Louise Mercieca on how to include the essential nutrients, while promoting an enjoyable relationship with food.

For children with autism, issues with food can be sensitive and sometimes complicated to manage. Many eating issues experienced by children on the autism spectrum may be as a result of a gastro-intestinal disorder. These may hinder the enjoyment of foods, the ability to sit at a table for any length of time, or spark anxiety around foods. Imagine if you were being repeatedly offered foods that cause you physical pain, but you were not able to articulate this? 

Constipation is common in children, and often children on the autism spectrum will have a more restricted diet, which may make constipation more likely. Children can forget to drink regularly, or they may not like the taste of water. They may not recognise thirst.

It’s unclear exactly why children on the Autism spectrum are also more prone to issues such as abdominal pains, constipation, bloating and diarrhoea. While dietary restrictions may be the biggest culprit, there’s growing evidence that stress impacts on these issues just as much as the food we eat.

Introducing new foods can be challenging, but it’s important to keep trying. Offer a food that remains familiar looking while building tolerance to small and incremental changes. Cognitive rigidity and the ‘desire for sameness’ can often explain why a child may demonstrate particular routines or rituals around food such as meal times, having to have the same plate, utensils or the same colour of cup. To the child, this is often the first predictor of whether a food is safe. If it feels familiar, then it feels safe. It can be frustrating to stick to the preferred and safe foods, as they can often be beige and limited in variety but in order to maintain weight and growth patterns, these safe foods need to be allowed first. Then the secondary (but crucially important) issue is how to broaden the range of safe foods.

One of the biggest issues with food is the anxiety around it. The bigger the issue becomes, the less likely the child is to try the food, and the more anxious they will feel around meal times in the future. Neophobia is the term used to describe an overwhelming fear of new or unfamiliar foods. Children on the Autism spectrum are more food neophobic, and that this could impact future health outcomes. The difficulties, of course, lie in the everyday practical steps involved in removing the neophobia and encouraging a child to try a wider range of foods. We know that forcing a child doesn’t work, only increasing anxiety and exacerbating the issue, so what steps can we take?

  • Get creative—we’re reversing the idea of ‘don’t play with your food’ and instead encouraging children to do so. For many the issue may be sensory—being able to smell and touch the food may help.
  • Incremental steps—it’s highly unlikely a child will eat a whole plate of food and setting an expectation that they will can lead to disappointment. Accepting that it would be a great result if they ate one thing is more realistic 
  • Praise—it’s important to be patient and encouraging (no matter how frustrating it may feel). If any progress has been made, this should be met with huge encouragement and if it hasn’t, it is important not to be negative. Changing food choices can be a long process, but persevering in the early years will help with adolescent and adult eating habits
  • Make small changes. Changing the pasta shape, for example, widens the options. 
  • Choice—children like to have some element of control over their food intake. A good way to do this is to offer three bowls of vegetables. It’s highly unlikely they’ll pick all three but they may pick one and that would be progress. 

Some children with autism may have extreme taste sensations. This may mean a preference for bland foods, yet others may be over-zealous with seasoning and desire overly spiced or salty foods. It’s great when children embrace spicy foods as long as they are not causing any digestive disturbances. 

For any child, managing a stable blood sugar level is beneficial for mood and behaviour. Dips in blood sugar can cause increased levels of the stress hormone cortisol. This will increase feelings of fear or anxiousness. Couple this with any of the above, and meal times could become particularly stressful for a child.

Louise Mercieca
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Louise Mercieca is a writer on health and nutrition and is an Early Years Nutrition Consultant, She has launched a series of online courses entitled ‘How Food Shapes Your Child’ and co-launched a Social Enterprise called The Good Food Academy.

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