Introduction
Autism Spectrum Disorder (ASD) has an impact on how people interact, relate, and connect with others. Autism is a spectrum illness, which implies that it impacts people to different degrees and in varying methods. Repetitive behaviors, social difficulties, and sensory problems are some major challenges autistic individuals face.
Eating and feeding are one of the fields impacted by autism. Children with autism are most affected by feeding issues, impacting their development, growth, and health. Behavioral issues, oral motor problems, sensory aversions, food refusal, and selectivity are some of the problems autistic children might encounter.
The interventions, consequences, and causes of feeding issues in autistic children are the purpose of this paper. The discussion topics are how autism impacts feeding, the strategies for addressing the problem, and the outcomes and risks of feeding problems. The role of diet and nutrition in autism and suggestions for future plans will be discussed.
How Autism Affects Feeding
Sensory Sensitivity
Autism can affect a person’s perception of and reaction to various sensory inputs, including noises, scents, temperatures, textures, and tastes, impacting their feeding preferences and behaviors in several ways. Some autistic children may experience sensory sensitivity, making them differently susceptible to particular sensory cues than others (Margari et al., 2020). For instance, they may perceive some foods as too mushy, spicy, bitter, bright, or loud. Also, controlling saliva, swallowing, and chewing are the oral motor skills they might encounter. They can find eating painful, uncomfortable, or stressful with these challenges.
There are several ways sensory sensitivity can affect children’s feeding habits. First, they may only consume foods with certain textures, shapes, or colors (Barrientos et al., 2023). They might refuse foods with different, blended, or mixed components. For example, they might only consume crunchy, round, or white foods. Second, autistic children can strongly dislike various tastes and smells. They might reject, spit out, or gag foods with a strong flavor or odor. For instance, they can refuse foods with cheese, onion, or garlic.
Third, children with autism may find different textures or temperatures in their mouths unbearable. They might desire foods that are rough or smooth, cold or hot. For example, they might only consume bread, soup, or ice cream. Fourth, autistic children may encounter issues with the social facets of feeding (Padmanabhan & Shroff, 2022). They can find it difficult to follow table manners, share food, or eat in front of others. For instance, they may leave the table, spit out food, or eat with their hands. Sensory sensitivity also affects how often and how much an individual eats. It can result in digestive problems, weight issues, and nutritional deficiencies.
Ritualism and Rigidity
Rigid and ritualistic behaviors can contribute to feeding difficulties in children. Rigidity and ritualism refer to the inclination to resist any variations or change and to follow a strict set of routines and rules (Margari et al., 2020). These behaviors affect certain aspects of feeding, such as manner, place, time of eating and presentation, color, and food texture. There are various ways rigidity and ritualism may be displayed in feeding difficulties.
First, children might only consume various flavors or brands of food and refuse any alternatives or substitutes. Second, they may only consume meals with a certain texture, such as smooth or crunchy, and avoid those with mixed or varying texture (Barrientos et al., 2023). Third, the child might only eat food with a specific color, such as brown or green, and reject meals with other patterns or colors. Caregivers and parents can find it challenging to offer their children a sufficient and balanced diet based on these behaviors.
There are certain reasons why autistic children might develop rigid and ritualistic behaviors around feeding. They might feel uncomfortable or overwhelmed by sensory aversions to various textures, tastes, and food smells. Also, they may feel distracted or confused by the variability or complexity of food because of difficulty processing sensory information (Padmanabhan & Shroff, 2022). In addition, they may become dissatisfied when presented with unexpected meal options since they may need help to express their preferences and demands.
Gastrointestinal Issues
Autistic children are highly prone to gastrointestinal (GI) issues, which can significantly affect their nutritional status and feeding habits. Inflammatory bowel disease, food intolerance, abdominal pain, constipation, and gastroesophageal reflux disease (GERD) are some of the GI problems autistic children encounter (Margari et al., 2020). For example, children with autism may avoid various textures or foods if they have GERD because they experience regular nausea, heartburn, or regurgitation. A child may feel uncomfortable or bloated when they are constipated. A child with inflammatory bowel disease might have fatigue, weight loss, and bloody stools due to chronic irritation in their intestines.
