Can’t Eat Won’t Eat
Written by Stella Chadwick for the Summer 2021 edition of the Autism Eye Magazine
Feeding issues amongst children with autism are far too common. The challenges tend to be eating a limited food selection, showing anxiety or tantrums when presented with new foods, and/or having ritualistic eating behaviours, such as not wanting different types of food to touch one another. In fact, research has shown children with autism are five times more likely to have such mealtime challenges.
FEEDING A CHILD WITH AUTISM
As well as sensory, texture, and environmental control factors, children with autism often suffer from issues with digestion and absorption, food and chemical sensitivities, oxidative stress, compromised immune function, mitochondrial disorders, impaired detoxification systems and higher than normal bacterial, viral and parasitic load. It doesn’t always have to be complicated though. For example, many children we see in our clinics are low in iron and zinc amongst many other nutrients. A deficiency in either of these nutrients can cause poor appetite, poor sleep, PICA (eating non-food items), anxiety, OCD, shortness of breath, dizziness leading to poor balance. In many cases by simply correcting these nutrients through diet and targeted supplements can make a significant difference in alleviating these symptoms.
Your child’s brain development, detoxification system, gastrointestinal health, immune function and general growth and development are highly dependent on the macronutrient content of foods such as protein, carbohydrates, and fats but also on vitamins, mineral, amino acids and fatty acids. This can create a viscous cycle where poor or limited food choices impact body and brain health and in turn impact mood, behaviour cognition, ability to sleep and focus and so on. As a parent or caregiver, you want to gently expand a narrow diet with sustainable, practical and achievable methods.
MAKE SURE IT’S NOT MEDICAL
Gastrointestinal distress is common among children with autism and the fear that food may cause pain may make your child refuse to eat. If you suspect this is the case, ask your GP for a referral to a Gastroenterologist for a thorough investigation. Constipation is a symptom we often see in our clinics and this alone can cause lack of desire to eat and a congested system with poor nutrient uptake. Chronic constipation that doesn’t respond to basic treatment can be due to a multitude of reasons, including poor hydration, lack of fibre, low hydrochloric acid in the stomach, low level of enzymes, and in extreme cases due to nerve damage to the colon or impaction. There are other possibilities which need to be discussed in detail with your medical professional.
CONSIDER FOOD INTOLERANCES
It will not come as a surprise that a subset of children with autism are extremely sensitive to processed sugar, additives and preservatives which tend to be the foods they crave. It is also reasonably well known that some children can be intolerant to gluten and dairy and in our clinical practice by removing these foods whilst ensuring a nutritionally rich and diverse diet has shown to improve bowel function, reduce hyperactivity, increase focus, reduce behavioural problems, improve communications and sleep. An excellent book on this topic is written by Paul Whitely, Autism: Exploring the Benefits of a Gluten-and Casein-Free Diet. What may be surprising is that some children have difficulty processing certain compounds in “healthy foods”. The key sensitivities are around the following groups of foods:
Phenols, found in large quantities in foods such as berries, cherries, some apples, grapes, tomatoes, peppers and so on (to find out more please read our article on Phenols in the winter 2021 issue of the Autism Eye Magazine)
Oxalates; such as in spinach, carrots, beets, chard, almonds, chia seeds and so on (to find out more please read our article on Oxalates in the winter 2020 issue of the Autism Eye Magazine)
Histamine; such as those found in aged meats and cheese, fermented foods like sauerkraut, tomatoes, citrus fruits, avocados and so on (to find out more please read our article on histamine in the Winter 2017 issue of the Autism Eye Magazine).
Many of these issues are due to an unbalanced and unhealthy gut ecosystem and our clinic specialises in working with children to navigate through these complex food challenges and provide parents with a comprehensive dietary programme that is achievable and actionable to help support the health of the child. We assess children’s needs through detailed and evidence-based food sensitivity testing and through detailed clinical assessment to ensure we can help identify allergies, sensitivities and deficiencies that may be affecting the food choices the child makes. Always work with a qualified professional when implementing elimination/challenge diets.
