Many children struggle with picky eating at some point, but children with autism may have feeding issues that go above and beyond just being a picky eater. Tackling autism and food issues can be major stressors for families; not only does it have the potential for being disruptive to family life but it may lead to malnutrition, constipation, and other medical issues in severe cases. Working on feeding problems can be a daunting task but there are effective, evidence-based interventions that can help!
Some parents become so used to making three different meals each mealtime to accommodate their child’s specific tastes that recognizing when picky eating becomes a problem can be challenging. Picky eating may become a bigger problem if your child is refusing food, engaging is disruptive behavior during mealtimes, has rigid food preferences, is experiencing poor growth, or is failing to master feeding skills that are consistent with their developmental age. If the child is eating a variety of textures (e.g., smooth like applesauce and crunchy like chips) and eating at least a few foods in all food groups, they might just be a picky eater. If the child has brand specific requirements (e.g., “I’ll eat goldfish crackers but they have to be name-brand and if they come in a different color bag, I won’t touch them!”), if family routines are disrupted, and if mealtime is becoming unbearably stressful, the picky eating may be becoming a bigger issue.
Implementing a few changes to your routine may help to improve mealtime behavior. Here are a few tips to get started:
- Have a consistent mealtime routine and schedule (whatever works for your family)
- Minimize distractions at the table. Try turning off TVs and iPads while eating.
- Use “Grandma’s rule” (e.g., eat your veggies before you get your dessert!) to help increase the likelihood that your child will eat a bite of nonpreferred food. Once they take a bite of a new food, give them a bite of their favorite food!
- Pick foods to introduce that are similar in texture and taste to things they already eat.
- Offer choices when possible. For example, “Should we try a bite of carrot or a bite of apple first?”, “Do you want to take two bites or three bites of chicken today?”, or “Red plate or green plate?”
- Limit access to preferred foods outside of mealtimes
- Keep it small - TINY bites to start!
- Monitor access to drinks - don’t let them fill up on juice or milk before meal time
- Celebrate small successes, and I mean c-e-l-e-b-r-a-t-e!
- Consider holding back very special activities, attention, or other strong motivators and use only for rewards at mealtimes.
- Make sure that your child is getting lots of attention and access to fun things for the mealtime behavior you want to see more of (e.g., reinforce appropriate behavior).
- Make sure they aren’t getting more attention for NOT eating - limit attention and access to fun things when your child isn’t eating or engaging in appropriate mealtime behavior.
Red flags for families may include compromised nutrition, if their child is not able to gain or maintain a healthy weight, or if their child is experiencing significant behavioral challenges. If parents are experiencing these challenges, they should seek out the assistance of professionals who having training in addressing feeding specific concerns. A collaborative approach may be best if the child has oral motor deficits and behavioral concerns! For example, a physician may rule out underlying illnesses, Speech and Language Therapists may address oral motor deficits, and Board Certified Behavior Analysts (BCBAs) may address behavioral concerns. In some cases, a feeding clinic may be warranted for adequate therapy. There usually isn’t a quick fix for feeding issues but there is help available!
Silverman, A. H. and Tarbell, S. (2009). Feeding and vomiting problems in pediatric populations. In Roberts, M. and Steele, R. (Eds.) Handbook of Pediatric Psychology: Fourth Edition.
Schreck and Williams (2006). Food preferences and factors influencing food selectivity for children with autism spectrum disorders. Research in Developmental Disabilities,27, 353-363.
Lukens, C. T. and Linscheid, T. R. (2008) Development and validation of an Inventory to assess mealtime behavior problems in children with autism. Journal of Autism and Developmental Disorders, 34, 342-352.