Children with autism facing these problems can experience distress, pain, and discomfort, which can result in poor appetite, food avoidance, and food selectivity. Also, some autistic children might have behavioral and oral motor impairments or sensitivities challenges, which may impede their feeding inclinations and skills (Page et al., 2021). For example, children with sensory sensitivities may limit their food choices if they dislike various textures or tastes of food. Children facing oral motor impairment might not manage to consume a range of foods because they might have difficulties manipulating, chewing, and swallowing foods (Barrientos et al., 2023). A child’s mealtime environment can be disrupted when behavioral challenges cause routines, rituals, or tantrums around feeding.
Communication and Cognitive Difficulties
Children with ASD are highly prone to communication and cognitive challenges, which can greatly affect their nutritional intake and feeding behaviors. Autistic children might have difficulties comprehending nonverbal gestures, verbal directives, and social cues during mealtimes, impacting their inclination to socialize with others, adhere to mealtime routines, and try new foods (Margari et al., 2020). It can result in selective eating, particularly low consumption of vegetables and high consumption of carbohydrates.
Cognitive and communication challenges may impact feeding in children with autism in various ways. Autistic children might not respond to their caregivers’ or parents’ verbal gestures or prompts to try new foods or eat more (Barrientos et al., 2023). They may be unable to nonverbally or orally express their preferences, thirst, or hunger. Also, children can face challenges controlling their eating pace, concentrating on their meals, or remaining seated at the table. Additionally, they might become upset or anxious if their mealtime environment or routine changes or if their meal needs to be presented or cooked in a particular manner.
The Strategies for Addressing Feeding Issues in Autistic Children
Sensory Sensitivity
Caregivers and parents can use various strategies to assist children with ASD in coping with sensory sensitivity and improving their eating habits. First, new foods should be gradually introduced and in lesser quantities. They can commence with foods the child already favors and steadily introduce new sensory attributes, such as flavor, shape, or color (Margari et al., 2020). For instance, if the children enjoy rice, add tomato sauce to change the taste. Second, the children should be provided with various foods and allowed to choose how fast and how much they want to consume. The child should not be bribed or forced to eat something they are not ready for or dislike.
Third, a calm and positive environment should have fewer noises and distractions that might overwhelm the child’s senses. Caregivers should avoid punishment or negative comments when the child rejects certain foods and provide positive reinforcement when they try new foods (Barrientos et al., 2023). Fourth, parents should promote the use of sensory tools, such as the eyes, nose, and mouth, before eating. Also, they should encourage sensory activities, such as playing games with food, to make it more engaging and fun.
Ritualism and Rigidity
Parents can use various strategies to address rigidity and ritualism in the feeding habits of children with ASD. First, parents should introduce new foods steadily by providing a small amount alongside acquainted food and increasing the frequency and proportion with time (Margari et al., 2020). Also, they can inspire their children to try new nutriments through rewards or praise.
Second, when children have some say in how and what they eat, they may feel more inspired and comfortable to eat. Parents can let the children choose what they want after providing several acceptable meal options. In addition, the children can be involved in food preparation, such as cutting the bread and washing the vegetables.
Third, parents can reduce sensory aversions by making food more appealing, such as mashing, chopping, and blending. Also, they can consider their children’s memory preferences by using varying cups or plates. Fourth, the parents are encouraged to seek professional assistance from a feeding specialist, a nutritionist, or a pediatrician if rigidity and ritualism interfere with the children’s feeding habits (Dumont et al., 2022). The professionals can propose personalized treatment plans, rule out psychological or medical causes, and evaluate the children’s eating habits.
Gastrointestinal Issues
There are certain strategies parents or caregivers can use to address gastrointestinal problems in autistic children and improve their feeding habits. First, they should consult a gastroenterologist or a pediatrician to treat primary health issues resulting in GI symptoms. Irritable bowel syndrome and celiac disease are some common conditions. Second, they must adhere to a dietary plan that fits the children’s preferences and needs. It can involve reducing or eliminating foods like spicy, dairy, or gluten, which can trigger GI signs (Margari et al., 2020). Also, it involves adding foods such as water, probiotics, or fiber, which can promote GI health.
