Christmas can be a challenging time for many reasons, and if you have a family member with food sensitivities, celebratory meals can become a battle field, writes Dianne Ferguson. 

Children with autism frequently have significant feeding difficulties with a highly restricted range of foods being eaten.

Feeding difficulties may be the first early problem a child may present with, in a child who later goes on to be diagnosed with Autism Spectrum Disorder (ASD).

Early feeding difficulties may include later acceptance of solids than is typical and being “slow feeders” at six months of age.

From 15 months until 54 months they are reported to be consistently difficult to feed and over time their diet may become more and more restricted. These feeding issues can be very stressful for the child and family. Contributing factors that interfere with development of feeding in children with ASD are medical problems, poor oral motor development, sensory difficulties, communication deficits, learning differences, and behaviour problems.

If you are concerned about your child’s restricted diet start with a visit to his/her GP to rule out any medical issues such as constipation. It may also be worthwhile seeing a dentist to rule out tooth ache being the cause of your child not eating well.

The following are some suggestions to encourage your child to try new foods and eat a varied diet.

Food Diary

Complete a food diary for three days. Record everything your child eats, the time of day and the amount they eat. This will provide you with some useful information about your child’s eating patterns and help you to understand the reasons for your child’s restricted diet. Sometimes this can be reassuring as you may find that your child actually has a better and more stable diet than you thought. Take note of the colour, the texture, flavour or shape of the food as children with ASD will often only eat food with a certain texture or colour.

Structure and Routine

Children with ASD respond well with structure and routine so having your child eat at the same place and follow the same mealtime schedule and routine each day will help them know what to expect. Warn your child the meal will be ready soon and follow the same routine of washing hands before eating to help them transition to the table for the meal. Sit at the kitchen table for the meal and allow them to sit in the same place using the same plates and cutlery each day if necessary.

Set meal times

Set aside five or six meals/snacks for the day and try not to allow snacking on food or drink between meals as this decreases the appetite and willingness to try new foods.

Preparation for meal times

Encourage your child to be involved in food preparation and to handle the food. This will give them the opportunity to have contact with food without the pressure of eating it. Try making sandwiches, fruit kebabs, and pizzas, measuring ingredients or stirring cake mixtures.

Family meal times

Eat together as a family at the kitchen table. Each person should have some of each food on their plate and there should be at least one preferred food of the child with ASD. If the child cannot tolerate all the foods on their plate, put the food they do not want on a separate plate beside them. Ensure the meal time is a positive experience with encouraging social interaction and talking about the properties of the food without the focus being on the child and their eating. Everyone is to stay at the table and meal times are best limited to no more than 15 – 30 minutes.

Range of food in diet

Make a list of all the food your child will eat and at meal times offer a particular food once every 2-3 days so that foods are rotating though their diet. This will help your child keep eating the foods they currently eat and not eat the same food every day. Try making a very small change to the way the food is presented for a food your child already likes. For example add something to it or change the shape by cutting it in a different way.

Physical Environment

Ensure there are no visual or auditory distractions at meal times and the environment is calm e.g.  turn TV and radio off. Provide a comfortable and supportive sitting position including providing foot support. Physical stability promotes good feeding behaviours and reduces distracting behaviours such as swinging legs. Use a high chair if age appropriate or a booster seat if necessary so your child can reach the table.

Visual strategies

Use a visual schedule to help your child follow the routine at meal times.  For older children menus can be prepared for the day or week. Food books can be made with pictures or photos of foods the child likes and new foods can be added as they increase the range of foods eaten. Social stories may be used to help children learn what to expect at meal times and/or why we need to eat. If your child has a special interest, this can be used e.g. a Thomas the Tank Engine plate, or having animal-shaped chicken pieces. Timers can be used so your child will know when the meal will be ready, or to provide a visual cue as to how long they will be sitting at the meal table

Professional Advice

Seek professional advice if your child is losing weight, showing a sign of poor health is not eating food from all the different food groups and is eating the same food every day and/or they are becoming increasingly more restricted in the range of food eaten. Also seek help if meal time behaviours are causing stress. One or more of the following health professionals may be able to help managing with feeding difficulties:

Dentist – eating difficulties may result in poor dental hygiene management and  a dental nurse can help with tooth decay

Dietitian – can offer advice on healthy eating and provide advice to help with both weight gain and loss.

Clinical psychologist – if the problem is thought to be psychological, these professionals can help to implement cognitive and behaviour strategies

Paediatrician – experts in child health issues who can help provide solutions to dietary issues.

Occupational therapist – may be able to offer advice on how you manage sensory difficulties relating to feeding difficulties.

Speech and language therapist – have a good working knowledge of how the mouth and jaw function and will be able to advise on feeding issues.

Child Development Service – some services have multi disciplinary Feeding Clinics that help children with complex feeding problems.

Bibliography

1. Autism Speaks. (2014). Autism Speaks launches guide for exploring feeding behaviour in autism. Retrieved from Autism Speaks
2. Emond, A., Emmett, P., Steer, C. & Golding, J. (2010). Feeding symptoms, dietary patterns, and growth in young children with autism spectrum disorders. Paediatrics, 126(2), 28.  Retrieved from
3. National Autistic Society. Dietary management. Retrieved from

• Dianne Ferguson is a registered Occupational Therapist currently working at the Child Development Centre at Waikato Hospital, and was also involved in setting up the ASD Coordinator role in Southland as she has a special interest in working with children with an Autism Spectrum Disorder. Dianne is a past member of our Professionals Expert Group and offers some suggestions for encouraging children with ASD to try new foods.
• This article was first published in Altogether Autism Journal Christmas edition, 2014