“My 4 year old has Asperger syndrome and sensory processing dysfunction. We will get times when he hardly stops eating for a day or two. Then the rest of the week, he won’t eat at all unless I force him, which leads to tantrums. Please help. Any advice would be greatly appreciated.”
This week’s “Food for Thought?” answer is from psychologist Michelle Spader, of Nationwide Children’s Hospital, in Columbus, Ohio. Nationwide Children’s is one of 14 centers in the Autism Speaks Autism Treatment Network.
The following information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional and/or behavioral therapist.
Thank you for your question. As you may know, eating and feeding issues are very common among children – as well as adults – who have autism. The Autism Speaks ATN/AIR-P Guide to Exploring Feeding Behavior in Autism provides guidance from experts.
Download the guide free of charge here.
Given your son’s inconsistent eating habits, our first concern is ensuring that he’s getting enough nutrients to support his health and development. To give you an idea of these needs, the American Academy of Pediatrics has published age-by-age “Dietary Recommendations for Children and Adolescents.” I also like the “serving size guidelines” in Feeding Your 1 to 5 Year Old, published by the Washington State Department of Health. (See below.)
While these are “daily” guidelines, we needn't expect a child to eat similarly every day. It’s okay if some days are better than others, so long as your child achieves a balance over the course of several days.
If your son’s eating doesn’t meet these guidelines – on average over several days – then I strongly recommend that you consult a registered dietician/nutritionist. He or she can assess whether your son is getting adequate nutrition. This will likely include your keeping a detailed food diary on everything he consumes for several days.
Ideally, you want to work with a dietician/nutritionist experienced with autism-related food issues. If your son is seeing a behavioral therapist – either at school or privately – I likewise recommend involving the therapist in your plan of action.
Along these lines, you may want to consider seeking help at a medical center with a comprehensive autism program.
* Find the Autism Speaks ATN center nearest you here.
Our ATN centers – and many other autism clinics – have behavioral therapists who specialize in feeding issues. Some have comprehensive feeding programs that bring together a team of specialists to help children who have autism and complex feeding issues.
Meanwhile, I’m glad to offer some general strategies to encourage more-consistent eating. This would start with your family establishing a meal schedule, if it hasn’t already.
Establishing a schedule
In my experience, I’ve found that it helps to create and post a daily schedule with set times for breakfast, morning snack, lunch, afternoon snack, dinner and evening snack. It’s important that the whole family follows the schedule.
As you may know, children – and adults – with autism often do best with visual aids. The Autism Speaks ATN/AIR-P Visual Supports Toolkit has helpful suggestions on how to create a visual schedule.
Learn more about visual supports and download the tool kit here.
On the visual schedule, I suggest listing the time that each meal and snack occurs. Encourage your son to look at a clock so he can track when each will take place.
When to redirect
If he requests food when it’s not time to eat, remind him of when the next meal or snack will occur and offer him water or encourage another activity. You may need to put food out of sight and reach while he’s learning the new routine.
When it is time to eat, invite him to sit down at the table with you and other family members.
Don’t force it
On the days when your son is resistant to eating, I do NOT recommend forcing him. Instead, simply ask him to sit with you at the table at snack and meal time – while keeping the food within his sight and reach.
It may help to set a timer so he knows how long he needs to stay seated. A good rule of thumb is around 10 minutes for snacks and 20 minutes for meals.
If you follow a consistent meal and snack schedule and use the timer, I’m hopeful that you’ll start to see a more-consistent eating pattern emerge for your son.
If the problem continues, please speak with his primary care provider to find a behavioral feeding therapist who can help. And please let us know how you and your son are doing in the comment section below or by emailing us again at GotQuestions@AutismSpeaks.org.