Picky Eating and Nutrient Supplements

Severe food selectivity issues, also known colloquially as ‘picky eating’, are one of the more common challenges faced by autistic children, writes researcher Ashe Yee.

13 October 2020 – Food sensitivity behaviour can include outright food refusal, preferences for food presented in a certain way (e.g. pureed), and aversions to certain textures, colours, smells, and even brands of food (Kral, Eriksen, Soders, & Pinto-Martin, 2013).

Food selectivity during meals have been commonly featured in the literature for decades, dating back even to a 1979 study that found 90 per cent of autistic children in the study sample reported these kinds of preferences (DeMeyer, 1979). A 2008 study comparing the eating habits of 3 – 5 year old autistic children to neurotypical children discovered that autistic kids were significantly more likely to have a favourite food texture (68% vs 5%), to be a “picky eater” (79% vs 16%), be resistant to trying new foods (95% vs 47%), and less likely to have a diverse diet of different foods (16% vs 58%).

These often-restrictive dietary preferences can be stressful for parents, many of whom worry that their children are at an increased risk for nutritional deficiencies due to the potential lack of healthy variety in their diet. The results of studies conducted on this issue, however, have been very mixed.

There have been many studies conducted that compare macronutrient intakes between autistic and neurotypical children, and there were no significant differences found in intake of carbohydrates, fats, or protein between the two groups (Kral, Eriksen, Soders, & Pinto-Martin, 2013). To illustrate the mixed results of studies examining macronutrient intake, one study showed that autistic children are lacking in protein compared to neurotypical children (Zimmer et al., 2012), while others have shown that autistic children consume significantly more protein than neurotypical children (Herndon et al., 2009), even to the point that they exceed the recommended daily intake (Levy et al., 2007).

Studies on micronutrient intakes have also been somewhat mixed, although more consistent patterns do seem to emerge. Johnson et al., (2008) examined the between-group differences for seven minerals, nine vitamins, fatty acids, and fiber and found no difference between autistic and neurotypical groups. Other studies however, found that autistic children tend to have significantly lower, or inadequate intakes of vitamin A, vitamin D, and calcium (Lockner et al., 2008; Herndon et al., 2009; Bandini et al., 2010).

Addressing Difficulties

It can be very difficult and sometimes frustrating to feed young children, let alone ones with selective eating preferences. For children with extreme eating difficulties, it may require a multi-disciplinary approach to find solutions, such as getting an evaluation from a gastroenterologist and/or a dietitian to develop a comprehensive food and behavioural plan (Kral, Eriksen, Soders, & Pinto-Martin, 2013). Nurses and support workers can also go a long way in helping by focusing on, and rewarding, small changes in behavior e.g. eating just a spoonful of a new food. Repeated small exposures to new foods over a period of weeks can also be beneficial in introducing children to something different and may increase the likelihood of them developing a liking for it.

The above solutions, while often helpful, are not always accessible to all families depending on their location, their finances, or due to long wait lists. Due to the difficulties in getting their children to try new foods and due to worries about nutritional deficiencies, many parents opt to use supplements instead. Unfortunately, as with the micro and macro nutrient research, there are relatively limited studies that have examined the efficacy of multivitamins and mineral supplements for children with autism, and in the ones that have, the results have also been mixed.

Stewart et al., (2015) examined multivitamin and supplement usage among 288 autistic children aged 2 – 11, and found that 56 per cent of children were taking dietary supplements, and that the most common micronutrient deficiencies (vitamin D, calcium, potassium, choline, and panthothenic acid) were not corrected by the supplements. In fact, the supplements caused several micronutrients (vitamin A, folate, and zinc) to exceed the recommended intake levels which can place children at risk for adverse effects. The study concluded that autistic children have similar micronutrient intake levels as neurotypical children, and these needs tend to be met by their respective regular diets. The micronutrients that they were getting from their daily meals are also the same micronutrients commonly found in multivitamins and supplements, which explains the excessively high levels of some vitamins and minerals. Unfortunately, the micronutrients that autistic children and neurotypical children are missing from their daily meals are rarely included in general purpose nutritional supplements.

