Autism and picky eating: Mealtime tips to improve your child’s nutrition

If you have a child with autism, you’re likely well aware of the food aversions, sensitivities and behavioral issues that can come into play at mealtime. It’s common for parents of children with autism spectrum disorder, or ASD, to worry about their child’s diet and nutritional status. If not addressed early on, these issues can also continue into adulthood.

Autism spectrum disorder is a developmental disability that is estimated to affect 1 in 44 children in the US. Due to issues communicating and restrictions associated with the disorder, ASD can lead to other behaviors that put people at risk for nutritional disorders.

People with ASD often experience the following:

• Do not adapt well to change
• Strict about order
• Have obsessive interests
• Must follow certain routines
• Experience hyperfocus
• Have different reactions to smells, sounds, tastes, looks and feels of objects or foods.

These experiences—on top of increased risk of anxiety, depression, stress, fear, unusual sleeping and/or eating habits, and gastrointestinal issues—are where poor nutritional status may come into play.

If you or your child is living with autism, there are steps you can take today to increase the variety and nutritional value of their diet. Here’s how.

How does autism affect people nutritionally?

Did you know that 20-30% of people with ASD also have an eating disorder? Issues like restrictive patterns, hyperfocus and emotional dysregulation that are common with ASD can lead to an increased risk of eating disorders, as well as nutritional deficiencies and gastrointestinal disorders.

People with autism are often coined as “picky” or “selective” eaters, often having a small number of foods that feel safe to eat. Research has shown that individuals with autism may be sensitive to the sensory properties of food, which reduces the variety of foods they eat.

As a parent, this can make mealtime frustrating. This is also an issue because it can lead to undereating, inadequate intake and ultimately, nutritional deficiencies.

People with autism also have higher incidences of gastrointestinal problems and food allergies. Issues like diarrhea, constipation, steatorrhea, bloating and acid reflux can increase restrictive eating and/or reduce the absorption of vitamins and minerals, leading to nutritional deficiencies. Having one of the major eight food allergies can also lead to restrictive eating and food fear due to cross-contamination and/or the allergen being a common ingredient in foods.

What can you do to help your child with autism?

There is no specific diet for ASD. There has been little research on gluten-free, casein-free, feingold and keto diets for autism. Of what research has been done on these diets, most have been in animal models or from anecdotal experiences.

Therefore, these diets are not recommended at this time for the management of ASD. All these diets can be very restrictive and lead to nutritional deficiencies if not monitored by a registered dietitian, so if you plan to try one of these diets, please seek medical advice.

So, what can be done to help improve nutrition in people with ASD? Here are a few tips on dealing with selective eating and nutritional deficiencies:

• Expand on foods that your child already likes. If your child likes oranges, try a different type of orange, like a clementine.
• Offer options. For example, instead of you choosing the vegetables offered at mealtime, try offering four or five options and let your child decide which one they want.
• Stepwise approach to trying new foods. Have your child look at the food, smell it, touch it, lick it and then finally try taking a bite if it isn’t too anxiety provoking. Try to take this one step at a time and keep trying to get further along in the process each time.
• Consider seeing an eating disorder dietitian. People with autism may need extra support from a dietitian. Consider seeing a certified eating disorder registered dietitian (CEDRD).
• Consider seeing a doctor to be screened for vitamin and mineral deficiencies. If you or your child is diagnosed with a deficiency, talk with your doctor about the best course of action to correct it, as well as with a registered dietitian to learn about food sources of the nutrient(s).
• Talk with your doctor about multivitamins and/or mineral supplements that may help.

Managing digestive issues and food allergies with autism

First, let me clear up a few common misunderstandings about food sensitivity tests. While often marketed as helpful tools for people with GI issues and suspected food sensitivities, food sensitivity tests and most direct-to-consumer genetic kits are not accurate measures of food allergies and intolerances and should not be used to determine medical treatment or diagnose conditions. Genetic testing can identify genes you might have but cannot ultimately determine what diseases you have currently or tell you how to treat diseases you already have.

Blood allergy testing is also not the most accurate measure of diagnosing food allergies. If used, it should be in conjunction with allergy skin prick testing and oral food testing to properly diagnose food allergies.

If you or your child has autism and is experiencing GI issues, here’s what you can do to help get to the bottom of the problem:

• Elimination diets conducted with a dietitian. By properly eliminating and reintroducing suspected foods with a registered dietitian, you may be able to figure out what is causing the GI upset.
• Medication and supplements recommended by your doctor. Supplements aren’t regulated by the FDA. Make sure to talk with your doctor before starting anything over the counter.
• Incorporate more variety into your diet and drink enough water. Lack of fiber and water can increase your risk for constipation. Since people with ASD tend to struggle with selective eating, this could be a reason for constipation and bloating.
• Eat consistently throughout the day. Did you know that not eating enough and going too long between meals can lead to bloating and gas? This could also be a reason for GI upset in those with ASD.
• Skin prick testing and oral food testing with an allergist to determine food allergies.

Make sure to work with your healthcare providers to ensure you are receiving well-rounded treatment for your child’s autism spectrum disorder. With the right support, you can make sure your child gets the nutrients they need through a balanced, varied diet tailored to their unique needs.

Questions about nutrition and autism? Talk to your doctor or find a dietitian near you.