Children with Autism and Nutrition: Mealtime Challenges and Tips on How to Make it a More Successful Experience

What is autism, and what are the causes ?

The prevalence of children diagnosed with Autism Spectrum Disorder (ASD) has risen dramatically over the past 20 years. In America, 1 in 54 children is being diagnosed with ASD [6]. ASD is more common among males, 4:1 male to female ratio, and may occur in all racial, ethnic, and socioeconomic groups [6]. The Centers for Disease Control and Prevention defines ASD as a developmental disability characterized by three core deficits: social, communication, and behavioral. Individuals with ASD are also characterized by presenting a range of restricted, repetitive, and inflexible patterns of behavior and interests. The specific causes of ASD are unknown, but most scientists believe that ASD is related to genetic and biological factors and environmental factors [7].

Physiological and cognitive impairments:

The onset of ASD occurs during early childhood [9]. Cognitive impairments symptoms of autism are many and may be identified according to the following core deficits:

• Social and communication impairments: characterized by difficulty using verbal and non-verbal communication [5]

• Restricted and repetitive behaviors: include repetitive body movements, motions, and a need for unvarying routine and resistance to change [5]

• Another significant symptom that is common among individuals with ASD is sensory impairment. This means that individuals with ASD may experience over or under sensitivities to sounds, light, touch, textures, tastes, smells, pain, and other stimuli [5]

Physiological impairments consist mainly of gastrointestinal disorders. There is a high incidence of GI in children with ASD, occurring in 46% to 84% of them [1]. In addition, ASD and its symptoms often cause children to have lower levels of pantothenic acid, biotin, folate, B12, vitamin A, vitamin D, vitamin E, and calcium [11]. The most common GI problems observed in children with ASD are:

• Chronic constipation or chronic diarrhea [1]

• Gastroesophageal disease [1]

• N/V [1]

• Flatulence, bloating, and abdominal discomfort [1]

• Ulcers [1]

• Colitis [1]

• Inflammatory bowel disease [1] 

• Food intolerance [1]

• Failure to thrive [1]

The challenge:

Due to the cognitive and physiological impairments caused by ASD, children may experience nutrient intake, absorption, and digestion deficiencies. This is a problem because they can be at a higher risk for malnutrition. For instance, parents and caregivers of children with autism often report disruptive mealtime behaviors. That is severe food refusal, limited food repertoire, and high-frequency single food intake [11]. They could also be picky eaters, leave the table frequently, throw or dump the food, making meal routines detailed or time intensive [4]. Cognitive and physiological symptoms related to the above behaviors may involve:

• Difficulties in sensory processing of food texture, smell, taste, and color [2]

• Difficulty focusing on one task for an extended period, which makes it hard for them to sit down and eat their meals from start to finish [2]

• Associating foods with stomach pain or discomfort due to GI problems [2]

• Medication interactions, since stimulant medications used with autism can lower appetite, thus reducing intake and affect growth. Also, some medications may affect the absorption of certain vitamins and minerals [2]

Tips to help overcome the challenge:

So, feeding time can often be stressful and frustrating for many parents, caregivers, and the children. In fact, around 89% of children with ASD experience challenging behaviors during mealtime [4]. This situation may cause children to have a negative perception of mealtime, which makes the situation even worse. For this reason, it might be necessary to implement fun and positive strategies to make mealtime a more successful experience for everyone. Here are some tips to help achieve this goal:

1. Set a time to prepare for mealtime: sensory difficulties can make children with ASD feel anxious when mealtime approaches. So, try relaxation techniques before mealtime, such as practicing deep breathing together for five minutes or doing “deep pressure tactile exercise” like having the child push the palms of their hands against yours [10].

2. Involve the whole family-siblings: eating together helps children to learn what they are supposed to be doing. Eating together also helps children learn through imitation, making it more likely that they will put new food in their mouths after seeing others doing so [10].

3. Introduce new foods by gradual exposure: it may take many exposures to the new foods before they accept them. Try serving the new foods along with familiar foods. Include foods with a variety of attractive colors and textures. Encourage them to touch the food with a fork, then with a napkin, then with their fingers [10]. Help them explore the new food by smelling it, touching it, and simply looking at it [3].

4. Make it fun: children learn through play and playing with food is not the exception. For instance, use cookie cutters to cut sandwiches into fun shapes; make faces on a pizza with veggies; try finger painting with pasta sauce. As you play with them, let them watch you eat and enjoy the new food [3].

