Autism Question #4: Help! My autistic child is a fussy eater!

Many autistic kids are labelled as a fussy eater. That is, they are highly selective about which foods they are comfortable eating, and leads to a restricted diet. This can be very frustrating and worrying – it can limit social opportunities like going out to eat, and it can have impacts on nutrient levels.

It’s not a quick and easy road to a full, balanced diet from a restrictive one. Firstly, it’s important to stay calm at the dinner table. Provide opportunities to desensitise to different smells, textures and tastes. Play with food and different textures if it’s a sensory aversion. And find ways to get nutrients in.

What does a ‘fussy eater’ look like?

For us, our autistic child has big sensory issues with food – look, texture, smell and colour in particular. This results in food avoidance and quite strong reactions to ‘non-preferred’ foods. Porridge, banana and other ‘gross’ foods are triggers – our child will scream loudly, refuse to sit at the table, and lose their appetite if any banana or triggering foods are placed near them. We’ve had food bowls turned upside-down, food thrown across the table, and many nights of refusing to eat because of strong sensory aversions to triggering food.

Preferred foods draw from a short list of safe and bland foods. Rice, plain pasta with no sauce, sausages, nuggets, chips, vanilla cake, pretzels.. these are safe beige foods for our child. Notice the distinct lack of fruit and vegetables on the ‘safe list’ of foods!

For other kids, there might be strong preferences for particular brands of foods, or only consistent looking processed foods, or particular ways of cooking foods (e.g. will eat something raw and crunchy but not soggy and cooked). This can change over time, with some preferred foods migrating to the ‘not-eating’ list. This can be frustrating because an already restricted list of safe foods reduces further. But what we want is for more foods to move to the ‘safe’ or ‘okay’ foods list.

Why are autistic kids ‘fussy eaters’?

Research from 2021 suggests that 70% of autistic kids have atypical eating behaviours – either restricted diets or particular brand preferences.

Often ‘fussy eating’ is actually a sensory issue. There may be sensory aversions to certain textures, colours, flavours or smells. This means that it’s not that a child is a ‘fussy eater’, but there is an actual sensory issue that they can’t overcome by being forced to eat food. Their response will be instinctual and might involve gagging, vomiting, feeling nauseous or being put off their appetite.

Sometimes there may be actual physical issues that are contributing to restricted eating. A child may have a tongue, mouth, or digestive issue that impacts on their physical eating.

Autistic children who are strong rule abiders may also have fixed patterns around how to eat – like specific brand preferences, needing to have foods not touch each other, or eating in a particular order or pattern.

How do you manage meal times with a ‘fussy eater’?

The advice from feeding specialists is to:

  • stay calm at the dinner table. Don’t make a fuss – no praise or censure. Practice ‘nonchalance’ and not giving much attention to the eating at all. You don’t want negative emotions at the table, because this can lead to more anxiety around food.
  • offer healthy foods to the whole family, and allow the child to decide what they will eat. This gives control to the child over what they eat, but also allows the adults to have control over the quality of what’s offered.
  • give kids the power to ‘fix’ their foods. If, for example, the pasta is too wet, then have them pat it dry with paper towel to ‘fix’ it. If it’s too cold or too hot, have them fix it until it’s okay for them to eat.

How can you expand ‘safe foods’?

The goal for most parents is to expand the range of foods that a child will eat. This will help the child:

  • increase their nutrient intake, being healthy and balanced in their diet
  • eat the same meals with the family
  • feel more comfortable eating out, going on school camp, traveling, eating dinner at other people’s homes, and other situations where there are different foods

There are a couple of strategies recommended by feeding specialists around how to expand a child’s ‘safe foods’.

1. Eat family-style meals

Family-style meals are where dinner is placed on the table in it’s separate components, and everyone can serve up what they want. This might be like tacos, where the toppings can be selected from a plate and constructed at the table. It might look like pasta with the sauce and grated cheese are separate so everyone can serve their own as they wish. This style of eating enables parents to provide ‘normal’ meals for everyone, allows exposure to different foods’ look and smell, and gives control to the child to decide what they are comfortable eating.

2. Engage in sensory play with food

Playing with food and exploring the different look, texture, smell, feel and taste of the food is one way to de-sensitise children to different foods. You could encourage your child to cook with you, touching new foods to their lips, and maybe taking a taste or touching it to their tongue. Then cook with those foods – whether it’s mashed pumpkin chocolate muffins, mini-pizzas, vegetable chips or avocado chocolate mousse. This exposure and safe exploration of foods can help build up the ‘safe list’ of foods, or at least the ‘okay’ list of foods that can be tolerated. Hiding ‘secret’ ingredients in muffins, for example, can also be a way of testing out new foods and increasing nutrition, while hiding most of the taste.

3. Division of Responsibility “We provide, you decide”

Parents have the responsibility to decide what to cook and offer children. But it is the child’s choice what they want to eat. This “we provide, you decide” mentality gives children the control and responsibility over what they put in their own bodies. But this also means that parents offer the one dinner meal. ‘Back-up’ foods (like eating toast if the child doesn’t eat dinner) shouldn’t be allowed.

You may like to keep track of what your child eats with a meal planner. Record what dinners you are offering. You can also track what foods your child has eaten, like a food diary or log. The Balance Planner has space each week for a meal planner. It has space each day in the ‘tracker box’ to record daily activities as well. Record this over a couple of weeks to get a clearer picture of what and when your child eats.

How can you increase nutrient intakes with restricted diets?

It’s of course worrying if your child doesn’t eat much of anything. You want to make sure they are getting some nutrients.

  • Multivitamin tablets or gummies is one way to supplement a diet.
  • Use meal supplement sachets or fortified milk drinks (like ‘Up and Go’). These are non-solid-food way to get energy and nutrients into a diet.
  • You can hide vegetables or fruits into foods like muffins, sauces or wrapped in a pastry. This might work, or might just make your ‘fussy eater’ child super suspicious of home-cooked foods!

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