Picky eating is an issue experienced by many parents, and there are typically very behavioral solutions proposed to parents. Often parents are encouraged to hold firm in their expectations and not negotiate on what will and won’t be eaten. For example, if the expectation is that the child will try one bite of each food on the plate before being given a choice for an alternative, parents are told that should be the rule for every meal, every time. A common question is, “But what if my child refuses to eat?” and a typical response is, “When they get hungry, they will eat.” For many children, this is true. Food pickiness is a common way that children practice exerting their own free will and test their limits.
However, recent research has shown that there may be different reasons for why children with autism struggle with picky eating:
Some studies have shown that up to 80% of children with Autism also experience a degree of GI inflammation. This can make eating experiences physically uncomfortable in a variety of ways, including developing sores in the mouth, experiencing redness and sensitivity around the anus due to irregular or painful bowel movements, or having to deal with indigestion/heartburn whenever food is eaten. If you were in a big amount of pain every time you ate, wouldn’t you be hesitant to do so, even if you were starving? The problem is that these kids often will refuse to eat even if they are hungry, because of their fear/anxiety of the pain that will come as a result. However, especially for younger kids, they may not be able to articulate this to you. As a parent, you can help identify this issue not only by watching out for physical signs of inflammation such as red or swollen areas on the body, irregular bowel movements, or obvious signs of digestive issues (heartburn, vomiting, stomach cramps, etc), but also by looking out for some behavioral signs. Children with a high level of inflammation are more inclined to engage in behaviors such as head banging, hanging upside down, leaning on furniture, and throwing tantrums. If you have thoughts that your child may have an underlying GI issue, it would be beneficial to seek consultation with a pediatric GI specialist.
Allergies and Sensitivities
Children with Autism are often more likely to have food allergies relative to those without an Autism diagnosis. This can also make eating an uncomfortable experience, leading to discomfort after eating, skin problems, and immune system deficiencies. It’s also important to keep in mind that sometimes kids crave the very foods they’re allergic to, so you can’t go purely by what foods your child likes and doesn’t like. The most common allergen for children with Autism is grain/wheat/gluten. Many are also allergic to Casein, which is the main protein found in diary products. If you think your child may have food allergies, it would be beneficial to consult with your pediatrician, or you may be referred to a dietitian or nutritionist.
Traumatic Body Memories
Although not relevant to all children with Autism, it is important to be aware of any traumatic experiences your child had as an infant. NICU and PICU experiences can often lead to oral sensitivities due to trauma experienced around the mouth from feeding or breathing tubes. If a G-tube was placed, this causes a child to miss out on oral experiences, and therefore those experiences are foreign and will need to be taught. It is important to recognize that even though these experiences happened when your child was an infant, our bodies are designed to hold and carry memories. Because these experiences happen when babies are pre-verbal, they can be especially difficult for children to process or understand. One way to work through this when children are old enough to understand what happened to them is to help them create a “storybook” using words or pictures (or both!) to help them tell their story and process their experiences. Therapy or counseling may also be beneficial, depending on the severity and extent of the trauma your child experienced.
A high percentage of children with Autism have sensory sensitivities, so if you notice your child avoiding specific foods, think about if there are any sensory characteristics they have in common. Do you find that your child avoids all hard food and will only eat soft foods? Is your child particularly sensitive to foods that have a strong odor? Once you identify the sensory issue behind the avoided food, you can better work with your children on getting the nutrients they need while limiting the chances of them going into sensory overload. This does not mean, by the way, that you should just take away everything that triggers a sensory reaction for good. On the contrary, it will actually be important for you to expose your children to the foods they are sensitive to, but this should always be done in the presence of many other options and choices. For example, if your child won’t eat crunchy food because it makes too loud of a noise, you wouldn’t want to give him a meal consisting of only apples, carrots, and crackers. Instead, giving him apples along with a peanut butter sandwich, a banana, and juice is a better way to expose him to the crunchy food without overwhelming him. Frequent exposure can help de-sensitize a sensory issue—just be sure you know that the food is only an issue because of that, and not because of an underlying GI issue! If you’re unsure, it’s always best to consult with your doctor before making any assumptions or changes.
* All material utilized in this blog post was obtained from a training by Susan L. Roberts, MDiv, OTR/L, entitled: Play with Your Food: Overcoming Food Selectivity and Nutritional Challenges for The Child with Autism. She is the author of My Kids Eat Everything: the Journey from Picky to Adventurous Eating. Additional information and resources can be found at www.susanlroberts.com
Author: Christina Stai
Dr. Christina Stai is a licensed clinical psychologist in both California and Iowa. She specializes in young children and received her doctorate in Psychology (Psy.D.) from Azusa Pacific University, an APA accredited school near Los Angeles. She completed an APA accredited internship and APPIC accredited postdoctoral fellowship at a residential emergency shelter with abused and neglected foster youth. We are proud that she has joined Hope Springs.