Navigating Feeding Behavior in Autism
Children with autism spectrum disorder (ASD) often have feeding issues. The stress of feeding can be overwhelming for both the child and the family. It can take a long time to help your child overcome their feeding problems, but the rewards of improved health and more flexibility with food are well worth it. Children with ASD can face significant challenges when it comes to feeding. For example, language delays can make it difficult for a child to express pain or discomfort that could interfere with their ability to feed.
What is feeding disorder and why does it affect children with ASD?
Feeding is a complex human behaviour, whether you believe it or not. The feeding behaviour of a person is determined by their developmental stage. Oral-motor skills are affected by medical, maturational and body mechanics problems. Sensory issues (food taste, smell and feel) as well as our experiences with food can also affect feeding. Feeding is smooth when all these factors are in place. Feeding behaviour can be affected if there is a problem in any of these areas. Every sensory system is involved in feeding (touch, vision, taste, smell, and sound). Sensory processing difficulties can be a problem for many children with ASD. This can make certain foods difficult to eat. Autism can cause children to have behavioural issues at mealtimes. Children may learn, for example, that they are allowed to leave the table if they refuse a dish they don’t like. Researchers found that 69% of children with ASD refused to try new food and 46% had eating rituals. For children to be healthy and grow properly, they need the right amount of calories and nutrients. Following these recommendations may help you address a child’s feeding issue if they have ASD. If your child’s eating problems are causing significant consequences, it is time to seek professional assistance.
Should I be worried?
- Your child may be losing weight or displaying signs of poor health
- If your child eats fewer foods or has a limited diet
- Stress can be caused by eating habits
Medical Conditions
What medical conditions can affect your ability to feed?
- Are your child’s stomachaches and pains causing a reaction? Your child may refuse to eat to avoid stomach issues. Constipation can also cause your child to have stomach cramps and refuse food. Acid reflux, stomach upset or medicines that your child takes every day can cause stomach pain. This may make them not want to eat.
- Is your child suffering from a food intolerance? A food allergy could be present if you notice that a child’s food causes GI discomfort, a rash, or other symptoms. Your primary care provider may decide to refer you and your child to a specialist for further evaluation, such as a gastroenterologist or allergist.
- It is less likely that children with ASD will have feeding issues due to tooth or swallowing problems, but it should still be considered.
Behavioural/Developmental Conditions
Are there behavioural/developmental conditions that might affect feeding?
- Are you noticing that your child is reacting to sensory elements in his or her food? Keep a record of what your child eats and how much. Also, note what they refuse to eat and their behaviour at mealtimes. This can help you and your PCP determine if your child has any food sensitivities.
- Feeding difficulties can be exacerbated by behavioural problems. Has your child’s negative eating behaviour been reinforced accidentally? Your child may have learned that he or she can get out of a difficult situation by being angry or upset. If your child can leave the table to play and then refuse food, it may make him or her more likely to do so again.
- Does your child have difficulty understanding or using language? Your child may not understand what you expect of him at mealtime if he has difficulty paying attention, obeying rules, or complying with your requests.
What should I do?
1. Consult your child’s PCP. Your PCP will be able to help you determine the best course of action. Your PCP will often be able to manage these issues. You may also need to bring in other professionals to your team to rule out any medical problems. Other professionals may be needed to address feeding issues.
2. Who else could be part of this team, besides your family and PCP? You may need to consult with medical specialists, such as allergists, GI doctors or psychologists. Also, you might want to ask occupational therapists and speech therapists. Registered dieticians are also trained in feeding issues.
Ask if the professionals are familiar with autism and feeding problems. You can ask about their experiences before you make an appointment.
What Can We Do to Help Feed Our Children at Home?
Avoid All Day Food. Avoid allowing your child to snack or have food and drinks available all day. This will decrease appetite, the willingness to try out new foods and the total number of calories consumed for the day. Limit your child’s eating to five or six meals/snacks per day. The rest of the family should also refrain from snacking all day. Your child will also snack all day if your family does.
Here are some helpful tips to make eating a bit easier. Families will have to be creative when using these tips because each child is unique. These strategies are proven to be effective in most feeding problems. These actions, along with the support and guidance of your child’s pediatrician and your team may help to slowly improve feeding issues.
Establish a Routine and Schedule for Feeding. Your child should eat in the same location and follow the same routine and schedule. By keeping the same routine, time and place for meals, your child will know what to expect and what to do.
Include Your Child. Even if your child doesn’t eat the finished product, let them help you select and create meals. By involving your child, you allow him or her to play and explore with food without any expectation that they will eat it.
Limit Mealtime. Even picky eaters eat most of their food in the first thirty minutes. Eat only 15-30 minutes at a time. Remove all food from your child’s plate at the end of the meal.
Negative behaviours should be ignored. If possible, ignore when your child is spitting throwing food or refusing to eat. You don’t want these behaviors to be encouraged by your attention. If these behaviours are severe, you may need to consult a specialist for proper management.
Reduce Distractions. Distractions like the TV can distract you from the task and food. Only feed your child when they are alert and attentive.
Eat healthily and enjoyably. Children learn through observation. Parents and other children who are present at the meal can show their child how to eat well. Don’t focus too much on what your child eats. Make it fun. Avoid nagging, begging and coaxing your child. You can teach your child to make healthy food choices by making them with your family.
Presentation. To increase your child’s likelihood of eating new foods, present them in small portions and in a fun or familiar way.
Reward positive behaviors. Praise your child when he or she approaches new foods. You can encourage new eating behaviours by offering immediate rewards such as bubbles, stickers, or blowing bubbles. Rewarding good eating habits will make them more likely to occur again.
Remember the Rule of 3. You should offer your child foods that he or she already enjoys as well as those that he or she has not yet tried. As a general rule, only serve three foods at once. Include between one and two foods that your child likes, as well as one food they don’t like. Place the food that your child won’t tolerate on another plate near your child to get them used to it.
Provide comfortable and supportive seating. Put your child in a booster, high chair or child-sized table to ensure that they can sit up straight without leaning back, swaying their feet or dangling them. For foot support, you can use a stool or stacks of old telephone books. This stability encourages healthy feeding and reduces distractions by making the child feel “anchored” and safe.
