concept for children who tolerate eating foods but are weary to try new foods. It is vital when serving food to your child with autism that you always include at least one safe food on their plate.
In addition to these one to two safe foods, you can serve a third unfamiliar food to expose your child to something currently outside their comfort zone.
Then, and this is the most important part, you must release your urge to pressure and entice your child to eat that new food.
Don’t pressure your child
The most common mistake that I see parents of children with autism make is to let their own anxiety and stress about their child’s eating cause them to pressure their child to eat.
Children with feeding difficulties do not respond well to this pressure, and it often backfires and results in even less willingness to try something new.
Instead, I instruct parents to expose their child to a variety of new foods slowly, intentionally, and always, along with their safe foods.
Instead of attempting to pressure the child to try it, I recommend the more effective modeling approach. You can try interacting with the new food and encouraging the smallest interaction at their child’s pace.
Exploring new foods by looking at them, smelling them, or touching them briefly is always the most fun for children when part of play!
This can look like making a mustache on your face with a bell pepper, pretending you are a dinosaur smashing blueberries, or chomping your meatball like an alligator.
Another fantastic way to get positive experiences with food in a non-pressuring environment is when cooking and preparing food.
Interacting with ingredients and being a part of the meal preparation process can often give a child time to gain comfort about new foods and can result in more openness when that food reaches the table.
Food play, cooking, and joyful interactions with their parents during mealtimes encourage eating more than any amount of pressure can. A positive and fun mealtime experience is the best thing you can offer your child with feeding difficulties.
Create a calm and positive mealtime environment
Because eating is such an immersive and challenging experience for children with feeding difficulties, limiting any distractions from mealtimes that take a child’s concentration away from eating is important.
The biggest crutches that parents often incorporate into mealtime are devices such as tablets, phones, and TVs. When a child eats while distracted, they are not consciously registering and processing the sensory experiences of eating.
Other ways to encourage mealtime participation are fun social experiences with others at the meal. Tell jokes and stories, or use other positive reinforcement methods for mealtime participation.
Be patient and take small steps
If your child continues to have significant difficulty with eating despite putting these strategies in place, feeding therapists such as occupational therapists or speech-language pathologists can help.
A professional with additional certifications in feeding approaches can help your child improve the skills required for eating. They will also guide you through implementing the necessary strategies to encourage improvement at home.
Often, the process of exposing your child to new foods can be a slow one to ensure that any improvement actually sticks.
Your child may need 30 presentations of a food before becoming comfortable enough to taste it, and giving them the time and space to work through their hesitance is important.
I often guide parents in setting realistic goals for their child that consider their sensory preferences and promote the importance of celebrating the smallest of successes.
Overcoming autism and feeding difficulties one step at a time
Overcoming feeding difficulties with your child with autism can be a long, difficult journey. It is essential to prioritize your own mental health as a parent to have the capacity to maintain the patience, persistence, and positivity that your child needs at the table.
Parents often need to discover regulation tools that they can use at the table when their child’s eating is triggering or stressful. This may include:
- deep breathing strategies,
- a positive mantra to repeat, or
- intentionally finding the small successes that occur each mealtime.
The best thing that parents can do to help their child with autism and feeding difficulties is to create a positive, enjoyable eating environment for their whole family.
With understanding, support, determination, and a collaborative team surrounding your child with autism, your child’s feeding difficulties can be improved, one meal at a time.
FAQs
Q: What are feeding difficulties in autism?
A: Feeding difficulties in autism can include challenges with trying new foods, sensitivities to certain textures or tastes, and struggles with mealtime routines. These difficulties may stem from sensory issues, anxiety, or difficulty with motor skills.
Q: Why do kids with autism refuse to eat?
A: Children with autism may refuse to eat due to sensory sensitivities or aversions to certain textures, tastes, or smells associated with food. Additionally, anxiety, difficulty regulating emotions, and the perception of eating as a negative experience can also contribute to their reluctance to eat.
Q: How do you teach an autistic child to eat by themselves?
A: Teaching an autistic child to eat independently may involve breaking down the task into small steps and using visual supports or social stories to illustrate expectations and routines. Consistent practice, positive reinforcement, and patience are vital in helping them develop this skill.
Q: How do sensory sensitivities impact eating in autistic children?
A: Sensory sensitivities can greatly affect eating in autistic children, as certain textures, smells, or tastes may be overwhelming or aversive to them. These sensitivities can lead to selective eating habits, food refusal, or extreme mealtime reactions.
References
ELLYN SATTER’S DIVISION OF RESPONSIBILITY IN FEEDING https://www.ellynsatterinstitute.org/wp-content/uploads/2015/08/ELLYN-SATTER%E2%80%99S-DIVISION-OF-RESPONSIBILITY-IN-FEEDING.pdf
Bandini LG, Anderson SE, Curtin C, Cermak S, Evans EW, Scampini R, Maslin M, Must A. Food selectivity in children with autism spectrum disorders and typically developing children. J Pediatr. 2010 Aug;157(2):259-64. doi: 10.1016/j.jpeds.2010.02.013. Epub 2010 Apr 1. PMID: 20362301; PMCID: PMC2936505.
Feeding Problems Including Avoidant Restrictive Food Intake Disorder in Young Children With Autism Spectrum Disorder in a Multiethnic Population https://www.frontiersin.org/articles/10.3389/fped.2021.780680/full
McElhanon, B. O., McCracken, C., Karpen, S., & Sharp, W. G. (2014). Gastrointestinal symptoms in autism spectrum disorder: A meta-analysis. Pediatrics, 133(5), 872–883. https://doi.org/10.1542/peds.2013-3995
Picky Eaters vs problem feeders questionnaire. SOS Approach to Feeding. (2024, February 12). https://sosapproachtofeeding.com/picky-eater-questionnaire-parent/
Satter, E. (2024). Raise a healthy child who is a joy to feed. Ellyn Satter Institute. https://www.ellynsatterinstitute.org/how-to-feed/the-division-of-responsibility-in-feeding/
Schreck KA, Williams K, Smith AF. A comparison of eating behaviors between children with and without autism. J Autism Dev Disord. 2004 Aug;34(4):433-8. doi: 10.1023/b:jadd.0000037419.78531.86. PMID: 15449518.
Zhu, V. and Dalby-Payne, J. (2019), Feeding difficulties in children with autism spectrum disorder: Aetiology, health impacts and psychotherapeutic interventions. J Paediatr Child Health, 55: 1304-1308. https://doi.org/10.1111/jpc.14638
