Picky Eating
What is Picky Eating?
Just like autism, there is a spectrum to picky eating, too! One parent may say their child who won’t eat a few certain veggies is a picky eater, while another parent may define their child’s picky eating as exclusively eating 2 foods. It’s clear there can be a huge difference in everybody’s meaning behind “picky eating” and there is no consensus on the definition, even among healthcare professionals. If your child does have an extremely limited diet, it’s helpful to have terminology that can help you communicate the severity of your child’s picky eating to your pediatrician, dietitian, or other therapist to help your child get the support they need.
If we think of picky eating being on the spectrum of “feeding difficulties”, then “picky eating” would be the most common at one end, with more severe feeding disorders at the other [1]. If you feel like your child’s picky eating is much more complicated and severe than “typical picky eating”, please read in the section below about Pediatric Feeding Disorder (PFD) and ARFID.
A limited diet can increase risk of a variety of nutritional concerns including nutrient deficiencies, poor growth, chronic constipation, underweight/overweight, or developing an eating disorder. Addressing your child’s picky eating sooner than later and with the correct approaches can make a huge difference in their success with eating later in life. Many of the typical picky eating approaches do not take into account neurodiversity, autism, or sensory sensitivity, so it’s important to utilize approaches that do.
Extreme Picky Eating: PFD & ARFID
If you feel your child’s diet is more than just “typical picky eating”, follow your gut! There is no harm in pursuing additional help, even if you find later on it is not needed. You know your child best, and the objection that they don’t need feeding support because they are plotting on their growth curve or “look healthy” is oversimplified. A child can still be an extremely selective eater and be a normal weight or even overweight, but also have vitamin & mineral deficiencies.
Two diagnoses, Pediatric Feeding Disorder (PFD) and Avoidant-Restrictive Food Intake Disorder (ARFID) can help provide terminology to help you communicate your child’s feeding struggles and help your child get the care that they need.
PFD is defined as impaired feeding that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction. It’s estimated that PFD affects 1 in 37 children under the age of 5 in the United States each year [#]. If you think your child may have PFD, you can complete the Feeding Matters Infant and Child Feeding Questionnaire and access resources through Feeding Matters.
In contrast, ARFID was created as a mental health diagnosis to describe children who have extreme feeding problems and risk of nutritional deficiency, but that do not have body image, shape, or size (like anorexia). Feeding Matters suggests that If a patient has a diagnosis of ARFID, it may be worth reassessing from the pediatric feeding disorder (PFD) perspective to see if the cause of feeding difficulties might include a medical or skill dysfunction, and not be purely behavioral.
To learn more about the difference between PFD and ARFID, click here.
Picky Eating & Autism
Picky eating and food avoidance is very common in those on the autism spectrum [2], some studies suggesting that upwards of 90% of kids with ASD experience some type of feeding concern [3, 4]. There are a variety of reasons for picky eating in autism, but some of the most common are:
Sensory Sensitivity
The most common reason for picky eating in autism is sensory sensitivity, often due to Sensory Processing Disorder. Eating is one of our most sensory-rich activities and involves all of our senses at once. Eating can easily be overwhelming for kids who are already at risk of overstimulation. Because of this, many children choose sameness in their diet to reduce sensory overwhelm. This may be a certain texture (often crunchy), a color (often beige/white), a certain taste, temperature, or smell. It’s common for packaged, processed, and fast foods to be the foods they navigate toward the most as they will be the same every time they eat it. Foods like fruit, veggies, meats, or whole grains often have undesirable textures, unfamiliar colors/shapes, and/or may require more oral motor strength to eat (many kids on the spectrum also have low muscle tone).
Gastrointestinal Issues
Another common reason for a limited diet is gastrointestinal issues and discomfort. If your child is chronically constipated or has other GI concerns, you may consider if this is playing into their dietary choices. It’s not uncommon for kids struggling with gut issues to prefer bland, starchy foods that are easier to stomach and digest. Unfortunately, these foods only further contribute to stomach upset, gut bacteria imbalance (dysbiosis), or yeast overgrowth. In this case, addressing their gut issue(s) is one vital piece to resolving their picky eating.
Low Muscle Tone or Dysphagia
Other reasons for picky eating in autism include chewing/swallowing difficulties or low muscle tone, which is common in autism. If they are physically unable to eat a food, no amount of hunger or force is going to be successful in making them eat. Discussing this with your child’s speech language pathologist or occupational therapist can be helpful to identify if this is a problem for your child.
Deficiencies & Medications
Nutrient deficiencies in a variety of nutrients including iron, zinc, vitamin B12, magnesium, and vitamin D may cause lack of appetite and/or abnormal sense of smell & taste. Additionally, certain medications, such as stimulants, may cause lack of appetite and/or increase in metabolic rate. Consult your pediatrician if you are concerned about this issue for your child.
