How does autism affect eating? A parent’s guide for picky and selective eaters

Written by Marci Fults, DO and medically reviewed by Rashelle Berry, MPH, MS, RDN, LD

Highlights

• Almost all parents of children with autism report some form of eating concern like food selectivity, rapid eating, chewing problems, food stealing, vomiting, etc.
• If you have a selective eater, see your pediatrician to rule out a possible nutritional deficiency and/or underlying medical causes of your child’s eating issues
• Autistic children need extra time to visually explore, smell, and touch their food before tasting it
• Autism feeding therapy can be offered through a number of different types of providers including speech and language pathologists, occupational therapists, behavioral therapists, and nutritionists
• Applied behavior analysis (ABA) is a type of behavior therapy that will aim to improve behaviors with mealtimes and increase dietary variety and decrease unwanted behaviors such as food refusal

Autistic children are more than 14 times more likely to have atypical eating habits.¹ These challenges can cause a lot of stress for children and their families. Let’s take a look at why food can be so stressful for your child, expert tips to overcome mealtime issues, when it’s time to see your pediatrician, and options for feeding therapy.

What kind of mealtime issues are common?

Some issues commonly reported by parents include food selectivity, food refusal (when children refuse to eat all or most foods presented to them), rapid eating, chewing problems, food stealing, and vomiting.²

Even though these issues are incredibly common, some parents of autistic children feel blamed for their child’s poor eating habits, and valid concerns can be ignored. They often hear frustrating and isolating comments from other parents like:

• “All children go through a picky eating phase, it’s not a big deal.”
• “You just have to show them who is in charge at mealtime — at our house, no one leaves the table until their plate is clean.”
• “I understand your frustration, my child is also sooo picky and never wants to eat their vegetables.”

It isn’t you.

Studies show that children with autism have significantly more mealtime problems than their sibling(s) living in the exact same environment!³ So, be sure to give yourself a break. You can love your child and all the things that make them unique and wonderful and still feel sad/angry/at your complete wit’s end.

So… most parents say their kids are reluctant to try new foods. What’s the difference between common pickiness and more selective eating?

Unfortunately, there is no current criteria to define minor picky eating habits vs. more severe selective eating. We talk a lot about the autism spectrum and how it affects children differently and in a range of intensity, and it can be helpful to think of your child’s relationship with food in a similar broad spectrum. Some children will exhibit minor picky eating habits like reluctance to try new foods that they will outgrow in childhood. Other children might exhibit more severe eating patterns such as eating only one type of food or refusing solid foods altogether.⁴ Here are a few specific examples of picky-eaters and more severe selective eaters.⁵

But doesn’t everyone love food?! What is it about food and eating that make it so difficult for autistic children?

It may not seem obvious, but eating is a complex behavior that involves perceptual, emotional, and cognitive processes. And we know that children with autism process things differently. While many of us look forward to things like our afternoon snack, it may be an activity that causes a lot of anxiety for your child.

Parents describe food selectivity being determined by a few of the following factors: texture (69%), appearance (58%), taste (45%), smell (36%), and temperature (22%).⁴ Uniform texture, bland and neutral color foods are reported to be overwhelmingly preferred by more than 90% of children with ASD.¹

Supporting Your Selective-Eater

First understand how your child perceives food so that you can create a positive mealtime experience. Though all children are different, let’s take a look at some of the senses involved in eating and how some children with autism may be experiencing them:

Sight: Autistic children spend more time looking at their food.

A research study was curious how children with autism visually explored food differently than neurotypical children. They found that when shown pictures of different foods, children with autism visually explored the images for longer. And while children without autism tended to explore complex looking foods (e.g., sushi, chicken parmigiana, etc) for longer than simple foods (e.g., crackers, cheese sticks, etc), children with autism explored simple and complex foods for the same length.⁶

How can you apply this understanding at mealtime? Understand that your child needs time to visually explore their food before tasting it. And while it may be intuitive to think that complex looking foods are more intimidating to try, your child will need the same amount of time to visually explore simple foods you place in front of them as well. Additionally, if a food is “broken” or not perfect-looking, your child might even refuse a preferred food.

Smell: How a food smells matters a lot to your child.

While you may have the urge to deeply breathe in the pleasant smell of a fresh baked pie and plug your nose at less appealing stewed cabbage, your child may feel differently. Researchers have found that children with autism do not take larger sniffs for ‘pleasant’ odors in comparison to ‘unpleasant’ odors.⁷

How can you apply this understanding at mealtime? Just because they smell a food intently or for a long time, it isn’t necessarily because the smell appeals to them. When they are using smell to interact with their food before tasting it, ask them if they like or dislike the smell. Also consider the smells produced when you cook food, and if that is preventing your child from coming to the kitchen at mealtime.