Third, parents can use a behavioral approach to assist the child in coping with GI anxiety and discomfort. This approach can comprise coaching the child on relaxation methods like guided imagery, advanced muscle relaxation, and deep breathing (Dumont et al., 2022; Page et al., 2021). In addition, parents can encourage the child to swallow safely, eat essential portions, or try new textures or foods by using positive reinforcement like reward and praise.
Communication and Cognitive Difficulties
Caregivers and parents can use certain strategies to address communication and cognitive difficulties and improve the well-being of autistic children. First, they can communicate choices and expectations through virtual aids. Written words, symbols, and pictures are some virtual aids they can use to represent varying utensils and foods (Padmanabhan & Shroff, 2022). For instance, parents can use a checklist to remind a child to sit at the table and wash their hands or use a picture menu to show what is available for lunch.
Second, caregivers can use positive reinforcement like rewards or praise for following directions or trying new foods. A child can adhere to mealtime rules or increase their food selection through positive reinforcement (Margari et al., 2020). Third, parents must establish a structured and calm mealtime environment since autistic children are easily overwhelmed or distracted by lights or noise in their surroundings. For instance, they can play soothing music, dim the lights, or turn off devices. Also, they can use a timer to show when mealtime commences and concludes and create a consistent schedule for snacks and meals.
The Risks and Outcomes of Feeding Problems in Autistic Children
Nutritional Deficiencies
Nutritional deficiencies are the outcomes of feeding issues in autistic children. A comprehensive review of 17 studies, including 881 children with autism, found that feeding issues in autistic children are five times higher than in non-ASD peers (Baraskewich et al., 2021). Food selectivity and an inclination for processed and starchy foods are the most significant feeding concerns. Food selectivity may result in a lower intake of important micronutrients for development and growth, such as proteins, vitamin D, and calcium.
For instance, a longitudinal examination of 288 children with ASD discovered that roughly a third were vitamin D deficient, with up to 54% being calcium deficient (Dumont et al., 2022). Skin disorders, wound healing, brain function, and bone strength can be affected by vitamin deficiencies. Thus, it is essential to prevent probable health issues and improve the well-being of autistic children by evaluating and addressing their nutrient intake and feeding behaviors.
Oral Health Problems
Feeding difficulties are frequent in autistic children, and they can have a significant effect on their dental health. Children with feeding issues might eat more acidic or sugary foods that destroy the teeth’s enamel, increasing the risk of dental cavities (Baraskewich et al., 2021). Feeding problems may affect the development of muscles, teeth, and jaw used in oral functions because they interrupt the child’s ability to chew and swallow (Descrettes-Demey et al., 2023).
Also, feeding problems can deter the child from pursuing dental care or reporting oral issues when required. Fear or discomfort may cause the child to resist visiting the dentist or brushing their teeth. Additionally, feeding issues can worsen the child’s oral health by causing bleeding, erosion, infection, or inflammation in the mouth.
Gastrointestinal Problems
Gut bacteria imbalance, food selectivity, and anxiety are some of the factors that cause gastrointestinal issues in autistic children with feeding problems. Diarrhea, stomach pain, and constipation may occur in autistic children. Hard and dry stool that is not easy to pass is known as constipation (Dumont et al., 2022; Page et al., 2021). Medication side effects, such as less physical activity, dehydration, and low fiber consumption, can cause constipation. Autistic children with sensory aversions to various textures, foods, or selective eating habits can have constipation.
Watery, loose, and frequent stool is referred to as diarrhea and can cause weight loss, electrolyte imbalance, and dehydration. Inflammatory bowel sickness, allergies, or food intolerance can cause diarrhea. Gut bacteria imbalance or immune system dysfunction is a common cause of diarrhea in children with ASD (Baraskewich et al., 2021). Also, autistic children may feel discomfort or pain in the stomach section. Communication difficulties, stress, and anxiety are the leading causes of abdominal pain in children with autism. Autistic children’s social skills, learning, mood, and behavior are impacted by gastrointestinal issues (Descrettes-Demey et al., 2023). Therefore, a dedicated team comprising a therapist, a pediatrician, and a dietitian should assist in detecting and addressing the issue.
