SELECTIVE EATING IN
CHILDREN WITH AUTISM
DAVE REX –SPECIALIST DIETICIAN FOR
HEALTH PROMOTING SCHOOLS
Children with ASD sometimes have very specific food
preferences. This can have an impact on their development,
mental wellbeing and physical health. It can also cause
significant practical and social difficulties for family and child.
HOW TO ASSESS WHETHER OR NOT THE DIET IS ADEQUATE
We need 40 nutrients in our diet. For children over 2 years of age, the
easiest way to assess whether or not we are likely to be getting these, is to
compare a child’s food choices with the “Eatwell Plate”
(www.food.gov.uk/scotland/scotnut/ eatwellplate/). Ideally, there should be
some foods consumed regularly within each of the 4 essential “food groups”.
In addition, there are specific advantages to including oily fish, “wholegrain
based” starchy foods, and green vegetables. These contain essential omega
3 fats, dietary fibre and magnesium (respectively), each of which benefit
physical and mental wellbeing. Remember that most children in the UK have
a diet that does not provide all the nutrients in the right amounts! This means
that their diet can be adequate for survival, but still not the best for optimum
health and mental wellbeing.
UNDERSTANDING SELECTIVE EATING IN CHILDREN WITH AUTISM
Children with autism may be more likely to stick with what they are most
familiar with. This can be because they become obsessed with a particular
food or routine. They may also avoid new foods because they find all new
experiences difficult to cope with. They may also refuse some meals
because they want something that they feel in control of. For a child who
finds communication difficult, refusing to eat something can be a way of
communicating stress or anxiety about something else. Also, many children
with autism experience taste, smell or texture differently. This can be a
further reason for finding some foods difficult to accept.
HOW TO INFLUENCE FOOD CHOICES
1. Having nutritious foods within sight, and making healthy choices yourself,
is usually the best approach in the long term. This is usually more effective
than persuasion, coaxing or any active encouragement. It is important to
appear not to care what choices are made. This is sometimes easier said
2. Some of the most preferred and least nutritious choices sometimes have
to be unavailable to make it possible for new foods to be accepted.
3. Providing a choice between two different foods or meals can be helpful.
It still allows a child to feel in control, even when neither choice is their
favourite. Ensure that the choices are realistic though.
4. Try having a “Self service” meal. This is where everyone helps themselves
to whatever they prefer from serving dishes placed in the middle of a table.
This is less pressure than putting food on their plate.
5. Sometimes, telling a child what meal is coming next can help. For examples,
including pictures of specific meals on a “visual timetable” can help.
6. Involve children in food preparation. The more a child is involved in
choosing, preparing and cooking ingredients, the more they have invested
in it and the more attached they become to the meal that is prepared.
Don’t actively encourage them to taste it though!
7. It is often best to get a selective eater to take a school meal rather than a
packed lunch. The modelling of other pupils, different setting and limited
menu often leads to “breakthroughs” with new foods that have been hard
to achieve at home.
8 Some older children with autism can be motivated to make more nutritious
choices simply through education about nutrition. This should always be
done in a very “Matter of fact” way or it soon becomes nagging and
SPECIAL DIETS AND NUTRITIONAL SUPPLEMENTS FOR CHILDREN WITH ASD
There are many “Special diets” and supplements promoted for children with ASD.
Below is a guide to the safest, most effective and practical options. Most of the
interventions listed below have some risks attached and are most safely and
effectively implemented with the support of a State Registered Dietitian.
|Milk (casein) exclusion
||Not the same as an allergy.
Produces morphine like
substance: can effect mood,
sleep or health. Often
referred to as “intolerance”.
|Milk products are a major calcium
They also provide iodine (also found in eggs and fish) and protein
(found in meat, fish, eggs, beans,
nuts and pulses
|Sometimes soya products or
goat & sheep milk / cheese
Other calcium fortified
substitutes are made from
rice, oats, or nuts.
||Some “wholewheat” foods provide valuable fibre. Without fibre, there are risks of constipation and poor blood sugar control. Make sure of enough fibre elsewhere in the diet.
||May need to avoid barley and rye. Oats maybe OK if labelled as gluten free.
|Food additive exclusion
||Some have been shown to worsen mood and concentration.
||No need to avoid all E numbers, a food additive sheet is available. Specific additives, colourings and sweeteners are the main problem.
||Various substances like phenols, salicylates and amines can cause physical or behavioural intolerances.
||Could take too many foods out of the diet just in case of intolerance. Foods containing these substances are very nutritious.
||Most common causes of reaction are oranges, tomatoes, tea and bananas. For some children also apples, berries and peppers.
|Healthy, well balanced diet.
||Use the Eatwell Plate as a guide. what's good for the body is good for the brain.
||Easier said than done for some children! Requires patience and modelling.
||Green vegetables, high fibre starchy foods, oily fish, beans, pulses, a little red meat, very little added sugar or high sugar foods.
|Vitamin and mineral supplement.
||Some have key roles in brain and poor intakes are common, e.g. iron, zinc, magnesium and folic acid.
||All nutrients have a "safe upper limit". Nutrients in foods are better absorbed.
||Useful 2safety net" especially for a child with a poor diet.
|Omega 3 supplement.
||May improve mood, sleep, attention or health in general.
||Very few except for very high doses. May lead to increased risk of bruising.
||250 to 1000mg per day, depending on diet and age of child. Children with raised red bumps on arms, high levels of thirst, dull hair and weak nails may be showing vitamin D deficiency.
|Vitamin D supplement.
||Importnat for healthy bones, may improve mood. May reduce a wide range of health risks.
||Few risks unless on a very high dose. If aiming to increase vitamin D levels through sun exposure, take care to avoid burning. However spend some time in the sun without sunscreen.
||Opinion varies on the ideal vitamin D dose. Blood vitamin D levels in Scotland are often low.