“My Child Has Autism: How Can I Get Them to Try New Food?”

Working in pediatrics, one of the most common questions you may encounter from parents of children with autism spectrum disorder (ASD) is about their child's diet, specifically the lack of variety in their diet. Understanding the nutritional needs and challenges faced by children with autism is crucial for providing effective guidance to their families. In this post, we'll discuss key nutrition recommendations and actionable suggestions to help support the dietary needs of children with autism.

Understanding the Unique Nutritional Needs of Children with Autism:

Children with autism often exhibit highly selective eating habits, sensory sensitivities, and food aversions, which can make mealtimes challenging for both the child and their caregivers. Additionally, research suggests that individuals with autism may have altered gut microbiomes, metabolic differences, and nutrient deficiencies, further emphasizing the importance of addressing their nutritional needs. It is crucial that you are sensitive to the stress and burden this places on families and realize that the traditional guidelines for “picky eaters” usually will not work for children with autism.

Key Nutrition Recommendations:

1. Ensure Adequate Nutrition: Encourage families focus on providing a balanced diet that includes a variety of nutrient-dense foods. While it's common for children with autism to have preferred foods, aim to incorporate a wide range of foods, often, to meet their nutritional requirements.
2. Address Sensory Sensitivities: Recognize and accommodate sensory sensitivities related to food texture, flavor, color, and temperature. Food chaining and sensory progression methods can be effective strategies for introducing new foods gradually and making mealtimes less stressful.
3. Offer Preferred Foods with Modifications: While it's important to introduce new foods, also consider modifying preferred foods to improve their nutritional value. For example, if a child enjoys cheesy crackers, gradually incorporate vegetables like broccoli by mixing them in or offering them as a dip.
4. Involve Children in Meal Preparation: Engage children in meal preparation activities to increase their exposure to different foods and empower them to make food choices. This can help build their confidence and willingness to try new foods. This can begin at the grocery store by allowing the child to place vegetables in the cart. Depending on the child’s severity, he can help wash or season the food. You may suggest they act like the “waiter” and serve the family the food.
5. Promote Play-Based Learning: Use play-based activities to introduce new foods in a fun and interactive way. Sensory experiments, cooking projects, and food-related games can help children explore and become more comfortable with different foods.
6. Set Realistic Expectations: Help parents set realistic expectations for their child's dietary progress. Acknowledge that introducing new foods may take time and patience, but small steps can lead to significant improvements over time.

What Should Clinicians Say:

When you’ve got less than 5 minutes:

Find out what the parents’ MAIN concern is: If the parent doesn’t come out and say it, ask them, “what is the main difficulty you’re facing right now?” It is OK to say that there isn’t enough time to fix everything, but you CAN offer 1 small strategy they can work on. “Unfortunately, today’s visit doesn’t give us enough time to explore all of his feeding challenges, but I do think nutrition is important and want to provide you with some guidance. What is the main thing you need my help with today?”

Quick Tips for Common Issues: Offer one or more of these ideas for the family to start to implement this week.

• Create a Structured Mealtime Routine: Establishing a consistent mealtime schedule can help reduce anxiety and provide predictability for children with autism. Aim for regular meal and snack times to promote a sense of routine and familiarity.
• Use Visual or Audio Supports: Visual aids such as picture schedules, mealtime charts, or social stories can help children understand mealtime expectations and transitions. Visual supports provide clarity and structure, reducing anxiety and promoting independence during mealtimes. Playing the same song whenever it is mealtime can teach the child what activity is expected.
• Offer Familiar Foods Alongside New Options: When introducing new foods, pair them with familiar favorites to increase acceptance. This helps reduce resistance and encourages children to explore new flavors and textures at their own pace. If placing the new food on the same plate is too overwhelming, allow it to be on the placemat or a napkin off to the side.
• Engage in Sensory Play: Incorporate sensory activities involving food to desensitize children to different textures, tastes, and smells. Activities like finger painting with food or exploring food bins can help children become more comfortable with sensory experiences related to eating. This can be done with dried pasta and dinosaurs or construction trucks.
• Offer Choices and Control: Empower children by providing limited choices during mealtime, such as selecting between two types of fruits or vegetables. Offering control over food selection can increase autonomy and reduce mealtime resistance. Instruct the parent to say, “Would you like an apple or an orange as a snack?” Rather than, “what do you want for a snack?”

Remember to approach feeding challenges with patience, flexibility, and a focus on promoting positive mealtime experiences.

When you’ve got more than 10-15 minutes:

For children with autism spectrum disorder (ASD), mealtime can be a challenging experience due to selective eating habits and sensory sensitivities. In addition to the above recommendations, consider teaching the parents about food chaining and sensory progressions, two effective strategies to introduce new foods and improve dietary variety while accommodating sensory preferences.

1. Food Chaining: A method used to gradually expand a child's food preferences by introducing new foods that are similar to their preferred foods. The process involves identifying preferred foods and gradually transitioning to similar but less preferred options. Here's how it works:

• Identify Preferred Foods: Start by creating a list of foods that the child readily accepts and enjoys eating.
• Find Similar Alternatives: Look for foods that share similar characteristics with the preferred foods in terms of flavor, texture, color, smell, and shape.
• Introduce Gradually: Begin by introducing small changes or modifications to the preferred foods, such as different brands or variations in preparation methods.
• Transition to New Foods: Gradually transition to less preferred options by gradually altering the sensory characteristics of the food while maintaining familiarity.
• For example, if a child enjoys chicken nuggets, the food chaining process may involve gradually transitioning from breaded nuggets to a different brand or shape to grilled or baked chicken tenders, then to plain grilled chicken strips. How long this process takes is completely dependent on the child, but 6 months is a good expectation to explain to the parent.

2. Sensory Progressions: focuses on gradually exposing children to new foods through sensory exploration and desensitization techniques. The process involves systematically introducing foods based on the child's sensory preferences and gradually increasing exposure over time. Here's how it works:

• Meet the Child at Their Comfort Level: Start by identifying the child's comfort level with different sensory experiences related to food, such as touching, smelling, and tasting.
• Gradual Exposure: Introduce new foods in small, manageable steps, starting with less intimidating sensory experiences (like look and touch) and gradually progressing to more challenging ones (like smell or kiss).
• Clear Expectations: Clearly communicate expectations to the child and provide a supportive environment where they feel safe to explore new foods at their own pace.
• Positive Reinforcement: Use positive reinforcement and rewards to encourage the child's willingness to engage with new foods and sensory experiences.
• For example, if a child is hesitant to touch or smell a new food, the sensory progression process may involve starting with simply having the food present on the table, then gradually progressing to touching, smelling, and eventually tasting the food.

Overall, food chaining and sensory progressions are valuable tools for supporting children with autism in expanding their food preferences and promoting healthy eating habits. By incorporating these strategies into mealtime routines, you can help children with autism develop a more varied and nutritious diet while respecting their sensory needs and preferences.

Finally, encourage the family to work with Registered Dietitians and feeding therapists to provide further comprehensive support for the child's dietary and developmental needs.

By addressing the nutritional needs of children with autism and providing guidance and support to their families, you play a crucial role in promoting their overall health and well-being.

If you would like more information on nutritional strategies for patient’s with autism, listen to episode 40 | Nutrition for Autism: Manage Mealtime Meltdowns with a Sensory-based Approach on The Exam Room Nutrition Podcast here: https://www.examroomnutritionpodcast.com/40-nutrition-for-autism-manage-mealtime-meltdowns-with-a-sensory-based-approach/