Behavioral Problems
Feeding problems in autistic children can result in certain behavioral issues such as mealtime rituals, sensory aversions, food selectivity, food refusal, and tantrums. The behaviors can interrupt a child’s family functioning, social interactions, and nutritional intake. Anxiety, anger, and frustration can trigger strong emotional outbursts known as tantrums (Padmanabhan & Shroff, 2022). Sensory stimuli such as the temperature, texture, and smell of food can overwhelm children with ASD and result in tantrums. Challenges in communicating needs or preferences or disliking the food might also cause tantrums in autistic children.
The rejection of entire or certain food groups is known as food refusal. They can refuse foods linked to negative experiences like vomiting, gagging, choking, or food that does not match their sensory inclinations. The preference for a specific presentation or brand of food or a limited variety of foods is called food selectivity (Baraskewich et al., 2021). Autistic children may be selective about their napkins or utensils or the food’s texture, shape, or color.
The negative reaction to various sensory facets of food, like appearance, texture, and smell, is known as sensory aversion. Autistic children have sensory aversions due to reduced or amplified sensitivity to particular stimuli and challenges processing numerous sensory inputs at once.
The rigid or repetitive behaviors children with ASD conduct during, after, and before eating are called mealtime rituals (Dumont et al., 2022). They prefer mealtime rituals because they pursue order and sureness in their environment. Also, conducting familiar routines can assist them in coping with stress or anxiety. A multidisciplinary team of professionals must conduct a conclusive evaluation and intervention to address the feeding issue.
Psychological Problems
Feeding issues in autistic children can significantly affect their psychological well-being and cause problems like obsessive-compulsive behavior, social isolation, low self-esteem, depression, and anxiety. Anxiety is the most common issue because children may experience distress or fear when encountering disliked or unaccustomed tastes, textures, or foods (Baraskewich et al., 2021). Also, they might worry about eating consequences like gaining weight, vomiting, or choking. Children with ASD may feel depressed due to the feeling of worthlessness, sadness, and hopelessness caused by their feeding issues. Their energy or mood levels can change; they have difficulty sleeping and lose interest in their hobbies.
Also, it is common for autistic children to have low self-esteem because they compare themselves with other individuals with regular eating habits, and it can undermine their social skills, assertiveness, and confidence. They can feel guilty, embarrassed, or ashamed about their feeding preferences or habits. Social isolation is another primary concern because autistic children with feeding problems will avoid circumstances where food is concerned, like restaurants and parties (Dumont et al., 2022).
In addition, they can feel misunderstood, rejected, or left out by others with dissimilar problems. Finally, children with ASD can create rigid rituals or rules regarding food, resulting in obsessive-compulsive behavior. It can cause repetitive behaviors like arranging, washing, or counting food items.
The Importance of Nutrition and Diet in Autism
Healthy nutrition and diet can benefit autistic children’s well-being. Some children’s quality and variety of food consumption may be affected by dietary aversions or preferences. Others might want to minimize ASD symptoms by following special diets like casein-free or gluten-free diets. Nonetheless, there is scarce proof that autistic children can benefit from these diets (Dumont et al., 2022). Furthermore, nutritional imbalances or deficiencies may emerge from curbing various foods, negatively impacting bone health, development, and growth.
Thus, before changing autistic children’s diet, consult with a registered dietitian or a care provider. The nutrition specialist will ensure they consume enough crucial nutrients and create a meal plan that meets their preferences and needs (Baraskewich et al., 2021). In addition, they can offer counsel on how to manage digestive issues, handle sensory problems, and introduce new foods.