5. Give them options: giving children choices helps them feel more positive and in control. For instance, try offering different types of protein, fruits, and vegetables and let him choose one of each. You can even make a game out of offering them to pick one surprise ingredient in the family’s dinner, which the rest of the family members can guess at during dinner time [3].

6. Praise, praise, praise, and praise: children with ASD love being praised. Praise and small rewards may gradually increase the time at the table to around 20 minutes [10]. Try ignoring challenging behaviors and praise them for “good behavior.” Reinforcement is an excellent technique to help increase the occurrence of desired behaviors, while ignoring some negative behaviors might help decrease the occurrence of unwanted behaviors [10].

As you can see, it is possible to make mealtime a positive experience when dealing with children with autism. It only takes some extra preparation and skills. Putting these skills into practice might be overwhelming at first, but eventually, the outcome will be worth it and rewarding.  

Edited by PreRD intern, Lauren Gatto

Written by Yesenia Tavarez: Hello! My name is Yesenia. I am a senior Dietetics and Psychology student at CUNY Queens College. My goal is to become a Registered Dietitian and work for the community providing help, education, and awareness to parents and teachers specifically. Also, contribute with my work as an advocate for equity and justice regarding food access for all, especially for children of school age. I enjoy free writing, trying new recipes, dancing, and hiking!
 

References:

[1] Al-Beltagi, M. (2021). Autism Medical Comorbidities. Pub Med Central (PMC), 10(3), 15–  28. Retrieved October 7, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085719/.

 

[2] Ansel, K. (2021, April 2). Autism Spectrum Disorders (ASD) and Diet. Eat Right/Academy of Nutrition and Dietetics. Retrieved October 7, 2021, from https://www.eatright.org/health/diseases-and-conditions/autism/nutrition-for-your-child-with-autism-spectrum-disorder-asd.

[3] Applied Behavior Analysis Programs Guide. (n.d.). Five Tips for Introducing New Foods to Your Child with Autism. Applied Behavior Analysis Programs Guide. Retrieved October 8, 2021, from https://www.appliedbehavioranalysisprograms.com/lists/five-tips-for-introducing-new-foods-to-your-child-with-autism/.

[4] Ausderau, K. K., St. John, B., Kwaterski, K. N. N., Nieuwenhuis, B., & Bradley, E. (2019). Parents’ Strategies to Support Mealtime Participation of Their Children With Autism Spectrum Disorder. Pub Med Central (PMC), 73(1). Retrieved October 7, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402415/.

[5] Autism Speaks. (n.d.). What Are the Symptoms of Autism? Autism Speaks. Retrieved October 7, 2021, from https://www.autismspeaks.org/what-are-symptoms-autism.

[6] Centers for Disease Control and Prevention. (2020, September 25). Data & Statistics on Autism Spectrum Disorder. Centers for Disease Control and Prevention (CDC). Retrieved October 7, 2021, from https://www.cdc.gov/ncbddd/autism/data.html. 

[7] Centers for Disease Control and Prevention. (2020, March 25). What is Autism Spectrum Disorder? Centers for Disease Control and Prevention (CDC). Retrieved October 7, 2021, from https://www.cdc.gov/ncbddd/autism/facts.html.

[8] National Institutes of Health. (2017, January 31). Nutritional Therapy for Autism. National Institutes of Health (NIH). Retrieved October 7, 2021, from https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatments/nutritional-therapy.

[9] National Institutes of Health. (2017, January 31). When Do Children Usually Show Symptoms of Autism? National Institutes of Health (NIH). Retrieved October 7, 2021, from https://www.nichd.nih.gov/health/topics/autism/conditioninfo/symptoms-appear.

[10] Pena, M. (2015, October 16). Mealtime Tips for Autistic Children with Eating Challenges. Autism Speaks. Retrieved October 8, 2021, from https://www.autismspeaks.org/expert-opinion/autism-and-mealtime-therapists-top-ten-tips-success.

[11] Shareela Ismail, N. A., Ramli, N. S., Hamzaid, N. H., & Hassan, N. I. (2020). Exploring Eating and Nutritional Challenges for Children with Autism Spectrum Disorder: Parents’ and Special Educators’ Perceptions. Pub Med Centra (PMC), 12(9), 2530. Retrieved October 7, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551651/.