Autism and eating behaviors: Child only eats junk food

By Moira Peña, BScOT, MOT, OT Reg. (Ont.)

This week’s “Food for Thought” answer is from occupational therapist Moira Pena, of Toronto’s Holland Bloorview Kids Rehabilitation Hospital. The hospital is one of 14 centers in the Autism Speaks Autism Treatment Network.

I’ve heard that kids with autism will eventually eat if they’re hungry enough. I’m considering taking away the hard candy, chips and crackers that our daughter snacks on all day to see if she will learn to eat real food. I’ve tried giving her nutritious foods in the past, but nothing worked. Still I worry. If I take her junk food away, will she starve herself? Should I just get tough and go ahead with this?

Thanks for your question. First, let me reassure you that many parents of individuals on the autism spectrum will identify with your situation. In fact, a recent comprehensive review of research on the subject confirms that children with autism are five times more likely to struggle with eating issues compared to their typically developing peers.

The first step in addressing these issues is to recognize that feeding problems and unusual behaviors around eating are a common symptom of autism. Try not to feel guilty about your child’s eating patterns. It’s not your fault that your daughter isn’t eating healthy foods. Your role as a parent is to offer nutritious options. Then it’s up to your child to eat.

Second, it’s important to consult with her doctor and/or a registered dietitian to ensure that taking away her chips and crackers is a medically sound option at this time. You want to make sure that she’s not underweight or undernourished before taking away food. The doctor or dietitian might recommend a nutritional supplement if there are concerns along these lines. You’ll also want to make sure that the doctor or dietitian continues to monitor your daughter’s health as you introduce the more nutritious diet.

If possible, I strongly recommend enlisting the help of a feeding therapist familiar with autism-related eating issues. He or she may be able to identify what’s contributing to your daughter’s refusal to eat other foods. This may include medical conditions such as chronic abdominal pain, gastro-esophageal reflux disease (GERD), constipation or food intolerances.

Many kids with autism also have postural issues that interfere with eating. Low muscle tone, for example, can make it difficult to maintain an upright seated position. Autism-related sensory aversions are another common reason for eating problems.

As you may well know, another common symptom of autism is an insistence on “sameness.” This can cause extreme anxiety when the individual is presented with new foods. A behavioral therapist experienced with autism can help address such issues.

Finally, some individuals with autism need help developing chewing skills. However, the fact that your daughter is eating hard candy tells me that chewing skills aren’t likely to be a problem.

Ten strategies to try at home

As for ideas to try at home, I have ten strategies to share. But first, take a deep breath and remember that change will take place in small increments. I want you to give yourself at least a full month to consistently try the following strategies for helping your daughter become more comfortable around a broader range of healthy food:

At every meal and snack time, offer a protein, vegetable or fruit, and a starch along with a small amount of her favorite chips. This may sound like a lot. But when a child is struggling with eating, we want to use every opportunity to provide a variety of nutritious options. Offer smaller quantities during snack time, but still offer options. If your child doesn’t eat her lunch, you will feel better knowing that she will have a full range of snack options coming up. And those familiar chips? They can give your daughter the signal that it’s okay to start eating. They will also encourage her to come to the table and sit with you.
Make food fun! Look at it from your daughter’s perspective: Food has become something that causes friction at home. Try to think about ways to make food enjoyable again. I’m not sure how old your daughter is. If it’s age-appropriate, consider playing “grocery store” together with plastic foods. Or take her grocery shopping and encourage her to touch different foods. Talk about the smell, color and feel of foods. Make up songs about foods. And yes, invite her play with food. If she doesn’t like touching food with her hands, show her how to use a spoon or dull knife to shape food into interesting forms. Involve her in snack and meal preparation as much as possible. The idea is for her to begin viewing food in a positive way. What better way to do that than through play?
Review your mealtime routines. Many families lead very busy lives. This makes it easy to let “family dinners” go by the wayside. But “family mealtime” can include just the two. The idea is to sit at a table together for at least 15 minutes. Your daughter may not eat anything at first. That’s okay. As she watches others eat, she’ll be exposed to the smell, sight and sounds of food being eaten. These are positive steps toward her tasting and eating the foods.
Don’t wait for hunger pangs. Many parents of children with autism have told me that their kids don’t feel hunger pangs or cravings like other children do. This observation deserves follow-up research. Meanwhile, I recommend against waiting for hunger to strike or asking your child if she’s hungry before offering food. The answer will probably be “no.” Instead, simply offer foods on schedule.
Offer a meal or snack every 2.5 hours. To avoid the temptation to continually snack, try to offer a meal or snack every 2.5 hours throughout the day. Keep the times as consistent as possible. It’s important for your child to have a routine around eating meals at definite times.
Introduce a visual schedule. Remember that children with autism tend to do best with clear routines. Use a written list and/or pictures to indicate the day’s meal and snack times. Post this in her room, in the kitchen and other places where she spends time. You can use a timer to let her gauge that mealtime is approaching. The idea is to give your daughter as much preparation time as possible prior to meals. This has the added advantage of helping her manage food-related anxiety.
Try some movement before meals. In occupational therapy, we often use movement to “wake up” a child’s body and senses. You may find that it helps to have a little physical exercise – if only marching around the table to music – before sitting down to a meal. Remember to make it fun.
Take the mood out of the food. I think this is a useful mantra for parents. By it, I mean that it’s important to monitor your own anxieties around your child’s eating. I understand that your child’s poor eating may be a constant cause for concern. Try to consciously reduce your anxiety or other negative emotions. Try to maintain a positive atmosphere around meals. Believe that your child will eat and celebrate every success!
Try serving food family style. Put foods on serving plates, and let your child serve herself. If your daughter is able, ask her to pass the plate on to the next family member. The idea is to give her as much control as possible over her eating. At the same time, you’re exposing her to the sensory aspects of the food each time she passes the plate.
Offer your child the same food as the rest of the family is eating, even if you think she’ll refuse it. Allow her to sit at the table while the rest of you eat. As I mentioned earlier, the look, smell and proximity of the food can help her make progress to eating more foods in the future.