STAY CALM AND BE PATIENT
This is easier said than done of course but avoid turning mealtimes (three times a day!) into stressful battles by setting realistic (small) goals and celebrating the smaller steps towards an eventual larger target. Children should only be expected to sit and eat for a limited number of minutes. Start with 1 minute per year of age and increase this by 1-2 minutes each day. Using a timer can be a great way to implement this. In general, the time should not be more than 20 minutes and much less if younger. For example, a 2-year-old should only be expected to sit and eat for between 12-15 minutes. Conversely there are kids who will take forever to eat! This is when we use the timer the other way around. If your child routinely sits for 30 minutes or more start reducing the time by a minute or 2 each day until you have reached the appropriate time for their age.
HELP A CHILD FEEL IN CONTROL
Many children with autism like routine and to have control over what is happening to them. At mealtimes this means that they could benefit from wanting to be included in the planning, shopping for, choice and arrangement of food. It’s also important to allow your child decide whether to eat and how much to eat. This is probably going to be the most challenging for a parent to implement as it is our instinct to feed our kids come what may! Pressuring a child to eat and offering a reward, such as a dessert after a certain number of bites, does not work and can put a lot of pressure on kids and make them even more picky. This doesn’t mean that you let the child do and eat whatever they want, but we need to make some simple rules to help.
- For a child with autism or other additional needs, new foods can be alarming – so don’t expect a child to progress straight to eating a food without first looking, touching and smelling it. In this instance ‘playing with your food’ is to be encouraged – so the item becomes less intimidating and more familiar.
- Persevere and serve the “new” food with “known” foods multiple times before it may be accepted. This can mean showing that food upwards of a dozen times!
- Many children don’t like foods to touch each other, and using a dividing plate can be a simple, fun, and effective way to help alleviate the stress. Also making food shapes and using colourful fun utensils can add to the excitement of eating.
CONSIDER FOOD TEXTURE
Hypersensitivity to textures and sensory issues are common among children on the spectrum. This can affect the type of foods they like to eat – to the point that crunchy foods are considered too loud when consumed or softer foods like a tomato are unbearable in the mouth. Work around this by cooking, chopping or blending food – or adding it to a sauce. If crispy or crunchy food is preferred then look to replace unhealthy options with those that offer maximum nutrition, but have the right texture for your child. There are a number of recipe ideas on our www.brainstormhealth.co.uk website which may inspire you).
You can do all this alongside the longer-term work of expanding food choices, allowing you to become more relaxed about meeting your child’s nutritional needs.
Children that struggle physically to eat – such as those with poor muscle tone in their gums – may also like to warm up to eating by preparing the mouth with blowing bubbles, sucking a drink through a curly straw, or using an electric toothbrush.
KNOW WHEN TO SEEK HELP
If you have ruled out all medical issues and have tried all the tips that normally work for children and your child is still struggling to eat then consider that your child is not just a “picky eater” but potentially a “problem eater” with complex needs. This is when a team consisting of a, Dietician or Nutritional Therapist, OT, Speech and Language Therapist, Behavioural Therapist may need to be involved. According to Elizabeth Strickland, the author of Eating for Autism, problem feeders have the following key characteristics:
- Eat fewer than 20 foods and keep reducing the number of foods they will accept
- Refuse to eat foods from entire categories of texture
- Will eat the same favourite food every day but will burn out and stop eating the food completely
- Cry and/throw a tantrum when offered a new food.
- Won’t tolerate a new food on their plate and unwilling to even touch or taste the food
- Very inflexible about particular foods (for example, they will eat only McDonald’s French fries not Burger King’s)
Helping your child to expand the range of food they accept, and to learn to try new and unfamiliar foods, may be a lengthy process, but an important one if you want your child to be healthy in the short and long-term. In very few cases you may require the help of a specialist team but mostly, as a parent you can make great progress following some simple rules, ensuring that you congratulate yourself and your child each step of the way of this vital journey.
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