Starting school or daycare is a big step for children; there are new routines to learn, new people, to get to know and a new building to navigate. for children with autism spectrum disorder (ASD) who attend mainstream settings, these challenges are magnified. One of the aspects of school life that can cause a lot of worries is food.
As all parents will know, picky eating is a very common childhood problem. For most young children, it is just a stage they move through. However, for children with autism, it can be a challenge that persists beyond the early years.
A very high percentage of children on the spectrum only accept a limited range of foods. While it is hard to put an exact figure on it, research suggests that up to nine out of ten children with a diagnosis of ASD will have an eating problem.
Food features in the school day in many ways. If your child stays for lunch, he/she may be having one of his/her main meals at school five days out of seven. Perhaps cooking or food preparation is on the curriculum, or maybe the children have a mid-morning snack together. If your child is not a confident eater, this can be very hard.
Let’s have a look at why eating can be so difficult for children on the autistic spectrum. Of course, every child is an individual and no two people with autism have the same needs and strengths. However, there are some characteristics of ASD which can make eating really challenging.
Sensory processing issues
Problems with the processing of sensitive data are one of the hallmarks of ASD. Researchers have linked oral defensiveness (where a child is extremely sensitive to the way food feels in the mouth) too picky eating. The communal eating environment poses other sensory processing challenges too. It can be very noisy; it can be visually busy; there may be strong smells to contend with – all before we even get to the food itself.
Meal and snack times in school or daycare are highly social. This is great because they provide an opportunity for the development of social skills if properly managed. For a child with autism, however, the interpersonal aspects of mealtimes can feel overwhelming.
Many children with autism cling to their routines with force – this can be especially true in relation to food. Staff is not always willing or able to cater to this behavioral rigidity in the same way that a parent might. Some children will also be extremely sensitive to very tiny changes and almost imperceptible differences in the way food is presented can be very challenging indeed.
Ten ways you can ensure your child’s needs are met:
1. Explore whether the eating environment can be optimized for your child
If the eating set-up is hard for your child, work with his/her teacher to think about precisely why this is. Maybe your child is especially sensitive to smells or noise? Maybe it is the social aspects of mealtimes which are difficult?
With the teacher, think about what can be changed. Can your child sit far away from the kitchen where cooking smells are not so pronounced? Can he/she sit quietly at a small table with just a couple of children, or maybe with a member of staff? Some children may even need a separate space to eat in, to minimize the risk of sensory overwhelm.
2. Make sure your child is never pressured to eat
There are many conventional approaches to feeding kids which—for a food-anxious child especially—can be experienced as pressure. For example, suggesting that he/she tries ‘just one more mouthful’ or a ‘no-thank-you bite.’ Be very clear with your child’s teacher in explaining that you want his/her eating decisions to be respected.
Even though it might feel supportive to persuade a child to try broccoli, doing so could make fear of broccoli worse. This is all about prioritizing long-term gain over short-term wins. Sure, a child might swallow a little broccoli, but this may make him/her feel more anxious at mealtimes and could damage the relationship with food.
3. Avoid discussing your child’s eating in his/her presence
‘What did my child eat today’? might be top of your list of questions about your child’s day. Daycare staff or teachers may also be keen to let you know how meal and snack times have gone. If your child is within earshot and can understand your conversation, try to avoid having these discussions about his/her eating. Ask for a written note or schedule a brief telephone call, instead.
When children are aware that what they eat is a major priority for you, this can add to the anxiety and pressure they feel at mealtimes. It may contribute to a need to exert more control over their eating by sticking rigidly to safe foods. Instead, what we want to create is a relaxed and positive atmosphere around food. Lots of talk about who has eaten what, makes this hard to achieve.
4. Make sure safe foods are always available
If your child only eats a limited range of foods, it is essential that a couple of his/her safe foods are always included on the menu at every meal and snack. If this isn’t possible, it may be preferable to send him/her with food from home. When children learn to trust that there will always be something available for them to eat, they feel less anxiety before and during meals.
