Picky Eating and Autism

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Kids with autism can be extremely selective when it comes to eating.  An estimated 46–89% of children with autism spectrum disorder (ASD) have feeding problems.  ASD children struggle with sensory defensiveness, a need for routine and sameness, and visual overstimulation, which makes expanding the palate difficult.  However, there is often more to this equation that needs to be sorted out in order to get our kids eating healthy and whole foods.

In this article, we will discuss the causes of picky eating in autism and measures to correct it. Then, we will offer tips to get your child to try more foods.

What Causes Picky Eating in Autism?

If we understand what causes picky eating, we can address these issues and reverse the problem.  Below, you will find brief descriptions of issues that can cause picky eating.

Sensory Problems

Many of our kids only like a specific texture, color, or temperature food.  While some might attribute this to sensory issues that are “just a part of autism,” it’s important to understand that several underlying medical problems can cause or contribute to sensory issues.  Interestingly, many of these medical issues are common to autism.  Because of this, we recommend that parents find a qualified doctor to determine if their child has any underlying medical conditions.  After proper medical care, sensory issues may decrease or disappear,  significantly improving your child’s quality of life. 

Oral-Motor Delays and Disorders

Another cause of picky eating in autism relates to oral-motor delays and disorders. Children with oral-motor disorders have difficulty controlling the muscles that move their tongue, lips, and jaw. Like sensory issues, they are common to autism.  In fact, according to this 2019 study, at least one in three children with autism has significant movement difficulties.

Because children with oral-motor delays/disorders have difficulty moving food around their mouth, they avoid certain textures, gag on food, and may even be afraid to try new foods.  Likewise, they tend to drink their meals instead of chewing them because it is easier—for example, a child who wants to drink milk for every meal.

If you suspect your child has oral-motor function issues, they need to be evaluated for both speech and feeding therapy, as oral-motor disorders affect speech and eating.

Problems Swallowing

Similarly, swallowing problems can cause picky eating.  When children have difficulty swallowing, they gag on foods.  Swallowing problems can result from a developmental delay or a medical issue, such as mitochondrial dysfunction or Eosinophilic Esophagitis (EoE).  Below, you will find brief descriptions of each. However, these are just two examples of several medical issues that can cause problems with swallowing. Therefore, it's essential to have your child evaluated by a qualified gastroenterologist.

Mitochondrial Dysfunction

Research suggests a high prevalence of mitochondrial dysfunction among people with autism. Mitochondria are tiny structures within cells that are responsible for creating energy. When mitochondria aren't working well, cells can't supply the brain, muscles, and other parts of the body with the energy they need to function optimally. This can affect many aspects of the body, including chewing, swallowing, and digestion.

The good news is that issues related to mitochondrial dysfunction can significantly improve with treatment. To learn more, please read Mitochondrial Dysfunction in Autism: Testing and Treatment Options.

Eosinophilic Esophagitis (EoE)

Eosinophilic Esophagitis (EoE) is an autoimmune disorder where white blood cells attack the esophagus, causing inflammation and sometimes pain. Since immune dysfunction is common in autism, EoE is found in many kids with autism.

Kids with EoE may have problems with eating, swallowing, food getting stuck, abdominal pain, gaining weight, or they may be completely asymptomatic. Sadly, kids with EoE are often mislabeled picky eaters even though there is a strong correlation between picky eating and GI disease, including EoE.

The only way to diagnose EoE is with an endoscopy and biopsies. When searching for a gastroenterologist to diagnose and treat EoE, look for someone with experience using the TIGERS/AGREE protocol. You can find a list of qualified doctors here.

Pain

Picky eating can be a self-taught behavior in response to pain. Understandably, kids learn to be wary of food very quickly if eating food causes them pain.  According to this study, children with diseases of the upper gastrointestinal tract are more likely to develop feeding problems.

Examples of conditions that cause pain, which can lead to picky eating, including the following:

Gastroesophageal Reflux Disease (GERD)

GERD is a painful condition where gastric acid and food from the stomach flow up into the esophagus. A 2016 study found a significant correlation between GERD and picky eating, irregular eating, and a preference for liquid foods.  And, given the high prevalence of gastrointestinal issues in autism, GERD might be something to consider discussing with your child's doctor.  An endoscopy can tell you if GERD is a factor in your child’s picky eating.  This link is a good overview of what to expect from the scope.

