Selective eating is a common problem in children with autism, with many only eating foods of a certain colour (e.g. white foods), or rejecting particular foods due to their texture or smell. This highly-restricted diet can cause a range of health problems, including nutritional imbalance, poor gut health, and weight management issues.
In this article, we explore the challenges of a selective diet, and how parents and carers can ensure their child is getting the healthy balance they need from their food.
For 8-year-old Tom, mealtimes are a ‘white food only’ zone. Tom, who is on the autism spectrum, has difficulties with sensory processing and integration. Over time, he has steadily rejected all other food types and is now so restricted in his diet, he will only eat five foods: fish sticks, chicken nuggets, mashed potatoes, white rice, and white bread-and-butter sandwiches.
Tom violently rejects the other types of food his father tries to offer him. This means dinnertime tantrums are common, making family meals exhausting and overwhelming for everyone. While Tom’s parents have all but given up trying to introduce new foods for the sake of peace, they are worried about the fact that Tom is not eating a healthy, balanced diet.
So what could be behind Tom’s unwavering insistence on white foods? Research shows that children on the autism spectrum are more likely to eat a narrow range of foods and have a greater number of feeding problems than those without autism. This may be due to ritualistic and repetitive behaviours, as well as sensory processing issues. What’s more, children with both autism and sensory issues are more likely to reject foods based on their colour, texture and smell.
For example, children with autism may only want to eat:
· white or yellow foods
· foods with either a crunchy or smooth texture
· foods that are either salty or bitter
· foods that have either a sweet or sour flavour
If your child is restricting their diet in this way, it is likely to be limiting their nutritional intake and can lead to a range of other significant medical problems – including developmental delays, issues with weight management (being either overweight or underweight), gastrointestinal problems, and chronic diseases such as obesity and diabetes.
White Food Woes
The problem is, the white foods in our diet tend to be the ones that are highly processed. In fact, white flours are used to make many of our popular ‘treat’ foods, such as crackers, breads, biscuits, pasta and cakes.
In order to obtain the white flour, naturally-brown whole grains are stripped of their nutrient-dense husks, meaning white rice and wheat lack fibre and essential vitamins. When eaten in high quantities, the nutrient deficiency occurring in white foods can impact gut health and nutritional balance.
And there’s more bad news! In addition to their lack of naturally-occurring nutrients, many of these white processed foods also contain added sugar to provide more flavour.
The Challenge: Introducing New Food Groups in Selective Eaters
If you’re attempting to introduce a new food to a child with autism, we know it can be a difficult and exhausting exercise. To ensure a safe and effective outcome, it’s important to work with your health team. Before you get started, you might want to consider the following:
1. Has your doctor checked whether there is a medical reason for your child not eating a certain food?
Sometimes, children with autism have painful gut symptoms which may be exacerbated by certain foods. In addition, mouth ulcers, food intolerances and allergies can all cause pain, which can prevent a child from eating or impact their relationship with food.
2. Has your health team (e.g. speech pathologist or dietitian) completed a motor skills check to confirm your child is able to chew and swallow comfortably?
3. Is your child’s eating problem based on a difficulty or a preference?
Engaging a Dietitian to Establish a Balanced Diet For Your Child
A dietitian is a health professional who is specially trained in nutrition and eating behaviours. They can help to develop strategies and tools that make it easier to introduce new food and improve your child’s nutritional balance.
A dietitian will work with you and your family to understand your goals, then create a practical action plan to achieve the desired outcomes. By exploring current eating habits and food types, the dietitian can develop an understanding of behaviour, motivations and incentives, as well as learning what works in your specific situation, i.e. for your family and your child.
There are many strategies which can assist in creating learning opportunities for your child around healthy food choices; a dietitian will aim to build a new and positive relationship between your child and their food.
Introducing new food to people with autism takes time and patience. Here are some of the ways a dietitian might approach the introduction of new food for a child with autism:
1. Introducing a new colour or texture can require many exposures – a child may need to see, touch and smell the new food multiple times before they are willing to taste it.
2. Games and child’s play will help to introduce new food in a fun way, without the pressure to taste straight away.
3. Food is a powerful way for a child to control their environment. By presenting your child with options, they can maintain this control and make choices for themselves. For example, the dietitian may ask “which one of these three foods would you like to try today?”.
As little Tom loves playing with dinosaurs, he and his dietitian used different foods as props for his dinosaur play. Tom gradually accepted touching and feeling the lettuce and broccoli, and was ok with grapes being in his space. As cauliflower was white, Tom allowed it to be mashed into his potatoes. Later, he accepted a banana in his lunch box, then some lettuce in his sandwich, and after another two weeks, a slice of tomato. Six months later, Tom had increased his food groups significantly and had even lost enough weight to be in the healthy range. Meanwhile, Tom’s mum and dad are relieved that he is getting a nutritional balance – and mealtimes are no longer an uphill struggle!
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.
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 pediatrics, 157(2), pp.259-264.
Baranek, G.T., Boyd, B.A., Poe, M.D., David, F.J. and Watson, L.R., 2007. Hyperresponsive sensory patterns in young children with autism, developmental delay, and typical development. American Journal on Mental Retardation, 112(4), pp.233-245.
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 Disorders, 44(9), pp.2175-2184.
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.
 Bandini et al, 2010; Johnson et al, 2014
 Baranek, 2007
 Sharp, 2010
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