Autism Spectrum Disorder (ASD) and Feeding
Apr 13, 2020
Parent Question: How can I help my child with Autism with his feeding issues?
Throughout my career as a Speech-Language Pathologist I have worked with children with Autism Spectrum Disorder (ASD) and feeding challenges. Children on the Autism Spectrum have a significantly higher incidence of feeding issues than typically developing children. These are some of the feeding differences I have encountered when working with children with ASD:
- Reduced variety of foods (e.g., only eat 1 food group, texture, brand, or colour)
- Difficulty accepting new foods (e.g., gagging, fear/crying, running away from the table)
- Challenges accepting changes in food preparation (e.g., slight changes in texture/colour or temperature can lead to complete refusal of a meal)
- Difficulty transitioning to table foods (e.g., only eat pureed foods)
- Only eating fast foods that are prepared outside the home (e.g., McDonald’s fries only)
- Difficulty tolerating changes in the mealtime environment/routine (unable to eat at school or someone else’s home)
- Only accepting food from one family member
- Require distractions to eat (e.g., iPad or phone)
Mealtime challenges for children with ASD can be strongly related to how the child’s sensory system processes information (e.g., heightened sensitivities to sound, smell, taste, touch, temperature, and movement). Difficulty with transitions can cause some children with ASD to refuse to eat or eat limited amounts to reduce the number of transitions with which they must cope.
Children with ASD often find it difficult to cope with the sensory and communication stresses at mealtimes. They may compensate by limiting sensory input (e.g., only eating familiar foods) and controlling their mealtime world (e.g., becoming very inflexible about changes in the mealtime routine). Limiting sensory input allows them to feel safer. Mealtimes often present sensory overload for children with ASD.
Gastrointestinal (GI) disorders are among the most common medical conditions associated with autism. GI issues include chronic constipation or diarrhea and/or irritable and inflammatory bowel conditions. GI conditions and discomfort can have a significant impact on children's feeding status.
12 Feeding Strategies I Teach Parents to Help their Child with Autism (ASD)
- Food exploration/play and repeated exposure to new foods:
- Food play separate from mealtimes. Have fun with food! (see my Food Play post on FeedingPlus Facebook Page)
- Presenting new foods for learning during mealtimes when the food has become more familiar. These could be presented on a separate or divided plate at mealtimes. Follow the 75-25 rule (75% of the plate familiar foods: 25% of the plate new foods).
- Food chaining = making very small (teeny tiny) changes to existing food preferences:
- Start small (the changes should not be noticed by your child)
- Hold changes for 1-2 weeks then gradually increase
- Make one change at a time
- Maintain a familiar and predictable mealtime environment when making changes to foods.
- Regular Meal-Snack-Meal-Snack-Meal Schedule:
- Allowing 3-4 hours between meals for appetite development
- Avoiding grazing throughout the day helps with growth and provides a routine
- Monitor the length of meals (20-30 minutes for meals and 10-15 minutes for snacks)
- Liquid Intake:
- Limit juice intake to 4-6 ounces per day to allow appetite for food
- For children over age 1, limit milk to 2-cups (approximately 16 ounces) per day.
- Offer milk after meals vs. before meals.
- Respect your child’s feeding and hunger cues:
- Keep in mind that it’s normal for your child’s caloric intake to vary from meal to meal.
- It’s important to let children learn to follow their own hunger/satiety cues
- As adults, we don’t eat the same amount every day and every meal. This applies to children too.
- Feeling Safe and Building Trust:
- Successful feeding is based on trust. Avoid tricking, pushing, or forcing at mealtimes.
- Allow your child to get the food out of her mouth or off of her plate (e.g., “all-done bowl”)
- Create a positive learning and communication environment
- Provide structure and routine
- Involvement in mealtime process:
- Encourage your child to help the table
- Help with food preparation (e.g., stirring, sprinkling, chopping, serving food to others)
- Choose between 2 acceptable foods
- Offering foods in courses to maintain interest in the meal vs all foods at once
- Look for fun feeding utensils/plates
- Fun food presentation on the plate (e.g., clown face, train, etc.)
- Family Meals:
- Family meals offer social and communication time
- Learning opportunities/positive role-modeling
- Oral (mouth) Stimulation and Sensory Play:
- “1-2-3 tooth brushing”
- Touching/play on face (tickle-time, bath time, cuddle time, praise)
- Sensory play with rice, water, noodles, play dough, pudding, paint
- Touching anxiety-causing foods through clear plastic bags/containers
- Encourage mouthing of a variety of different toys and feeding utensils.
- Use of praise, rewards/incentives:
- Specific praise: e.g., “Good eating!”, “Good chewing!”, “Good touching!”, “Good trying!” instead of general praise: e.g., “Good boy/girl”
- Incentives (avoid rewarding food with “better foods”)
- Give praise for interacting with a new food
- Rate the new foods as “thumbs up, thumbs down, or so-so” or with smiley faces
- Re-introduce “thumbs up” or “so-so” foods
- Use of distractions:
- Many children need distractions to decrease anxiety at mealtimes
- Some children do well with a “Meal toy-bag” (interesting toys that are only brought out at only at mealtimes) to help them tolerate small changes to their foods.
- Try to incorporate food or mealtime related distractions (e.g., their own bowl and spoon)
With intervention, I have witnessed children with severely restricted food intake progress toward new foods, improved nutrition, and happier family mealtimes.
If your child is demonstrating GI issues, I suggest speaking with your child's physician for medical advice. Often treatment of Gastrointestinal issues will help with your child's feeding progress.
Feeding progress tends to be slow and it would be overwhelming to implement all of the above strategies all at once. I suggest starting with one or two small changes to help your child with ASD work toward improved mealtimes. As a starting point, I suggest creating an improved feeding schedule with 3-4 hours between feedings paired with exposing your child to new foods every day, in a non-threatening way (e.g., food play outside of mealtimes or a separate plate of learning foods during meals).
Remember not to pressure your child to “try” or “eat” the foods, just offer them for looking, touching, smelling, kissing, and perhaps eventually eating. If your child feels calm and safe at mealtimes, he/she will be much more likely to accept new foods.