Children with autism and other neurodevelopmental differences tend to experience many eating challenges. In a 2019 article, researchers found that 70% of autistic children experience eating challenges compared to less than 5% of children in the general population (Mayes & Zickgraf, 2019). The most common mealtime struggle involves limited food preferences, commonly referred to as “picky eating.”
While every child is unique, there are strategies parents can adopt to promote positive eating habits. Let’s explore common reasons neurodivergent children struggle with picky eating and what parents can do to support more varied choices.
Understanding Sensory Preferences
According to the Diagnostic and Statistical Manual of Mental Disorders – 5th edition (DSM-5), hypersensitivity or hyposensitivity to sensory input is one component of an autism diagnosis (Diagnostic and Statistical Manual of Mental Disorders, 2013). Children with autism experience the sensory world differently, which can make eating a wide variety of foods difficult for them. They tend to gravitate toward carbohydrates and processed junk foods, which may be more sensory-pleasing (Madra et al., 2020).
Many studies have linked sensory processing difficulties to picky eating. A 2021 meta-analysis of eating challenges in children with autism reviewed three studies that found the textures of foods to be the main reason for food refusal in autistic children. In these studies, the foods that resulted in sensory-related challenges included mixed texture food, such as oatmeal, smooth or creamy textures like peanut butter, and foods that required excessive chewing, such as meat. Children in these studies preferred consistent textures like hotdogs more frequently than inconsistent or mixed textures. The researchers also found that sensory-induced picky eating was often linked to multiple factors, such as both the taste and color of the food (Baraskewich et al., 2021).
When offering foods, consider the sensory components, including temperature, smell, taste, texture, and color. Consider your child’s sensory preferences and focus first on expanding their options to healthy foods that match those preferences. Your child can eat well while avoiding foods that they are sensory-aversive to. You may also want to consult an occupational therapist to support your child’s sensory processing needs.
Strategies for Managing Picky Eating in Autism
Understanding your child’s sensory preferences and needs is a great first step. Now, let’s dive in and consider several strategies for supporting your child’s picky eating.
Evaluate potential medical concerns
For some children, picky eating may be caused by an underlying medical condition, such as gastrointestinal (GI) discomfort. GI disorders are more than 4x more likely in children with autism (Madra et al., 2020). There are many other health problems that commonly co-occur with ASD as well. If your child struggles with healthy eating habits, speak with their pediatrician or another healthcare provider to have medical conditions ruled out. You may also want to consider consulting a dietitian to help guide you in developing a plan, especially if there are allergies, food sensitivities, or other considerations. Speech and Language Pathologists are also a great resource to evaluate oral motor function to make sure your child has the oral motor skills to eat properly.
Create a Structured Mealtime Environment
Neurodivergent children tend to thrive on consistency and predictability. Establishing a predictable mealtime routine in your family can provide a sense of structure and security.
Here are a few ways you can create structure:
- Set regular meal and snack times to help your child anticipate and prepare for upcoming meals. Reduce extra snacks outside of these times, if possible. This will help ensure your child is more likely to feel hungry at the next snack or mealtime, setting them up for success.
- Establish a mealtime location that is distraction-free, ideally sitting down at a table. If your child struggles with sitting still for extended periods, focus on slowly increasing the amount of time they will sit to eat. At first, this might be sitting long enough for just one bite. That’s okay! Gradually work up to sitting for longer durations.
- Create and implement a visual schedule. Visual schedules outline your child’s day or parts of the day. This can include meal and snack times, so your child can visualize what to expect, potentially reducing mealtime If your child is in ABA therapy, ask your BCBA for help with creating a visual schedule.
Introduce Nutrient-Rich Foods Creatively
Promoting a healthy diet is not as simple as providing your child with whole grains, fruits, veggies, and other healthy foods. You may need to get creative!
- Consider nutritious foods that are similar but not the exact same as your child’s current food preferences. This could be as simple as offering the same foods from a different brand, new flavors of a snack they are familiar with, or foods that have similar textures as the ones your child prefers.
- Gradually expose your child to new foods, one food at a time. Encourage your child to first touch and then smell the food. When they’re ready, have them touch the item to their lips, then lick it, and ultimately, take a bite. If they want to spit the food out after the first bite, it’s okay to let them. Have a napkin handy. It’s perfectly fine to go slow and steady, allowing them to gradually acclimate to new foods. If you’re offering a new healthy snack and your child is only comfortable licking it, that’s okay! Offer lots of encouragement and positive reinforcement with each step along the way.
- Combine new and familiar foods in a new pairing. Add a small amount of something new to a familiar or preferred food such as peas in macaroni and cheese or a very small amount of peanut butter on their favorite crackers. Introducing new foods alongside familiar foods can increase the likelihood your child will try something new.
- Keep trying! Research shows that children are more likely to accept foods after 8 or more exposures (Spill et al., 2019). If your child doesn’t seem interested in a new food, try again later or another day.
Build Independence in Food Choices
Fostering independence in your child can go a long way in supporting healthy habits. Encourage your child to play an active role in mealtime choices. Giving children a sense of control over life decisions, including eating choices, is vital for promoting autonomy.
Here are a few ways you can work on building your child’s independence:
- Involve your child in mealtime planning, from grocery shopping to preparing the food. Consider age-appropriate tasks that your child can help with, such as washing vegetables, mixing ingredients, setting the table, or cutting with supervision.
- Encourage your child to make simple choices such as deciding which cup to use or choosing where they get to sit at the table. This can help make meal and snack times a more positive experience for them.
- Avoid power struggles with foods, as that may make things worse, teaching the child they don’t have control over their eating habits.
Conclusion: How to Promote Positive Eating Habits in Children Diagnosed with Autism
Instilling healthy eating habits in your child takes time and patience. While there are special circumstances that contribute to picky eating in children with autism, it is possible to achieve a healthy diet. You can create a positive and healthy relationship with food by understanding your child’s unique needs, providing a supportive environment, and encouraging independence in mealtime routines and food choices. Celebrate the small wins on your child’s journey. Encouraging and reinforcing little changes can make a big difference in your child’s overall health and well-being.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Baraskewich, J., von Ranson, K. M., McCrimmon, A., & McMorris, C. A. (2021). Feeding and eating problems in children and adolescents with autism: A scoping review. Autism: the international journal of research and practice, 25(6), 1505–1519. https://doi.org/10.1177/1362361321995631
Madra, M., Ringel, R., & Margolis, K. G. (2020). Gastrointestinal issues and Autism Spectrum Disorder. Child and Adolescent Psychiatric Clinics of North America, 29(3), 501. https://doi.org/10.1016/j.chc.2020.02.005
Mayes, S. D., & Zickgraf, H. (2019). Atypical eating behaviors in children and adolescents with autism, ADHD, other disorders, and typical development. Research in Autism Spectrum Disorders, 64, 76-83. https://doi.org/10.1016/j.rasd.2019.04.002
Spill, M., Callahan, E., & Johns, K., et al. (2019). What is the relationship between repeated exposure (timing, quantity, and frequency) to foods and early food acceptance? Repeated exposure to foods and early food acceptance: A systematic review. USDA Nutrition Evidence Systematic Review. https://www.ncbi.nlm.nih.gov/books/NBK582166/
