Many children who have a diagnosis of autism may also demonstrate some feeding problems. These feeding problems can range from mild food selectivity (“picky eaters”), to more severe food refusal. No matter the degree of severity, it is extremely important to effectively treat these issues as it is important to ensure that children are receiving the proper nutrients on a daily basis to grow and thrive.
It is common for all children to demonstrate some food selectivity, typically between the ages of 2-4 years old. However, being a “picky eater” becomes detrimental if restrictive eating behaviors persist past approximately age four, and especially if a child begins losing weight. A weight of at or below the 3rd percentile typically results in a diagnosis of Failure to Thrive.
In order to prevent inappropriate eating behaviors from developing, consider the following:
Typically developing children, without feeding problems, need to be exposed to new foods approximately 15 times before preference for that food can be determined. Children who have feeding problems should be exposed to foods a minimum of 30 times before preference can be accurately determined. Therefore, when presenting a new food to your child, don’t be discouraged if they “turn it down” by pushing it away, wrinkling their nose, or spitting it out. Be persistent, and offer that same food again the next day… and the next day until your child has had 30 exposures.
Develop an eating schedule and predictable routine. Generally eating breakfast, lunch, dinner and snacks at the same time each day will allow your child to develop good eating habits. Avoid snacks prior to meal times, as snacks are filling and decrease your child’s motivation to eat during mealtime. Also avoid beverages before meals that could be too filling, such as milk and juices. A child should be hungry before meal times begin to allow for the most success.
Present only small amounts of each food group so the expectation of your child’s eating requirements are small. Just a couple pieces of a protein, a vegetable and a fruit are often sufficient at each meal.
Once inappropriate eating behaviors have developed, consider the following:
Ensure that inappropriate behaviors, such as pushing food away, spitting food out, and crying do not terminate a meal time. Stopping the presentation of food contingent on any of the above listed behaviors will likely result in those behaviors occurring more frequently in the future. Therefore, require that your child take at least a taste of the food before stopping the meal.Some children may demonstrate very strong aversions to meal times, in general. For example, a child may begin to cry simply upon the sight of a spoon or the sight of food. In these cases, a much slower sequence of desensitization may be required. The beginning steps in this situation may require a child to simply keep food on his/her plate without pushing it off or crying. Once this step is tolerated, food may be presented on a spoon and set on the plate. This step may progress to touching the spoon, with a small piece of food, to the child’s lip. Then later, the requirement would increase to touching the food to his/her tongue, until the child places the food in his/her mouth and ultimately swallows the food.
Another strategy to expose a child to new foods is to “pair” (or associate) a non-preferred food (such as carrots) with a preferred food (such as cookies). Using this strategy, once a child takes a bite of carrots (and swallows!), the child is given a bite of a cookie as a reward. Over several presentations of this strategy, over time, the carrots become more and more preferred.
It is always important to contact your Primary Care Physician when you become concerned about your child’s eating habits. Therapies, such as Applied Behavior Analysis (ABA), have demonstrated success in treating feeding problems for children with a wide variety of diagnoses. It is important to begin effect treatment as soon as a feeding problem is detected.
Breanne Hartley, PhD, BCBA-D
Verbal Behavior Center for Autism (VBCA)