Touch: Autistic kids tend to be more sensitive to objects and textures.

The concept of ‘oral tactile defensiveness’ sounds complex but many parents may be familiar with the concept. It describes the over reaction a child may have when objects come in contact with their mouth (food, tongue depressor at the doctor’s office, etc.).⁸ In addition to this general over responsiveness, it is well known that autistic children are very sensitive to textures.

How can you apply this understanding at mealtime? The simple act of moving a fork near your child’s mouth may spark a meltdown if they are not comfortable. Give them time to look, smell, and touch the food before eating utensils are picked up or in sight. Some children will not want to touch food with their fingers or get messy. As far as texture, children with autism also usually prefer meals with uniform textures (e.g., either crunchy and dry, or smooth puree) and are hesitant with mixed textured foods.⁹

Phrases that Help and Hinder Your Selective-Eater

Now that we have a better understanding of how your child perceives and responds to food, take a look at the chart below for some tips on how to encourage your selective eater and what to avoid.¹⁰

Professional Care

You should also consider scheduling an appointment with your pediatrician if you have a selective-eater. Your doctor will check if there are any possible nutritional deficiency and/or underlying medical causes of your child’s eating issues (food allergies, chronic constipation, etc.). A 24-hour food diary can be helpful information to bring to your appointment.

Feeding Therapy

Your doctor may recommend feeding therapy to help your child with their negative feelings and behaviors towards food. Feeding therapy can be a part of your existing speech and language, behavior, or occupational therapy. For example, a speech and language pathologist (SLPs) can help with chewing and swallowing related issues and an occupational therapist (OT) can help with fine motor skills related to eating. Applied behavior analysis (ABA) is a type of behavior therapy that will aim to improve behaviors with mealtimes and increase dietary variety and decrease unwanted behaviors such as food refusal.

Professionals trained in feeding therapy will work with your child and help support parents as well. Some other specific feeding issues that may be addressed during feeding therapy include:

• Trouble feeding oneself
• Food aversions
• Poor posture and/or body control
• Sensory and texture issues

Next Steps

Is your child getting a complete diet? Learn how you can support your autistic child’s caloric needs, feeding strategies, and more with our learning center!

Join our Foodie Friday community channel for more tips! If your child has other health conditions, be sure to speak with your pediatrician about special dietary needs.

Resources for Parents

The AAP Parenting Website: www.healthychildren.org

Dietary Guidelines for Americans: www.dietaryguidelines.gov

USDA: Food and Nutrition Service: www.fns.usda.gov

HHS: Food and Drug Administration: www.fda.gov

Let’s Move!: www.letsmove.gov

MyPlate: U.S. Department of Agriculture: www.myplate.gov

References

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2. Leader G, Tuohy E, Chen JL, Mannion A, Gilroy SP. Feeding Problems, Gastrointestinal Symptoms, Challenging Behavior and Sensory Issues in Children and Adolescents with Autism Spectrum Disorder. J Autism Dev Disord. 2020;50(4):1401–1410. doi:10.1007/s10803–019–04357–7
3. Nadon G, Feldman DE, Dunn W, Gisel E. Mealtime problems in children with Autism Spectrum Disorder and their typically developing siblings: A comparison study. Autism. 2011;15(1):98–113. doi:10.1177/1362361309348943
4. Williams K, Seiverling L. Broccoli Boot Camp: Basic Training For Parents Of Selective Eaters. Bethesda: Woodbine House; 2019:1–15.
5. When does autism-related picky eating cross the line to feeding disorder? Autism Speaks. https://www.autismspeaks.org/expert-opinion/when-does-autism-related-picky-eating-cross-line-feeding-disorder. Accessed March 23, 2022.
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10. Phrases That Help and Hinder. Hungerandhealth.feedingamerica.org. http://hungerandhealth.feedingamerica.org/wp-content/uploads/legacy/mp/files/tool_and_resources/files/phrases-that-help-and-hinder.pdf. Published 2022. Accessed March 14, 2022.
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13. Marı ́-Bauset S, Zazpe I, Mari-Sanchis A, Llopis-Gonza ́ lez A, Morales-Sua ́ rez-Varela M: Food selectivity in autism spectrum disorders: a systematic review. J Child Neurol 2014, 29:1554- 1561.
14. Eating Habits: When to Worry | Marcus Autism Center. Marcus Autism Center. https://www.marcus.org/autism-resources/autism-tips-and-resources/eating-habits-when-to-worry. Published 2022. Accessed March 15, 2022.
15. Mayes S, Zickgraf H. Atypical eating behaviors in children and adolescents with autism, ADHD, other disorders, and typical development. Res Autism Spectr Disord. 2019;64:76–83. doi:10.1016/j.rasd.2019.04.002