Constipation

Not only is constipation extremely painful, but it can also cause children to feel full and not want to eat. Because constipation is common to autism, you may want to consider having a doctor evaluate your child to determine if constipation is playing a role in their selective eating. Also, it's important to know that constipation can occur even if your child has daily bowel movements, so the only way to rule constipation in or out is with an abdominal x-ray.

To learn more about constipation in autism, click here.

Dental Issues

Many of our kids suffer daily from pain caused by untreated dental issues. However, there are things you can do to help prevent this from occurring to your child:

  • Be patient and considerate when helping your child develop good oral hygiene skills, such as brushing and flushing.
  • Likewise, find a good pediatric dentist who has experience working with children who have special needs.
Critical Note About Pain

It is important to know that communication issues can hinder your child’s ability to identify and express pain.  Because of this, it is essential to find a way for your child to communicate their thoughts, experiences, and feelings with you.  TACA has resources to help.  Learn more by reading Speech Issues in Autism.

Mineral Deficiency

Mineral deficiencies are another common underlying medical problem(s) that can trigger selective eating. For instance, this paper titled Macro- and MicroNutrient intakes in picky eaters: A Cause for Concern, tells us that intake of zinc and iron are below recommended levels in picky eaters.

Unfortunately, mineral deficiencies will only worsen with continued picky eating. Supplementing zinc can be particularly helpful. This is because gustin, the major zinc protein in saliva, influences your sense of taste. Interestingly, given the relationship between zinc and taste, plus the fact that taste and smell are so closely linked in human physiology, an impaired sense of taste and smell are common symptoms of zinc deficiency.  Also, juicing fresh vegetables and fruits may be a solution to get active enzymes, vitamins, and minerals into your child. You can start by syringing the juice into their mouth little by little.

PANS/PANDAS

Like the medical issues mentioned above, PANS/PANDAS is common to autism, and two of the most prominent symptoms are OCD and selective eating.  PANS/PANDAS occurs when strep or other triggers such as Lyme or viruses trigger a misdirected immune response, which results in inflammation in the brain.  You can learn more about PANS/PANDAS and Autism here.

Cerebral Folate Deficiency (CFD)

Recent science has shown that some kids with autism may have a disorder called Cerebral Folate Deficiency (CFD), which occurs when the folate in the blood is normal, but the folate in the brain is too low.

CFD can cause many developmental problems in children with autism, including picky eating.  Thus, properly treating CFD can make a difference in eating habits.  Find more information on Cerebral Folate Deficiency and Autism here.

Candida (Fungal) Overgrowth

When there is a fungal overgrowth in the GI tract, it can cause the child to crave grains, carbohydrates, and sweets.  These foods then feed the pathogens and make the child less likely to want other types of foods, creating a vicious cycle.

So, if you have a picky eater that craves bread, crackers, cookies, and sweets, you may be dealing with a fungal overgrowth in the gut.  For more information, please read Yeast Overgrowth in Autism.

Food Sensitivities and Food Addiction

Yes! Our kids can actually be addicted to certain foods. Sadly, most of the time, kids tend to crave foods they should not be eating.

For example, let’s look at gluten and casein.  Gluten and casein are very long-chain peptides (small versions of proteins), similar in structure to natural opioid-binding peptides. Long-chain peptides are difficult to break down.  Suppose the digestive system is not properly breaking down gluten and casein. In that case, undigested peptides from these foods can access the bloodstream via a permeable gut lining, also known as leaky gut.  Once in the bloodstream, they travel to the brain, where they attach to the brain’s opiate receptors. This opiate reaction causes an addiction to the food, much like an opiate drug would.

Also, addiction to particular foods can happen when children eat food containing highly addictive ingredients such as glutamic acid in the form of monosodium salt (MSG).  This is why Doritos are so addictive–they contain MSG, which the brain craves like a drug.  Examples of other popular foods with MSG include Ramen Noodles, Pringles, many seasonings, and even deli meats.

Take-Aways for Causes of Picky Eating in Autism:

  • See a pediatric gastroenterologist.  Your child may need a KUB (abdominal x-ray) to check for constipation or scopes to check for other medical issues.
  • See a functional medicine doctor to test and treat nutritional deficiencies, candida overgrowth, mitochondrial dysfunction, cerebral folate deficiency, and other possible underlying medical problems.
  • Have your child evaluated to see if there is a need for occupational, speech, or feeding therapy (see below).
  • Consider a zinc supplement.
  • Start a gluten-free, casein-free diet.
  • Consider juicing to get your child needed nutrients.
  • Get rid of the junk food.

