Healthy eating

Many children with autism are selective about what they eat or how they eat it. Children with autism may be more likely to stick with what they are most familiar with. This can be because they become obsessed with a particular food, plate or routine.

They may also avoid new foods because they find all new experiences difficult to cope with or refuse some meals because they want something that they feel in control of. For a child who finds communication difficult, refusing to eat something can be a way of communicating stress or anxiety about something else.

Also, many children with autism experience taste, smell or texture differently. This can be a further reason for finding some foods difficult to accept. Some children eat a limited diet because of their strong desire for sameness; this gives them a sense of safety and calm.

It can be upsetting and tiring to watch your child refusing to eat or to try new foods. This can be a complex issue to unravel and you may need to seek expert help. What we do know is that when an individual is anxious, one of the first things that happens is their digestive system slows down (butterflies in your stomach — fight or flight). If your child is a selective eater, the aim is to work towards creating a calm, happy setting so they will be more willing to try new foods. You should not force them to eat and should allow them access to foods that they will eat.

The usual approaches to selective eating may not work. If you think your child is an extreme selective eater ask your GP or health worker for help and advice. They may be able to refer you to your local dietician or feeding clinic (if available), who can assess your child’s diet, check that it is nutritionally balanced and give you practical hints, tips and support.

At present there is no evidence that any therapeutic diet can treat the core symptoms of autism. Some parents report that their child has improved after following a special diet. Others report that their child’s bowel issues have improved. Lots of families don’t report any changes.

If you decide you want to try a special diet, there is more information on these via the National Autistic Society website. It is strongly recommended that you seek balanced, impartial advice about this before embarking on this road. Many of the diets are expensive, a few can be harmful, and for children who seek routine a drastic change in what they are given to eat can be very distressing. This is especially true if your child is an extreme selective eater. The two diets that families have tried most commonly are:

Gluten and Casein Free diet (GFCF diet)
Fish oils and supplements high in Omega 3

There are many, many other dietary interventions that have been suggested for ASD but there is no proven benefit from research trials. If you think you may try one of these anyway, it is highly recommended that you speak to your GP, or community paediatrician first; they will be able to discuss the pros and cons with you. A dietician can make sure your child’s diet is nutritionally balanced so they are not missing essential nutrients which could affect the overall health and growth of your child.

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Why children with ASD can be selective eaters is not clearly understood but there are factors to consider:

Sensory issues and food

Children with ASD often have sensory issues and so food may not smell, taste or feel the same as it does to us. These issues may extend to memory anxiety - e.g. remembering an event / person when a particular food was eaten and that thought being so strong that it interferes with eating that food now.

‘Every time you ask me to try an apple I remember back to when I had a bad tummy, and I had an apple and was sick. When I have the fruit in my mouth my memory is so strong I can taste, feel, and smell the memory of the sick, and I can’t taste the apple… that’s why I won’t try it.’ - [Individual with ASD]
What about the environment?

Is the environment putting them off eating? Bright lights, noisy children, sitting opposite messy eaters could be some of the reasons they are finding eating new foods difficult.

‘I need to eat on my own because I can’t block out the way other children eat, they eat with their mouths open, the food is falling out, they are picking their noses and it puts me off eating.’ - [Individual with ASD]
PICA

Sometimes children with ASD eat ‘non-food’ items e.g. soil, paper, fluff, sand etc (including swallowing it rather than just exploring the object with their mouth). This is called PICA; if your child does this talk to a health professional as there is sometimes a medical reason for this.
Is something else going on?

Sometimes children refuse to eat because of an underlying medical problem that may be making eating hard - sore mouth, painful teeth, constipation, and find it harder to verbalise or show you this. Your GP may be able to refer you to the appropriate health professional.

Need more information?

Books:

Food Refusal and Avoidant Eating in Children, including those with Autism Spectrum Conditions: A Practical Guide for Parents and Professionals by Gillian Harris and Elizabeth Shea
How to get you Kid to eat But not too much by Ellyn Satter
Can’t Eat won’t eat by Brenda Legg

Websites:

National Autistic Society – www.autism.org.uk
Social stories - https://carolgraysocialstories.com/
NHS/Change4 Life – www.nhs.uk/change4life

Healthy eating

Why children with ASD can be selective eaters is not clearly understood but there are factors to consider:

Sensory issues and food

What about the environment?

PICA

Is something else going on?

Cambridgeshire Children and Young People's Services

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