DINNERTIME DILEMMAS

Addressing Disruptive Eating Behaviours in Children With Autism

Eating a varied diet is essential for our health. However, unhealthy eating behaviours in children with autism can result in a very restricted diet, which in turn can lead to nutritional imbalance, health problems and behavioural issues.

While each child is different, in this article, we look at the common food challenges facing children with autism, and the services available to help you improve your child’s eating habits and minimise mealtime stress.

Meet Rachel. Her daughter Katie, who is on the autism spectrum, has a difficult relationship with food. Mealtimes are stressful, as Rachel struggles to meet Katie’s very specific needs – the same fork, the same chair, the same food, over and over again. Rachel is exhausted and worried about Katie’s health – she’s underweight and seems more prone to sickness than her other children. 

And if eating at home is difficult, eating out is almost impossible. Finding healthy food options for Katie is a challenge, and her behaviour becomes increasingly disruptive the hungrier she gets. As a result, Katie is no longer invited to other children’s homes. 


As a parent or carer of a child with autism, Rachel and Katie’s story might sound very familiar. For while most of us are enticed by the smells, textures and colours of different foods, this is often not the case for children with autism. Perhaps, like Rachel, mealtimes in your household have become battlegrounds of stress, disruption, anxiety and conflict – not only for your child, but the entire family.

If so, you’re not alone. In fact, 49-89% of children with autism eat fewer foods and have a lower nutritional intake, due to a combination of ritualistic behaviours (e.g. needing to use a particular utensil or have food presented in a certain way) and sensory processing issues.

Autism and Disruptive Eating: The Behavioural Cycle

Demanding or refusing particular foods is common in children with autism. For example, your child may only want to eat the following food types:

  • White foods, e.g. white bread, pasta, chicken nuggets, fish sticks etc.
  • Foods without any smell
  • Foods with a particular texture

Introducing new foods can be a huge challenge. Aside from impacting your child’s health, this can also limit social options and flexibility – eating out at a restaurant can be a nightmare! 

This becomes a vicious cycle.

The Effects of Poor Eating Habits on Children’s Health

Restricted diets can have a number of significant health impacts on children with autism.

Children who have long-term reduced nutritional intake are more likely to have a slower growth rate, developmental delay and further medical conditions or ill-health

Children with autism and nutritional imbalances have a greater chance of experiencing food intolerances, weight management problems, infections, behavioural issues and sleep disturbances.

They are also more likely to suffer from poor gut health and bowel problems. This can cause significant gastrointestinal symptoms, such as diarrhoea, constipation and flatulence. In addition, nutritional imbalances can impact the absorption of nutrients, making the imbalance even worse.

Rachel is determined to reduce mealtime stress so that her family can eat together happily. She’d really like Katie’s health to improve so she can attend school regularly, and is worried about gut problems like constipation, which has resulted in hospitalisation in the past.

Rachel decides to engage the services of a dietitian, which is supported by her NDIS funding. The dietitian works with Katie and her family to understand and analyse her eating habits and patterns. Seeing that Katie is only eating white foods, the dietitian is able to identify the nutrients that are missing from her diet. She also looks at what works well, such as how Rachel can encourage Katie to eat, and what motivates Katie to engage in positive eating behaviour.  


How a Dietitian Can Help to Improve Your Child’s Eating Behaviours

It’s very important to address nutritional imbalances in children with autism as soon as possible. Early intervention - at a time when children are growing and developing habits for their future - can be critical for long-term health. 

A dietitian is a health professional who is specially trained in nutrition and eating behaviours. They can analyse your child’s current nutritional intake and identify what nutrients or food elements may be missing. They will also consider your child’s environment, family dynamics, and sensory sensitivities and behaviour, to establish solutions that work for everyone involved.

A dietitian may work with your family to establish clear goals and then create a plan of action to achieve these goals. This could include: 

  1. Understanding what is missing from your child’s diet, such as fibre for gut health, and essential vitamins and minerals. Suggestions can then be made for food or supplements to develop a nutritional balance.
  2. Identifying food intolerances, such as gluten or dairy, which may be impacting your child’s ability to eat a variety of food. This requires education and training to understand options.
  3. Establishing routine behaviours around mealtimes, such as eating as a family to model healthy eating behaviours. Recommendations can be made to slowly introduce variations in the routine, allowing for more options around food types and eating venues.
  4. Developing strategies to introduce new foods for children with sensory integration issues. This may be assisted by games and learning opportunities designed specifically for children. 

Each session with your dietitian will aim to improve your child’s nutritional intake and health, make mealtimes more manageable, and reduce medical symptoms such as gastrointestinal problems as soon as possible. In doing so, steady progress will be made towards your child’s and family’s goals.

Working with their dietitian, Rachel and Katie found that the white foods Katie was eating lacked fibre and many other nutrients essential to her health. They learnt which foods contained fibre naturally and slowly introduced these one at a time. Through some carefully designed games and a few toy animals, Katie started to play with a ‘jungle’ of lettuce, which helped to introduce her to a new food and colour. 

The rest of the family helped too, by committing to a family dinner five nights a week in order to establish healthier eating behaviours. And when Katie ate all of her dinner, she was allowed to watch 30 minutes of her favourite TV show before bed – a very attractive reward!

Over time, Katie’s gut symptoms began to resolve and she became more regular. She started to eat more food groups, and explore different colours and flavours. Katie was happier, mum Rachel was less stressed, and mealtimes become a more enjoyable experience – so much so that last Friday night, the whole family even got the chance to out at their local Italian restaurant!

 

If you’re concerned about unhealthy eating habits in your child with a disability, our qualified dietitians are here to help, from meal planning and nutritional analysis to advice on healthy eating. Learn more about our dietitian services, which are supported by your NDIS funding.  

 

 

 

References:

Bandini, L.G., Anderson, S.E., Curtin, C., Cermak, S., Evans, E.W., Scampini, R., Maslin, M. and Must, A., 2010. Food selectivity in children with autism spectrum disorders and typically developing children. The Journal of pediatrics157(2), pp.259-264.

Johnson, C.R., Turner, K., Stewart, P.A., Schmidt, B., Shui, A., Macklin, E., Reynolds, A., James, J., Johnson, S.L., Courtney, P.M. and Hyman, S.L., 2014. Relationships between feeding problems, behavioral characteristics and nutritional quality in children with ASD. Journal of Autism and Developmental Disorders44(9), pp.2175-2184.

Kawicka, A. and Regulska-Ilow, B., 2013. How nutritional status, diet and dietary supplements can affect autism. A review. Roczniki Państwowego Zakładu Higieny64(1).

Kuhlthau, K., Orlich, F., Hall, T.A., Sikora, D., Kovacs, E.A., Delahaye, J. and Clemons, T.E., 2010. Health-related quality of life in children with autism spectrum disorders: Results from the autism treatment network. Journal of autism and developmental disorders40(6), pp.721-729.

Ledford, J.R. and Gast, D.L., 2006. Feeding problems in children with autism spectrum disorders: A review. Focus on Autism and Other Developmental Disabilities21(3), pp.153-166.

Seiverling, L.J., Hendy, H.M. and Williams, K.E., 2011. Child and parent variables associated with texture problems in children’s feeding. Journal of Developmental and Physical Disabilities23(4), pp.303-311.

Sharp, W. G., Jaquess, D. L., Morton, J. F., & Herzinger, C. V. (2010). Pediatric feeding disorders: A quantitative synthesis of treatment outcomes. Clinical Child and Family Psychology Review, 13(4), 348–365.

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