Picky eating is a common concern for many parents, yet it often presents with greater intensity in children on the autism spectrum. While many children experience phases of food preferences, food selectivity is a frequent observation in autistic children. This can lead to significant stress at mealtimes for families. Understanding the unique aspects of eating challenges in autistic children is an important step toward addressing these concerns.
Understanding Food Selectivity
Food selectivity, or picky eating, is notably more common among autistic children than their neurotypical peers. Research indicates that the prevalence of feeding problems in autistic children ranges from 46% to 89%, a significantly higher rate compared to the 10% to 35% in neurotypical children. While all children can be picky, food selectivity in autistic children often differs in nature and intensity, involving a narrow range of accepted foods. These preferences frequently lean towards starches and snacks, with frequent rejection of fruits and vegetables.
In some cases, this food selectivity can be severe enough to be classified as Avoidant Restrictive Food Intake Disorder (ARFID). ARFID is a feeding disturbance characterized by avoiding or restricting food intake, typically due to sensory characteristics of food, fear of choking, or lack of interest. This can lead to nutritional deficiencies or psychosocial impairment. While not all picky eating in autism constitutes ARFID, autistic individuals are at a higher risk for this condition; one study found one in five autistic participants at high risk.
Underlying Factors of Food Selectivity
Several factors contribute to food selectivity in autistic children, often stemming from the core characteristics of autism. Sensory sensitivities play a significant role, as autistic individuals can be over or under-sensitive to various sensations, including those related to food. This can manifest as strong aversions to specific tastes, smells, textures, or even the visual appearance of food. For instance, some children may refuse foods with a mushy texture, strong odors, or certain colors, limiting their food choices.
Anxiety and the need for predictability also significantly influence eating habits. Autistic children often thrive on routine and sameness, and changes in food presentation, type, or mealtime environment can induce distress and refusal. The unpredictable nature of food itself, with its varied sensory properties, can be a source of anxiety. This rigidity can extend to brand-specific preferences, where a child may only accept a specific brand.
Challenges with oral motor skills can also contribute to food selectivity. Some autistic children may experience difficulties with chewing, swallowing, or coordinating the movements required to manage certain food textures. This can lead to an aversion to foods that are difficult to chew or swallow, sometimes resulting in a preference for softer or liquid foods. Furthermore, difficulties with interoception, sensing internal states like hunger or fullness, can affect eating patterns. If a child struggles to accurately perceive these internal cues, their eating behaviors may appear inconsistent or atypical.
Strategies for Supporting Eating Habits
Creating a predictable and structured mealtime environment can significantly support autistic children with food selectivity. Establishing consistent meal and snack times each day, alongside familiar settings, can reduce anxiety and promote a sense of security. Visual schedules indicating when meals will occur and timers to define meal duration can also be beneficial in setting clear expectations. Limiting access to other foods or drinks between meals can help ensure children are genuinely hungry when it is time to eat.
Sensory integration approaches are helpful for gradually expanding a child’s food repertoire. This can involve slow, repeated exposure to new foods in non-pressured ways, allowing the child to interact with the food without the expectation of eating it. Modifying textures of existing accepted foods, such as pureeing or mashing, can also be a gentle introduction to different sensory experiences. Utilizing sensory tools, like weighted utensils, might make the eating process more comfortable for some children.
Positive reinforcement plays an important role in encouraging new food acceptance. Approaching mealtime challenges with patience and positivity, celebrating small successes, and avoiding coercive tactics can foster a more relaxed eating environment. Involving the child in food-related activities, such as grocery shopping, washing produce, or simple food preparation, can increase their engagement and willingness to try new items. This participation can help desensitize them to new foods outside of the pressure of eating.
Seeking professional support is often an important step for families navigating significant food selectivity. Pediatricians can rule out underlying medical conditions, such as gastrointestinal issues or allergies, which might be contributing to eating difficulties. Occupational therapists (OTs) can address sensory sensitivities and oral motor challenges, while speech-language pathologists (SLPs) can assist with chewing and swallowing difficulties. Registered dietitians specializing in autism and feeding disorders can provide guidance on ensuring nutritional adequacy, possibly recommending supplements if necessary, within the child’s accepted food range.