Feeding issues in autism

What are the feeding issues in children with autism? What are the implications of these problems on function?

Feeding issues in children with autism can be affected by:

Sensory (Environmental)

Medical

Behavioral issues. 

Since sensory issues are involved with feeding, many children with autism will be hypersensitive and will only have foods of a certain color (usually white) and texture (soft) or they are hyposensitive and crave foods that are spicy and crunchy.  Considering foods have the different flavors-sweet, sour, salty, spicy, bitter and neutral, different smells, different textures of crunchy, chewy, soft, mixed, puree, thick liquids and thin liquids and of course temperature-cold, hot, warm, room temperature, it is understandable that a child with some hypersensitivities would refuse many foods.  It is a lot for a nervous system to organize. A child will choose a food that has a favorable sensory experience.

Many children with feeding issues include food elimination.  This is when a child will stop eating a food that was preferred or liked and will not regain it even after a break.  Many children with autism will keep eliminating foods until they are down to a few foods that need to be served a certain way in a specific location. 

Children with autism have difficulty with a change in routine, they like everything to be the same and have a consistent routine.  This can be seen with feeding, they may want the same foods, same container, same plate, same location, etc.

Specifically, the “children diagnosed with ASD, compared to typical children, refused more foods, required more specific utensils to eat, required food presented in more specific ways, were more likely to consume foods at a lower texture (eg, pureed food), and ate a narrower range of foods.” (Kodak)

Research discusses the difference between a picky eater and a problem eater. (http://thinkingautismguide.blogspot.com/2010/07/autism-feeding-issues-and-picky-eaters.html)

A "picky eater" can:

• Have aversions to some foods, but still eat a variety
• Eat foods from each texture group and food group
• Tolerate the presence of new food
• Be willing to touch or try new foods

A "resistant" or "problem" eater will often:

• Eat 15 to 20 foods or fewer
• Refuse of one or more food groups (often preferring carbohydrates)
• Refuse of one or more texture type (often preferring crunchy or soft foods, not both)
• Tantrum or melt down at meal times
• Prefer one flavor (often sweet or salty)
• Prefer strong flavors OR bland flavors
• Prefer foods of the same color
• Prefer certain foods to always be the same brand. For example, only chicken nuggets from McDonald’s.
• Gag when trying new foods
• Display anxiety over the presence of new foods on their plate, on the table or even in the room
• Find the smell of certain foods to be noxious

Children with autism might also eat their foods in layers.  For example, they may dissect a burger, eating the cheese, then the hamburger, and then the bun all separately.

Medical issues would include looking at the oral motor function (chewing, tongue movement, lip closure, etc.) and dysphagia through swallowing studies, assessment of food sensitivities and allergies, medication and their effect on eating, GI concerns, information on the diet and nutritional concerns.

Behavioral issues may include failure to thrive, rumination (regurgitation, re-chewing re-swallowing), pica (eating non edible items), obesity and anorexia nervosa can affect children with autism.  Pica and rumination can have serious health consequences.

Results from Kodak’s research “indicated that when children exhibited inappropriate behavior, parents responded by (1) providing a toy during mealtime or allowing access to a more highly preferred food, (2) allowing the child to stop eating, and (3) reprimanding the child or coaxing the child to eat (‘‘This is good for you. You should eat your food.’’)”.  They looked at how the above influences affected the child’s’ behavior.   They labeled the conditions attention escape and tangible. “During the attention condition, a therapist provided reprimands and coaxed the child to eat each time the child engaged in inappropriate behavior.  During the escape condition, the therapist allowed the child to take a brief break from eating following inappropriate behavior. Finally, during the tangible condition, the therapist provided the child with a toy or another food item when the child engaged in inappropriate behavior. Results of this assessment indicated that providing one or more of these consequences following inappropriate mealtime behavior resulted in an increase in child inappropriate behavior for 67% of participants. “

So all these feeding issues can affect the child in many negative ways.  Some of the GI issues and other medical issues can have side effects that mimic autism. (To be discussed in a later blog).  Nutrition and having a homeostatic condition is a concern and would affect all levels of functioning including growth, development, attention, and cognitive functioning.  Sensory issues not addresses will continue to affect all the feeding.  Behavioral issues as stated above will become worse unless a team approach and changes are completed.

The following video will show some of the struggles that parents deal with multiple times a day in order to feed their child.

Kodak, T., Piazza, C., (2008) Assessment and Behavioral Treatment of Feeding and Sleeping Disorders in Children with Autism Spectrum Disorders.  Child and Adolescent Psychiatric Clinics of North America 17: 887-905

http://www.autismlink.com/pages/autism_feeding

http://www.iidc.indiana.edu/index.php?pageId=476

http://thinkingautismguide.blogspot.com/2010/07/autism-feeding-issues-and-picky-eaters.html