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Healthy eating
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Selective 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.
Why children with ASD can be selective eaters is not clearly understood but there are factors to consider.
Diet as a treatment
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 2 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 dietitian 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.
PICA
Sometimes children with ASD eat ‘non-food’ items, for example, 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.
Top tips
- Spend some time monitoring your child’s eating. Keep a food diary to see how many different foods your child is eating. You may find that they are in fact eating a wider variety of foods than you thought.
- Be a ‘detective’ and try and guess why they are eating in a certain way. If they can talk, ask them why they can’t eat or if they can write, ask them to try and write it down, or draw what’s wrong.
- A place mat which is ‘their area’ to eat can help.
- If your child finds eating with others difficult, make sure they are not sitting directly opposite another person.
- A place mat which is ‘their area’ to eat can help.
- If eating at school is difficult, ask what the environment is like at school or even visit the school during a meal time.
- Try and make meal times predictable. Serve 3 meals and planned snacks and try and establish a routine.
- Visual prompts, timetables, choice boards or choice books (pictures or words) can be helpful. Using these strategies try giving your child a choice between two less preferred foods so they still have some control for example, ‘carrots or peas?’
- Try writing a social story these can be used to help your child try new foods or to explain why eating a varied diet is important.
- Expose your selective eater to food at every opportunity, get them to handle food, play with food, and help in the kitchen, so food and eating becomes relaxed and fun. Try and make eating and being around food a pleasure not a chore.
- Use your child’s interest as motivators, for example, make the food into a train, line up peas, maybe their favourite character could come to ‘tea’.
- Remember, you need to persevere. You often have to expose your child to a new food a lot (15 times or more) before they accept it as new food and will try it or eat it.
- If your child has PICA (regularly eating non-food items) talk to a health professional as there is sometimes a medical reason.
