Nutrition Interventions for Children with Special Health Care Needs

Chapter 23 - Nutrition Interventions for Autism Spectrum Disorder
Nutrition and Feeding
The unique nutrition-related aspect for children with ASD is their selective food
choices that often result in a narrow list of foods accepted. Parents frequently report
“picky” eating, although this behavior is more persistent than the transient picky
eating typically seen in young children. This diet selectivity is influenced by the same
range of general behaviors seen in children with ASD. See Table 23-1.
Although most parents report that their infants fed well and generally accepted
baby foods, the transition to table foods after the first year tends to be more
problematic. A frequent pattern is a preference for dry, crunchy foods; and refusal
of soft, smooth textures, e.g. mashed potatoes and cooked cereal. Typically, finger
foods are preferred to using eating utensils. Foods frequently reported in the diets
of children with ASD include dry cereal (eaten as a finger food; no milk added),
crackers, chicken nuggets, pizza, bread, hot dogs, and plain pasta, while intake of
vegetables and fruits tends to be minimal. Over time, some children narrow their
food acceptances even more, to fewer than 10-15 items; within that restriction, only
certain brands or methods of preparation are allowed.
It is easy to understand that families become anxious when their children continue
to refuse foods, despite being offered a variety of foods. Eventually, parents respond
by giving their child foods they know he/she will eat. This leads to different and
sometimes separate meals for the child, and if behavior is an issue, less participation
in family mealtime.
Table 23-1 Feeding Behaviors of Children with Autism
Autism Concerns Feeding Characteristics
• Difficulty in transitioning to textures
• Increased sensory sensitivity
• Restricted intake due to color,
texture, temperature, odor
• Decreased acceptance of foods over
time; refusal of “new” foods
• Difficulty with changes in mealtime
routines, tantrums
• Preference for dry, crunchy foods (no milk on
dry cereal)
• Food groups most likely refused or limited –
vegetables and fruits
• Often adequate intake of protein (though
limited selection) and dairy foods
• Often prefer finger foods (sensory issues?)
• Refusal of vitamin/mineral supplements
Children with ASD tend to have growth parameters within normal limits, although
overweight and underweight can be seen secondarily to feeding behaviors. Energy
needs are usually met, although the food sources may be limited or an entire food
group omitted. Due to their selective eating behaviors, the micronutrient intakes of
these children may be minimal or inadequate. A recent report of preschool children
with ASD indicated nutrients most at risk were vitamin A, vitamin E, fiber, and
264 Nutrition Interventions for Children With Special Health Care Needs