Picky eating is a common concern for many parents, but for families with children on the autism spectrum, it can be especially challenging. While most children go through phases of food preferences, the relationship between autism and picky eating often runs deeper. The struggle to introduce new foods, the limited variety of acceptable textures, and the anxiety surrounding mealtimes can leave both parents and children feeling frustrated.
As a pediatric occupational therapist specializing in feeding, I’ve worked with many children on the autism spectrum who experience significant feeding difficulties. In this blog, we will explore the reasons behind picky eating in children with autism, offer strategies for families to approach mealtimes with less stress, and highlight how occupational therapy can play a crucial role in improving feeding habits.
Picky eating in children with autism often stems from a combination of sensory processing challenges, rigid routines, and communication difficulties. While every child with autism is unique, there are common factors that contribute to feeding difficulties.
Children with autism often experience heightened or diminished sensory responses, including to taste, texture, smell, and appearance of food. These sensory sensitivities can make the experience of eating overwhelming. For example:
Children on the autism spectrum often rely on routine and predictability to feel safe and secure. This extends to their eating habits. They may develop a very limited diet consisting of only a few specific foods that they feel comfortable with. Attempts to introduce new foods can cause distress, leading to food refusal or tantrums at mealtime.
Children with autism may have difficulties expressing their needs and preferences, making it hard for caregivers to understand why they are refusing food. A child may not be able to verbalize that they dislike the texture of a certain food or that the smell is overwhelming. Instead, they might communicate their discomfort through behaviors such as crying, pushing the food away, or throwing tantrums at the table.
When it comes to feeding, children with autism can exhibit a range of challenging behaviors that make mealtimes difficult for both the child and their caregivers. Some of the most common behaviors include:
While picky eating can be frustrating, it’s important to consider the nutritional and developmental impact this can have on children with autism. Many children on the autism spectrum consume diets that are low in variety, which can lead to:
Parents often feel caught between wanting to ensure their child is getting enough to eat and trying to introduce healthier, more diverse options into their diet.
Occupational therapy (OT) is highly effective in addressing picky eating and feeding challenges in children with autism. As a pediatric OT, I use a variety of strategies to help children gradually expand their food preferences while reducing mealtime stress.
Sensory integration therapy helps children become more comfortable with different textures, smells, and tastes. By gradually exposing children to sensory experiences in a safe and supportive environment, we can reduce their aversion to certain foods.
Occupational therapy often involves food play, where children engage with food in a non-threatening way. This might include activities such as:
OTs can help children with autism expand their food preferences by using a technique called food chaining. This involves introducing new foods that are similar to foods the child already enjoys. For example, if a child likes chicken nuggets, we might gradually introduce grilled chicken by altering the texture slowly over time.
For children who rely on routine, establishing a structured mealtime routine can help them feel more comfortable and less anxious during meals. As an OT, I work with families to develop strategies such as:
For children with significant nutritional concerns, occupational therapists often work closely with dietitians and pediatricians to ensure the child is getting the necessary nutrients for healthy growth and development. A team approach ensures that the child’s dietary needs are met while addressing behavioral and sensory feeding challenges.
Parents can also implement some strategies at home to help their child with autism become more comfortable with a variety of foods and reduce picky eating behaviors. Here are some tips:
Introducing new foods to a child with autism takes time, and it’s important to be patient. Research shows that it can take up to 10-15 exposures to a new food before a child will accept it. Offer new foods without pressure, and celebrate small victories, such as touching or smelling the food.
Start with small changes to your child’s preferred foods. For example, if your child only eats chicken nuggets, try introducing a different brand or slightly altering the texture. Gradual changes are less likely to overwhelm your child and lead to food refusal.
Giving your child a sense of control over their food choices can reduce anxiety around mealtimes. Offer two or three options for each meal so that your child can choose what they feel comfortable eating. Ensure that at least one of the options is a food they already enjoy.
Consistency is key for children with autism. Try to maintain regular meal and snack times each day, and avoid making mealtime too stressful. If your child refuses a new food, avoid pressuring them, and try offering it again at a later time.
Use positive reinforcement to encourage your child to try new foods. Praise them for small steps, such as touching or smelling the food, and offer non-food rewards for making progress, such as extra playtime or a favorite activity.
While picky eating is common in children with autism, it’s important to seek help if your child’s eating habits are causing significant nutritional concerns, weight loss, or family stress. If your child has a very limited diet, experiences extreme anxiety around mealtimes, or refuses entire food groups, it may be time to consult a pediatric occupational therapist or feeding specialist.
Picky eating in children with autism is often a multifaceted challenge involving sensory sensitivities, rigid routines, and communication barriers. However, with patience, the right strategies, and support from professionals such as occupational therapists, children can expand their food preferences and reduce the stress associated with mealtimes. As a pediatric occupational therapist, I have seen firsthand how individualized feeding therapy can make a positive impact during mealtime!
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