Probiotics and supplements might be beneficial for some autistic children with digestive problems or nutritional gaps. However, these products are known to have side effects and should be used cautiously. An individual’s immune system, metabolism, and genetics can determine the safety and effectiveness of probiotics and supplements (Descrettes-Demey et al., 2023). Additional investigation is required to assess the appropriate doses and types of probiotics and supplements for autistic children.
Current Issues and Future Plans for Autism and Feeding Problems
There are several current problems impacting autism and feeding problems management. First, identifying and diagnosing feeding issues in autistic children lacks regulated evaluation criteria and tools. Second, the preferences and needs of autistic children and their families have limited evidence-based strategies and interventions (Dumont et al., 2022). Third, disciplines and sectors like social services, education, and health experience service and care coordination challenges. Fourth, remote and rural areas have barriers to accessing affordable and essential support and services. Fifth, children with autism face discrimination and stigma, which can impact their well-being and quality of life.
There are several recommendations regarding plans for autism and nutrition issues. First, diagnosing and screening feeding issues in autistic children requires a valid and reliable evaluation and criteria. Second, more assessment and research are needed to determine the efficient interventions and appropriate practices for improving autistic children’s feeding outcomes (Baraskewich et al., 2021).
Third, enhanced communication and collaboration are required among stakeholders like advocates, policymakers, researchers, and caregivers. Fourth, underserved areas need more accessibility and availability of dedicated support for autistic children. Fifth, the dignity and rights of children with autism and their families and the stigma regarding autism and feeding problems should be raised.
Conclusion
Autism is a developmental ailment affecting social behavior and communication. Feeding issues, such as sensitivity to taste or smell, consumption of various foods, and constipation, are common challenges affecting children with ASD. Gastrointestinal problems, rigidity, and sensory sensitivity are some of the causes of feeding problems. The nutrition, growth, and health of autistic children, their social relationships, and their families can be affected by these feeding problems.
Various interventions can be helpful depending on the type and severity of the feeding problem. Dietary modification, nutritional adjustment, and behavioral therapy are some examples. The role of diet and nutrition is complex, but various supplements and nutrients can improve some behaviors and symptoms in autistic children. However, additional research is required to address feeding problems in autistic children, which will improve their well-being and quality of life.
References
Baraskewich, J., von Ranson, K. M., McCrimmon, A., & McMorris, C. A. (2021). Feeding and eating problems in children and adolescents with autism: A scoping review. Autism, 25(6), 1505-1519. Web.
Barrientos, B. A. V., Badajos, A. F. T., Bucog, E. F. M., Mauro, R. V. C., & Bulan, P. M. P. (2023). Mealtime experiences of children with autism spectrum disorder from the perspectives of Filipino occupational therapists in Cebu: Implications for practice. Internet Journal of Allied Health Sciences and Practice, 21(1), 2. Web.
Descrettes-Demey, V., Demey, B., Crovetto, C., Simonnot, A., Berquin, P., Djeddi, D. D., & Benarous, X. (2023). Relation between sensory processing difficulties and feeding problems in youths with autistic spectrum disorders: A comprehensive systematic review and meta-analysis. Review Journal of Autism and Developmental Disorders, 1-13. Web.
Dumont, E., Jansen, A., Duker, P. C., Seys, D. M., Broers, N. J., & Mulkens, S. (2022). Feeding/eating problems in children who refrained from treatment in the past: Who did (not) recover? Frontiers in Pediatrics, 10. Web.
Margari, L., Marzulli, L., Gabellone, A., & de Giambattista, C. (2020). Eating and mealtime behaviors in patients with autism spectrum disorder: Current perspectives. Neuropsychiatric Disease and Treatment, 2083-2102. Web.
Padmanabhan, P. S., & Shroff, H. (2022). Addressing mealtime behaviors of children with autism spectrum disorders in schools: A qualitative study with educators in Mumbai, India. International Journal of Developmental Disabilities, 68(2), 198-206. Web.
Page, S. D., Souders, M. C., Kral, T. V., Chao, A. M., & Pinto-Martin, J. (2021). Correlates of feeding difficulties among children with autism spectrum disorder: A systematic review. Journal of Autism and Developmental Disorders, 1-20. Web.