Autism and Selective Eating

By Rachel Vallis

Registered Specialist Paediatric Dietitian

FUSSY EATING

Some element of fussy or picky eating is a normal part of childhood development. Parents may find the initial stages of weaning are straightforward and enjoyable. Children accept new foods, are interested in what other people are eating and fall in to a routine of regular meals. At around the age of 20 months, the neophobic stage begins. The way food looks, smells, what it is served with, all starts to become a much more important part of why food is accepted or rejected. A child may have previously loved carrots, but now, if chopped in the wrong way, too hard or too soft, they will be declined.

This stage can last up to the age of 6, although in most children it subsides much sooner. Levels of food refusal can certainly feel severe to parents, but in most cases, the phases are short-lived and do not impact on the child’s growth and development. There are various strategies to manage fussy eating, but commonly, a Dietitian’s role will be to support parents with their parenting choices and style, reassuring them their child is getting everything they need.

AUTISM

Autism is not an illness. People living with Autism have brains that work in a different way. Communicating feelings, understanding how others might be feeling and being overwhelmed by sensory stimuli are common areas people living with Autism might find more challenging than most. It’s that heightened sensory sensitivity that can lead to selective eating patterns.

SELECTIVE EATING

Rarely will eating be the only indication that a child may have Autism, but selective eating is certainly a trait that is commonly found in the behaviours of people with Autism. Extremely selective eating may be the trigger for further assessment and an eventual diagnosis of Autism.

When a child increasingly limits the variety of foods they eat, possibly cutting out whole food groups from their diet, this may be a sign that it is more than “normal” fussy eating. When children will only eat one brand of a food, seem to be sensitive to textures and reject food that is “broken”, parents and professionals may suspect there is an underlying cause.

FROM THE PERSPECTIVE OF THE CHILD

Imagine being hungry and being offered slugs, with a side of mouldy vegetables. How hungry would you have to be to eat that “food”? Imagine being served a meal of blue potatoes and yellow chicken. Would you be suspicious of the foods? Would you find them appetising?

These examples can help us to understand the hurdles we ask children with autism to overcome when it comes to food. A heightened sensory level means that even the slightest change in a food can make it seem terrifying. The smell of some other food in the kitchen can ruin a meal. The sight of someone eating an un-tolerated food can be very unpleasant.

A heightened sensory level means that even the slightest change in a food can make it seem terrifying.

A boy of around 14 in my clinic once explained his food selection so eloquently. He told me that he didn’t like surprises with texture. Although he liked the taste of some protein foods, he often couldn’t risk the chance that there might be a particularly chewy or fatty bit in the meal. He could tolerate minced meats to an extent, and got on well with more processed foods like veggie burgers because they were the same every time. He acknowledged that it made his diet a bit boring. But he said it was worth it, to eat food that he considered low risk. He also said he loved spicy foods and would use spice and other flavours to claim back some variety in his diet.

MANAGING SELECTIVE EATING

The most pressing thing to consider in nutritional adequacy. A restricted diet can be optimised in order to promote normal growth and development which will be monitored closely. A Dietitian will support parents using food modifications and nutritional supplements to improve the content of a young person’s diet in a way that is accepted by the individual child. Along-side this, strategies to desensitise a child to new foods can slowly help to increase the variety of accepted foods.

Another important role of the Dietitian, and other involved healthcare professionals, is to help the parents cope with feelings they may experience in their child’s food journey. Parenting a child with Autism isn’t always the same as parenting a child without. Parents have to adapt and break “the rules” to do the right thing for their child. Guilt and being judged is often reported. It’s important for parents to hear that they are doing an amazing job. They are creative, and patient and devoted to giving their child the best start.