Feeding Therapy

In addition to a doctor who can identify and address any medical issues, you may need to add a feeding therapist to your child’s team.  Feeding therapy can help your child overcome feeding issues related to:

  • Oral motor delays/difficulties, including sucking, chewing, swallowing, and gagging
  • Sensory defensiveness
  • Medical problems that cause a person to associate pain with eating
    • In this circumstance, therapy will only work after you address the medical issue causing the pain.
  • Traumatic experiences that have caused a person to develop a fear of food

A speech or occupational therapist can evaluate your child to determine if they need feeding therapy.  But, it's important to note that feeding therapy is a specialty within itself.  It requires additional training and experience. Therefore, not all occupational and speech therapists are feeding therapists.

Furthermore, because oral-motor issues can significantly impact eating, your child’s feeding therapy may involve a team consisting of both occupational and speech therapists. In some cases, a behavior therapist, nutritionist, or dietician may be consulted for nutritional or behavioral advice.    

Practical Tips for Picky Eaters

Below, you will find suggestions for things you can do at home to develop positive eating experiences and motivate your child to try more foods.

Tips To Help Before Mealtime
  • Limit snacks. While some kids may need snacks to make it throughout the day, allowing them to graze all day long is counterproductive, so limit snacks to ensure your child is hungry at mealtime.
  • Consider timing. By the time dinner rolls around, children are often exhausted or overwhelmed from sensory input throughout the day. Given that, try introducing new foods in the morning or afternoon, in a quiet environment with soft, soothing music when your child is hungry.
  • Encourage movement.  If a child’s body has been moving for at least 15 minutes before eating, you will have a better success rate with eating.  Jumping on the trampoline and swinging are examples of good movement.
  • Utilize social stories. A social story explains to the child what is expected. An example of a social story for picky eaters is here. A visual schedule may work as well.
Tips to Help During Mealtime
  • Add food to your child’s plate in small increments.  Sometimes we need to break things down into small steps to help children overcome severe sensory issues and aversions.  Therefore, try placing one thing on your child's plate at a time so they don't become visually over-stimulated. Then, add more as tolerated.
  • Use salt.  Salt stimulates the salivary glands and makes you hungry. Therefore, starting a meal with something salty and crunchy can warm up the mouth and get it ready to eat. Also, since most kids like salt, adding it to veggies or other food can help.
  • Dip it.  Find a GFCF spread your child likes and serve it with fruit and veggies. After all, dipping is fun!
  • Chill food before serving.  The colder the food is, the less the child can taste it. For instance, many kids will eat frozen peas but not cooked or raw peas.
  • Get creative when you cook.  Bake steamed, pureed, and chopped vegetables into food. For examples of ways to sneak veggies into food without sacrificing flavor, check out this site.
  • Diffuse an essential oil.  Kids usually decide if they like a food by the way it smells.  Hence, diffusing an essential oil while eating may trick the olfactory system.
Tips for Creating Positive Associations with Food
  • Try food chaining. Food chaining is a technique that creates a series of links between foods your child likes to eat with new foods you want them to try to eat.
  • Play games with food.  Using food to play games can take the pressure off eating.  This is a fun plate to use with kids to keep them motivated.
  • Try the “Smell it, Kiss it, Lick it” approach. Using this approach with each new food gives kids more control over their eating. But, be patient. Just getting over these small hurdles is a big accomplishment for some kids.
  • Use a reward system.  A sticker chart works well.  Work on one food every day until he or she will eat it consistently. Make sure the reward is attainable by setting goals that fit your child’s abilities.

Conclusion

Because picky eating can result from many different circumstances, it may require a team of professionals and a commitment from home to make considerable changes. As parents who have been through this, we understand that it's not an easy challenge to overcome. But, experience has taught us that it can be overcome. And, if we can do it, you can too!

Further Reading:


All content in this article is for informational purposes only, including links to products and/or websites mentioned. To clarify, TACA does not receive any compensation or commission for providing them.

Furthermore, the information on this page is not a substitute for professional advice, diagnosis, or treatment. For this reason, always seek the advice of your physician, therapist, or other qualified health provider with any questions or concerns you may have.