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How to tackle eating problems in children with autism

Parents of children with autism often find mealtimes incredibly challenging. This is because those on the autistic spectrum can be very restrictive about the foods they choose to eat, in some cases limiting themselves to only a few different types. This can lead to weight loss or gain, and deficiencies in certain nutrients in the long term.

Autism and eating

Often parents feel like they are failing if they are not able to get their child to eat a balanced diet. But you mustn't blame yourself. Autism and food difficulties are common, because the condition can cause:

  • Increased sensitivity to food and the general environment.
  • Anxiety and fear of new things.
  • Rigidity in day-to-day routines. For instance: doing things at certain times in the day, sitting on their favourite seat or eating particular foods.

While working in child weight management earlier in my career, I often found myself supporting families with overweight children who were on the autistic spectrum. Our sessions were largely about developing a step-by-step strategy for a more varied diet which the child felt happy with.

But in order to achieve this, psychologist Dr Gillian Harris from Birmingham Food Refusal Services cautions that parents and carers shouldn't discourage autistic children from eating the foods they feel safe with.

"Allow them to eat their preferred and safe foods. This will maintain weight and allow the child to reach their predicted growth trajectory. Over-encouraging them to eat anything new is likely to cause anxiety, food refusal and weight loss."

She also admits that while it can be tempting to disguise new or unfamiliar foods within the child's 'safe' foods, it is not recommended.

"This can contaminate the 'liked' food, leading to refusal of that item, perhaps permanently."

If you are concerned that your child with autism is losing or gaining weight or following a very restrictive diet, your first port of call should be your GP. Otherwise, here are some tips Dr Harris and colleagues suggest you try at home that might make mealtimes a little easier:

Tackling sensitivity

People on the autistic spectrum are often found to have either over-sensitivity or under-sensitivity to food. The diagnosis for severe sensitivity is now known as an avoidant/restrictive food intake disorder (ARFID). Someone with this condition may be particular about the following aspects of food:

  • Choosing only soft or only crunchy foods.
  • Preferring foods with no smell or those which have more pungent smells.
  • Selecting foods that are a particular colour and/or having strict opinions on the packaging or brand of product.
  • Tastes: choosing only sweet, savoury, spicy or bland foods.

Being faced with a food that doesn't fit the person's preferred profile can cause a lot of stress. To give you an idea of how it may feel, imagine being told to eat a food totally covered in mould and seeing those around you happily eat it. Now, imagine having to go through this every time you are faced with new food.

How to help

Think about your child's food preference profile. For instance: "They like soft, beige-coloured food without strong flavours or smells." From this, you can make a list of meals with similar characteristics. Don't try to introduce them all at once; instead, try one at a time.

Remember you can get creative and prepare foods so that they meet this profile. For example, they might not like the crunch of a carrot but may be more likely to try it if you were to make a soup out of it or a mash.

Dealing with anxiety

It is not uncommon for someone who is highly anxious or stressed, (regardless of whether they have autism) to lose their appetite. But as autism tends to cause higher levels of anxiety, it can have a huge impact on eating. People with the condition can find new situations, people and places incredibly daunting.

Plus, they can be highly sensitive to their environment, especially when it comes to sound. Loud noises can be almost painful, causing high levels of stress. If they are then trying to face a new food in this situation, it is unlikely they are going to want to eat it. This could also cause a food to be black-marked, meaning the child will refuse to try it again.

How to help

Think about when your child is most relaxed and what helps them to feel calm. Use this list to make the process of eating less stressful. For example, if they find lots of noise tricky, try turning off the television or stereo and keep meals to quiet areas.

To reduce anxiety when trying to introduce new foods, try coming up with scenarios or stories about the food being eaten that have happy endings.

A change in routine

Many people with autism like routine and familiarity as it feels safe. This means food and mealtimes can prove a huge challenge. For instance, having to sit in a different place to eat, using an unfamiliar plate or eating at a different time to usual can be hard to process.

How to help

When introducing a new food, try to reduce change in other areas of their environment. If you aren't eating at home, make sure to discuss it with your child beforehand; let them know what to expect and who will be there.

Some extra tips

It won't happen overnight, and that's OK

Introduce new foods slowly. Your child may only look at it the first time, smell it the next, touch it the following time and then eventually try putting it in their mouth. It can take months to get there but it is important to be patient. Try to make it an enjoyable process for them as it will make it easier next time around.

Make sure there isn't an underlying stomach problem

It is common for people with autism to have gut-related symptoms such as stomach pain, constipation, diarrhoea or gas and they may find it hard to communicate it to you. You can use resources such as the pain scales on the National Autistic Society (NAS) website to identify if discomfort is what is causing them to avoid eating or, in some cases, to eat too much food.

If you are concerned that there might be a stomach issue, arrange an appointment with the GP.

Keep talking

If your child's eating behaviour changes - for example, they suddenly start eating more or less - talk to them to find out why. It might be that something has happened which has caused them to want to comfort eat or not eat at all.

Are there foods that can help autism?

Many scientific studies have looked into whether there are foods which can improve symptoms of autism. Currently there are no approved recommendations; however, there is some evidence that certain nutrients may play a part.

Omega-3 deficiency is said to be common. Some studies have shown that giving people with autism omega-3 supplements improves mood and behaviour; while vitamin A, vitamin B3 and magnesium have all also been shown in some studies to improve symptoms. However, none of these is currently an approved treatment option.

If you are concerned that your child may have a deficiency, you can discuss this with your doctor, or seek help from a nutritionist.

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