Nutritional Considerations for Children with Autism Spectrum Disorder

According to the CDC, one in 59 children is estimated to have autism¹. The National Institute of Mental Health defines autism spectrum disorder (ASD) as a developmental disorder that affects communication and behavior². ASD is complex, presenting differently in each person, involving persistent challenges in social interactions, speech and nonverbal communication, and restricted/repetitive behaviors¹. Such behaviors could magnify the challenges of mealtime as well as influence the likelihood of food aversions and sensitivities.

The Journal of Autism and Developmental Disorders published a comprehensive meta-analysis of scientific studies on feeding problems and nutrition status in children with autism spectrum disorders³. This report demonstrated the lack of research between feeding and ASD, while highlighting the results of significantly more feeding problems, lower intake of calcium and protein in children with ASD in comparison to their peers. Further, this review demonstrated diagnostic presentations of children with ASD such as constipation and gastroenterological disturbances as well as severe tantrums, sensory impairment and feeding problems related to the social and behavioral demands of feeding situations³. Based on researched anecdotal and case reports, children with ASD have been described to present with unusual eating patterns and rituals such as displaying strong emotional responses to new foods, with intensified selectivity of texture, presentation, and food preparation³. It is common that children with ASD gravitate more towards carbohydrates and processed food selections often rejecting fruits and vegetables³. Research has also demonstrated a relationship between dietary vulnerabilities and ASD suggesting interventions such as gluten and/or casein free diets in this population due to linked sensitivities³. Due to the importance of nutritional adequacy for the growth of children, consulting with a dietitian may be beneficial for families and/or caregivers of children with ASD to properly assess the child’s nutritional status and needs.

At LCWNS, our RD’s work with children and families to create more confidence and comfort surrounding food, feeding, and related gastrointestinal or sensitivity issues, together creating a more pleasant mealtime experience while supporting your child’s individual needs for growth and development.

Here are some tips to consider if you have a child with ASD experiencing feeding challenges:

Constipation:

• If your child is presenting with perceived discomfort and lack of bowel movements, take a look at his or her fiber intake. Fiber is a tricky nutrient, as both too much and too little could cause your child to be backed up. If you suspect the fiber intake is too low, try incorporating more fibrous vegetables such as broccoli and greens, fruits such as berries, beans and lentils, or seeds such as chia or flax into your child’s meals. If you suspect your child is eating too much fiber, be aware of these foods and try alternating days of which they are incorporated, this also can help with variety of nutrient intake. Keeping a food log may help to identify the patterns between your child’s intake and bowel movements.

Eczema:

• If your child is experiencing eczema and/or gastrointestinal discomfort consider their dairy intake. What type of milk are they drinking? Are yogurt and cheeses highly present in their diet? Try eliminating dairy for at least 2 weeks and observe if any changes occur. Research has examined a link between ASD and casein sensitivities, therefore your child may find comfort in the elimination of dairy products. In order to ensure you child is still meeting his or her calcium, vitamin D and protein needs, opt for dairy-free alternatives that contain such nutrients. Check out our blog on how kids can get calcium with dairy-free brands and products.

Perceived Gastrointestinal Discomfort:

• Are you recognizing your child seems uncomfortable, often holding their stomach, bloating or having frequent/infrequent bowel movements? Your child may be sensitive to gluten, as researchers have identified a possible link between ASD and gluten sensitivities. Take a look at the snacks your child is eating, gluten is hidden in many foods as well. Additionally, many foods now have added fiber in the form of inulin or pea fiber, as well as the many cauliflower-based products on the market, which may cause further GI upset. Creating a food diary for/with your child may help identify potential triggers that can alleviate your child of associated discomfort. Luckily, the gluten-free market has increased popularity making this substitution a bit easier for families to swap their favorite products.

Selective Eating:

• Do you struggle getting your child to try fruits and vegetables? Does your child present with tantrums when their foods touch? Is the mealtime environment stressful when trying to get your child to eat a variety of different foods? You are not alone. Rather than trying to beg, bribe and force your child to try new foods, here are some tools that may guide your selective eater into becoming an adventurous eater. Children with ASD often are structured to make connections using matching, concrete visualizations. Without having to recreate the wheel try these options to support you and your child’s meals:
• Food Scientist Placemat– A colorful and descriptive, sticky adhesive placemat with “The 5 Senses Test” will encourage your children to use their 5 senses to explore both known and new foods. Put your imaginary lab coat and goggles on, as your child becomes their own food scientist, identifying what colors, shapes and sizes they see on their plate, what their food feels like, what they hear when they take a bite, what they smell, what they taste, and answer the big question “do I like it?”. Trying new foods and flavors becomes a fun science experiment, while also saving the mess! This Food Scientist Placemat is available on Amazon, in a 40-pack set of individually folded mats, and makes a great tool for your young picky eaters!
• Copy-Kids: Eat Fruits & Vegetables– This video series, produced for children aged 6 months to 5 years, is a great tool to help influence your child to enjoy eating fruits and vegetables! Just turn it on, provide your kiddo with a sample of the featured fruit or vegetable in the selected episode, and watch the power of compelling imitation entertainment. Available on Amazon Prime Video or DVD, Copy-Kids presents 12 7-minute episodes featuring adorable children aged 9 months to 4 years, eating with giggles and fun: bell pepper, bananas, oranges, carrots, strawberries, avocado, raspberries, tomatoes, apples, broccoli, blueberries. Amazon Prime Series Season 2 features: kiwi, pineapple, peas, peaches, green beans, grapes, corn, celery, cauliflower, cabbage, blackberries, watermelon and an additional episode from leading Speech & Language Pathologist and Pediatric Feeding Therapist Dawn Winkelmann.  This is a simple yet revolutionary tool for parents who want their kids to develop a life-long habit of healthy eating.
• Food/Cookie Cutter Shapes– Use cut out molds to create your child’s favorite animal or movie/cartoon character, making trying new foods more fun! From your Power Ranger loving eater to your princess obsessed eater, they’ll turn any food- sandwiches, bread, pancakes, cheese and even lunch meat, into Mighty Morphins, Disney Princesses, and even Zoo Animals. Choose your child’s favorite shapes/characters/animals/designs, and watch their food come to life, to bring joy to the table and the meal-time experience more exciting.

Trying to figure out your child’s food triggers or sensory challenges while also trying to make sure they’re getting in adequate nutrition could be hard work, especially if your child is non-communicative.  Our dietitians are happy to work with you and your family to help guide you and empower you to fill their bellies, fuel their brains, and create an enjoyable mealtime experience.

References

1. What Is Autism Spectrum Disorder? Accessed May 7, 2021. https://www.psychiatry.org/patients-families/autism/what-is-autism-spectrum-disorder
2. NIMH » Autism Spectrum Disorder. Accessed May 8, 2021. https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/?utm_source=rss_readersutm_medium=rssutm_campaign=rss_full
3. Sharp WG, Berry RC, McCracken C, et al. Feeding Problems and Nutrient Intake in Children with Autism Spectrum Disorders: A Meta-analysis and Comprehensive Review of the Literature. J Autism Dev Disord. 2013;43(9):2159-2173. doi:10.1007/s10803-013-1771-5