Child with Autism Won’t Eat Foods that ‘Smell’

October 9, 2018

I have two kids with autism. My oldest literally can't sit at a table with foods that "smell." That happens to be anything except pizza, bread and fruit. How can we deal with this?

Today’s “Food for Thought” answer is by pediatric psychologist Elizabeth Pulliam. Dr. Pulliam practices at the University of Arkansas for Medical Sciences & Arkansas Children's Hospital. Both are part of the Autism Speaks Autism Treatment Network (ATN). Dr. Pulliam also co-authored the Autism Speaks ATN/AIR-P tool kit: Exploring Feeding Behavior in in Autism: A Guide for Parents. (Follow the text link for free download.)

Thank you for your question! As the mother of two children with autism, you are familiar with the sensory challenges that many children with autism face each day. Hypersensitivity to smells is a very common one, and it often causes problems at the table. The resulting anxiety can cause food refusal and interfere with a child’s ability to share in the important social aspects of mealtime. This can make mealtimes more stressful for everyone in the family.

It sounds like leaving the table is your son’s way of escaping the fear or other unpleasant feelings he experiences when he smells certain foods.

I support your desire to help him sit at the table with these aromas. The key is working slowly. He needs to be exposed to the smells in baby steps. The goal is to use these baby steps to bring him closer and closer to the table until he can handle food smells.

“Systematic desensitization” and “graduated exposure” are psychology’s fancy terms for this technique. It involves teaching children relaxation, distraction and other calming strategies to help lessen anxiety when exposed to something they fear.

It usually helps to tailor these approaches to a child’s age and developmental levels, as well as to his ability to handle stress. If your child is working with a behavioral therapist or child psychologist, I strongly recommend that you enlist their help. It’s important to remember that no one intervention fits the needs of all children. This is why, as a general rule, I recommend working with a specialist who has a chance to get to know your child.

Below are some general strategies to consider:

Reduce stress before the meal 
It’s important to help your son relax before and during mealtime. So before you start moving him closer to the table, I encourage you to teach him some strategies for coping with the stress that this learning experience may bring.

It can help, for example, for your son to engage in some enjoyable exercise before mealtime. Exercise prompts the body to release anxiety-reducing endorphins. So consider joining your son in some running, jumping or dancing before a meal.

In fact, enjoying most any favorite activity or sensory experience is a good way to head into mealtime on a relaxed, positive note.

Deep breathing exercises are another good way to help your son calm himself. Show him how to slowly inhale from his belly up through his chest, hold the deep breath for a few seconds, then slowly let it out again. Repeat this several times. Sometimes I use blowing bubbles to help teach deep breathing.

Helpful distraction
Ultimately we want your son to be able to sit at the table and enjoy his food and the company of others around him without being distracted. However, in the beginning, some distractions can help reduce the anxiety prompted by food smells. The idea is to help your child focus on something besides the smells he dislikes while sitting at or near the table.

For example, you might try playing some calming music. Or you might allow him to have a favorite toy at the table. Initially, you might even allow him to watch a favorite video or TV show during meals. Explain to him that he must sit at (or near) the table if he wants to continue watching the video or keep the toy.

If distraction works, gradually try using it for shorter periods until your child no longer needs it. Clearly, it’s far from ideal for kids to eat in front of the TV or with toys at the table. This is just a temporary tool to get the ball rolling.

Praise and encouragement
I encourage the use of praise and/or small rewards for each little success. By this, I mean any show of sincere interest or effort. I suggest using small rewards for small steps along the way and possibly a larger reward once he reaches the goal you set together or the goal you want for him. That “big goal” might be sitting at the table for a meal that involves smells he had previously avoided. In these ways, you can help motivate your child to work with you.

Putting the steps in action
As you start the process, I suggest taking a small initial step that causes little distress. For example, if your son currently sits in the living room while others eat at the table, try moving his usual seat just a few feet closer to the kitchen. Enthusiastically praise his efforts to stay in his seat.

Every few days or so, move the seat a little closer to the table. Use the pace that you and he feel is right. Continue to reward him for eating his meal closer to the table – or at least staying there for a time.

Remind your son how much you enjoy having him closer to the family.

And remember those relaxation techniques and distraction tools. If you see your son starting to get anxious, cue him to use slow, deep breathing and/or use your other strategies as needed.

As your son is probably more sensitive to some food smells than others, expect that some foods and mealtimes will require more coping strategies than others.

Depending on your child, this gradual desensitization process could take weeks to months. So don’t give up!

If things just aren’t moving forward – or the process feels too challenging to do on your own – please don’t hesitate to enlist the support of a child therapist or behavior specialist. These professionals can be found at any of the 14 centers in the Autism Speaks Autism Treatment Network. (Find the ATN center nearest you here.)

For a listing of autism specialists and therapists in your area, you can browse the Resource Guide on the Autism Speaks website, or call the Autism Speaks Autism Response Team for personal help finding the right specialist in your area. Call 888-288-4762 (en Español 888-772-9050) or email familyservices@autismspeaks.org.