BOTTOM LINE:
Picky eating is especially common in children on the autism spectrum due to sensory sensitivity, among other reasons. Picky eating can range from mild to extreme, and getting support sooner than later can help your child have feeding success later in life. Many of the typical picky eating approaches do not take into account neurodiversity, autism, or sensory sensitivity, so it’s important to utilize approaches that do.
Our Top Picky Eating Tips for Autism
While it’s best to work alongside a dietitian or feeding therapist who specializes in picky eating for autism, there are a few things that you can try at home to start expanding your child’s diet. (Also - if you haven’t yet checked out our Roadmap - there is an entire lesson dedicated to picky eating!
1. Find Your Child’s Food Sensory Profile
Take a few minutes to reflect on your child’s diet. What are their favorite foods? Do you notice any similarities or patterns? For example, you may notice that your child’s favorite foods are chicken nuggets, french fries, and potato chips. All of these foods are crunchy, beige/white, and salty.
2. Offer Foods Within Their Sensory Profile
Instead of skipping straight to a green vegetable (we’ll get there eventually!), start with a food that feels more familiar and perhaps resembles one of their current safe foods. In the example above, the child preferred crunchy, beige/white, and salty foods. Maybe you start with a plantain chip and work your way from there! It doesn’t have to be the perfect & healthiest food to start. We are working on building confidence and positive experiences with exposure.
3. Take Gradual, Sensory-Friendly Steps
Instead of skipping straight to asking your child to “take a bite”, consider starting with minimal exposure (or just one sensory experience) and building on it. You could start by having the food on a separate plate and simply talking about the food in neutral descriptors (What color is it? What else do you know that is the same color?) and gradually move up to more involved exposure like using a spoon to serve another member of your family, using kid-friendly cutting tools to help prep the meal (or just have fun!), smelling it, giving it a lick, chewing and spitting it out, etc.
Don’t put too much pressure to move up these steps too quickly and try to follow your child’s comfort level.
4. Start Small and Safe
Only present one new food at a time, and start with a small serving size, even as small as your pinky fingernail! Be sure to always have at least one or two safe foods available at the same meal.
5. “The Rule of Ten”
It takes at minimum ten times for a child to try a food before deciding if they like it or will eat it. For kids with autism, this number often increases to 20-30. Be patient and set your expectations that your child likely won’t like this food the first few times you expose them to it, but this exposure is what will help push the needle forward!
6. Follow a Consistent Routine
Try to have as consistent meal times as possible throughout the day and a similar routine leading up to mealtime. Children on the autism spectrum thrive in routine, so having some sameness around food can help reduce anxiety and overwhelm leading up to trying something new.
Example: March to wash hands → march to the table → sit down → take a deep breath/say grace/a moment of silence → start mealtime → when mealtime is over have child clean plate off into the trash (or aid them in doing this) → put plates in the dishwasher or sink → mealtime is over
7. Keep It Positive & Low Pressure
It’s so understandable to feel frustrated when your child won’t try something new. Sometimes you just know that if they took a bite they’d like it! However, pushing a child to take a bite can push them past their sensory limit and may cause a negative experience with that food and may cause more anxiety around mealtime or that food in the future. Try to keep the conversation light, fun, and about other things than food! Sometimes the less pressure, the more success with eating.
8. Get Professional Support
Feeding experts exist for a reason! You do not have to do this alone. You can find feeding specialists through a few different resources. Take the time to find a therapist that you connect with and is a good fit for your family!
Supplements
It’s common for kids who are picky eaters to miss out on key nutrients. You may consider the following supplements to help fill in nutritional gaps while you work on expanding their diet.
Multivitamins - this is a great place to start to cover all of your child’s nutritional bases. Note that not all multivitamins are made the same, and many are not ideal for kids on the autism spectrum. Click the link to read more about what we are looking for in a supplement and some of our top favorites.
Protein Supplements - many children who are selective eaters do not consume protein-rich foods, including meats. If your child isn’t consuming enough protein day-to-day (find their protein needs here), you may consider a protein supplement.
Fish Oil - omega-3 fatty acids are important for brain health, and especially important for kids on the autism spectrum. Most foods that are rich in omega-3s are not top foods for picky eaters (fish, chia & flax seeds, etc)
Prebiotics - many kids with limited diets miss out on dietary fiber found in fruits, vegetables, and whole grains. Prebiotics are a fiber supplement that can help provide some dietary fiber and prevent/treat constipation that commonly accompanies low fiber intake.
Author
Written by: Brittyn Coleman, MS, RDN/LD, CLT