Verdict

The use of supplements and multivitamins for autistic children is a difficult area to navigate. There are many mixed studies on how effective they are, and even when they do target a specific nutrient deficit, it is not always enough to bring it to an appropriate level (Stewart et al., 2015).

Furthermore, when parents are investigating the use of supplements, they may encounter people claiming to be autism experts that are able to ‘cure’ autism via the use of expensive multivitamins and supplements. There is no evidence to support their pseudoscientific claims whatsoever, they are trying to take advantage of families, and they should be avoided at all costs.

If you are considering using multivitamins or mineral supplements, it would be worthwhile to first consult a dietitian, or at the least your child’s pediatrician, to screen for any potential deficiencies. A dietitian should be able to conduct a comprehensive assessment, physical examination, and a blood count to examine nutrient levels, as well as potentially helping with a meal plan. If any nutritional deficits are discovered, like calcium for instance, they would be the best person to recommend supplements to try and target it, or foods to try and integrate into a child’s diet.

Once an appropriate food plan has been developed. The family could then use a behavioural approach to start adding and introducing new foods to the child’s diet. Token systems, social stories, and visual aids are all good ways to help introduce new foods, and there is quite a lot of information around these online. Overall, though it is best to start expanding the diet based on nutritional value.

In conclusion, if parents suspect that their child is experiencing nutrient deficiencies, I would recommend seeking the help of a medical professional to screen their nutrient intake first, rather than assuming that they are based on their selective diet alone and giving them a general multivitamin that they may not benefit from.

  • Ashe Yee – (B.A. – Psychology) – joined the Altogether Autism team as a researcher in late 2019. She graduated from the University of Newcastle in 2016 with a Bachelor in Psychology (First Class Honours). She is passionate about delivering evidence-based information to families in need, and in fighting against the spread of misinformation about autism.
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References

Bandini, L. G, Anderson, S. E., Curtin, C., Cermak, S., Evans, E. W., Scampini, R., et al. (2010). Food selectivity in children with autism spectrum disorders and typically developing children. Journal of Pediatrics, 157, 259-264.

DeMeyer, M. K. (1979). Parents and children in autism. New York Wiley.

Herndon, A. C., DiGuiseppi, C., Johnson, S. L., Leifeman, J., & Reynolds, A. (2009). Does nutritional intake differ between children with autism spectrum disorders and children with typical development? Journal of Autism and Developmental Disorders, 39, 212-222.

Johnson, C. R., Handen, B. L., Mater-Costa, M., & Sacco, K. (2008). Eating habits and dietary status in young children with autism. Journal of Developmental and Physical Disabilities, 20, 437-448.

Kral, T. V. E., Eriksen, W. T.., Soders, M. C., & Pinto-Martin, J. A. (2013). Eating behaviors, diet quality, and gastrointestinal symptoms in children with Autism Spectrum Disorders: A brief review. Journal of Pediatric Nursing, 28, 548 – 556.

Levy, S. E., Souders, M. C., Ittenbach, R. F., Giarelli, E., Mulberg, A. E., & Pinto-Martin, J. A. (2007). Relationship of dietary intake to gastrointestinal symptoms in children with autistic spectrum disorders. Biological Psychiatry, 61, 492-497.

Lockner, D. W., Crowe, T. K., & Skipper, B. J. (2008). Dietary intake and parents’ perception of mealtime behaviours in preschool-age children with autism spectrum disorder and in typically developing children. Journal of the American Dietetic Association, 108, 1360-1363.

Stewart, P. A., Hyman, S. L., Schmidt, B. L., Macklin, E. A., Reynolds, A., Johnson, C. R., James, S. J., & Manning-Courtney, P. (2015). Dietary supplementation in children with autism spectrum disorders: Common, insufficient, and excessive. Journal of the Academy of Nutrition and Dietetics, 115(8), 1237-1248.

Zimmer, M. H., Hart, L. C., Manning-Courtney, P., Murray, D. S., Bing, N. M., & Summer, S. (2012). Food variety as a predictor of nutritional status among children with autism. Journal of Autism and Developmental Disorders, 42, 549-556.

 

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