Some children with autism may find it hard to notice and interpret their bodies’ cues. This can be the case in relation to hunger and fullness. It is hard for children to learn to recognize this rhythm (of appropriate hunger and fullness) throughout the day if they are skipping meals because none of their safe foods were provided. Talk to your child’s teacher about how this can be supported.
5. Plan for school meals
If your child is changing rooms or just starting at school or daycare, a bit of preparation will go a long way. Arrange a visit to the eating area before your child starts so that he/she knows what to expect. Maybe you could (with permission) take some photographs of the dining area to chat about at home.
You can also help your child prepare for communal meals by using social stories. Your child’s teacher may well be able to provide support with this. The more you can do to help your child understand how to navigate mealtimes, the easier they will be for him/her.
6. Keep exposures to food positive
Children who are anxious about new or disliked foods will benefit enormously from positive, fun exposures to those foods in a supportive environment. It is very important though, to make sure that those exposures don’t end up adding to any negative associations with food. Most importantly of all, no child should ever be pressured to eat or even touch foods they are not confident with.
Chat with your child’s teacher so that you can share your feelings about what he/she can tolerate. Maybe your child would love to help bake but couldn’t handle touching the mixture. Maybe he/she could help make a fruit salad but might want to wear gloves if the sensation of wet, sticky juice on his/her fingers is too tricky. You know your child best; a teacher will value your input when it comes to gauging which activities will help him/her, and which may be too much.
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7. Good communication with staff
At the heart of working successfully with school and daycare is excellent communication. Work on fostering a great relationship with the adults working with your child so that together, you can be a team.
Good communication is a two-way street; it might be that the staff has some useful resources and ideas that they can share with you. It might be that strategies working at home, need to be replicated in the classroom. Being as consistent as possible is key. If your child gets conflicting messages about food when he/she is at home and when he/she is at school, this can be very confusing.
8. Dedicated meetings
Consider setting up a meeting specifically to talk about your child’s relationship with food. Be very clear about what you wish to get from the meeting and make sure you plan a follow-up so that anything that has been agreed can be monitored and reviewed.
Some parents find it helpful to summarize what they wish to talk about in an email. Not only will this help you order your thoughts, but it will also give staff some time to reflect and prepare for the meeting.
9. Share useful resources like this article
Good teachers and daycare staff will be very open to developing as professionals. Share good quality resources with them so that you can help them meet your child’s needs. They are not necessarily ASD or feeding specialists and will hopefully be keen to learn more.
In my book for early years professionals, I explore what the research evidence tells us about how professionals working in school or daycare settings can support young children’s relationship with food. There is a chapter dedicated to working with children with ASD and a chapter about sensory processing too.
10. Correcting misunderstandings
As a picky eating specialist, I am often told by parents of children with autism that their child’s teacher has interpreted his/her limited eating as bad behavior or even attributed it to poor parenting. This attitude is not accurate and needs to be respectfully challenged.
Children with autism have very specific needs in relation to food, and their eating has to be understood through the lens of their ASD diagnosis. We can do so much by sharing evidence-based good practice with adults working with children. Bandini, L. G., Curtin, C., Phillips, S., Anderson, S. E., Maslin, M., & Must, A. (2017). Changes in Food Selectivity in Children with Autism Spectrum Disorder., Changes in food selectivity in children with an autism spectrum disorder. Journal of Autism and Developmental Disorders, Journal of Autism and Developmental Disorders, 47, 47(2, 2), 439, 439–446. https://doi.org/10.1007/s10803-016-2963-6, 10.1007/s10803-016-2963-6  Cermak, S. A., Curtin, C., & Bandini, L. G. (2010). Food selectivity and sensory sensitivity in children with autism spectrum disorders. Journal of the American Dietetic Association, 110(2), 238–246. https://doi.org/10.1016/j.jada.2009.10.032  Cermak et al., (2010). ibid.
This article was featured in Issue 75 – Helping Your Child with Autism Thrive