Autism and Picky Eating: Insights and Strategies from a Pediatric Occupational Therapist Picky eating is a common concern for many parents, but for families with children on the autism spectrum, it can be especially challenging. While most children go through phases of food preferences, the relationship between autism and picky eating often runs deeper. The struggle to introduce new foods, the limited variety of acceptable textures, and the anxiety surrounding mealtimes can leave both parents and children feeling frustrated. As a pediatric occupational therapist specializing in feeding, I’ve worked with many children on the autism spectrum who experience significant feeding difficulties. In this blog, we will explore the reasons behind picky eating in children with autism, offer strategies for families to approach mealtimes with less stress, and highlight how occupational therapy can play a crucial role in improving feeding habits. Understanding the Link Between Autism and Picky Eating Picky eating in children with autism often stems from a combination of sensory processing challenges, rigid routines, and communication difficulties. While every child with autism is unique, there are common factors that contribute to feeding difficulties. 1. Sensory Processing Issues Children with autism often experience heightened or diminished sensory responses, including to taste, texture, smell, and appearance of food. These sensory sensitivities can make the experience of eating overwhelming. For example: A child may be hypersensitive to certain textures (e.g., soft, mushy foods like mashed potatoes), finding them uncomfortable or even unbearable to touch or eat. Strong flavors or unfamiliar smells may trigger a negative response, causing the child to avoid specific foods. Visual aspects of food, such as the color or presentation, might also play a role. A child may refuse to eat a meal if it doesn't "look right" to them. 2. Limited Variety Due to Rigid Routines Children on the autism spectrum often rely on routine and predictability to feel safe and secure. This extends to their eating habits. They may develop a very limited diet consisting of only a few specific foods that they feel comfortable with. Attempts to introduce new foods can cause distress, leading to food refusal or tantrums at mealtime. The repetitive behavior and need for sameness commonly seen in autism can make it difficult for children to tolerate changes in their meals, such as a different brand of the same food item. Even minor alterations in how food is prepared or presented can cause a child to reject the food altogether. 3. Communication Barriers Children with autism may have difficulties expressing their needs and preferences, making it hard for caregivers to understand why they are refusing food. A child may not be able to verbalize that they dislike the texture of a certain food or that the smell is overwhelming. Instead, they might communicate their discomfort through behaviors such as crying, pushing the food away, or throwing tantrums at the table. Common Feeding Behaviors in Children with Autism When it comes to feeding, children with autism can exhibit a range of challenging behaviors that make mealtimes difficult for both the child and their caregivers. Some of the most common behaviors include: Narrow Food Preferences: Sticking to a few select foods, often from the same food group (e.g., eating only carbs like crackers, bread, or pasta). Refusing Certain Textures: Avoiding specific textures, such as crunchy, soft, or chewy foods. Strong Aversion to New Foods: Refusing to try new foods, even after multiple exposures. Sensitivity to Temperature: Preferring foods to be served at a specific temperature and refusing to eat if it’s too hot or cold. Visual Rejection: Rejecting foods based on their appearance, such as color, size, or shape. Impact of Picky Eating on Nutrition and Growth While picky eating can be frustrating, it’s important to consider the nutritional and developmental impact this can have on children with autism. Many children on the autism spectrum consume diets that are low in variety, which can lead to: Nutrient Deficiencies: A lack of fruits, vegetables, and proteins can result in deficiencies in vitamins and minerals, such as vitamin C, iron, and calcium. Growth Delays: Limited caloric intake or poor nutrition can impact a child’s growth and development, leading to weight loss, stunted growth, or malnutrition. Gut Health Issues: A restricted diet, especially one low in fiber, can contribute to gastrointestinal issues, which are common in children with autism. Parents often feel caught between wanting to ensure their child is getting enough to eat and trying to introduce healthier, more diverse options into their diet. How Occupational Therapy Can Help with Picky Eating Occupational therapy (OT) is highly effective in addressing picky eating and feeding challenges in children with autism. As a pediatric OT, I use a variety of strategies to help children gradually expand their food preferences while reducing mealtime stress. 1. Sensory Integration Techniques Sensory integration therapy helps children become more comfortable with different textures, smells, and tastes. By gradually exposing children to sensory experiences in a safe and supportive environment, we can reduce their aversion to certain foods. Desensitization activities: These might include playing with food outside of mealtime, allowing the child to touch and explore food textures without the pressure to eat them. This can help reduce sensory defensiveness. Graded exposure: Slowly introducing new foods alongside familiar, preferred foods. For example, offering a new vegetable in small portions on the same plate as a favorite food can increase familiarity and reduce fear. 2. Food Play and Exploration Occupational therapy often involves food play, where children engage with food in a non-threatening way. This might include activities such as: Playing with food textures (e.g., finger-painting with mashed sweet potatoes) to help them become more comfortable with different sensations. Using food in creative ways like building with cut-up vegetables or creating shapes with mashed foods. This helps children become more familiar with foods without the pressure of eating them immediately. 3. Gradual Food Transitions OTs can help children with autism expand their food preferences by using a technique called food chaining. This involves introducing new foods that are similar to foods the child already enjoys. For example, if a child likes chicken nuggets, we might gradually introduce grilled chicken by altering the texture slowly over time. 4. Mealtime Structure and Routine For children who rely on routine, establishing a structured mealtime routine can help them feel more comfortable and less anxious during meals. As an OT, I work with families to develop strategies such as: Creating visual schedules for mealtimes that outline what will happen during the meal. Using timers to set boundaries for how long the child needs to sit at the table, reducing mealtime power struggles. Consistent mealtime routines to create predictability, such as always starting with a preferred food and gradually introducing a new one. 5. Collaboration with Dietitians and Feeding Teams For children with significant nutritional concerns, occupational therapists often work closely with dietitians and pediatricians to ensure the child is getting the necessary nutrients for healthy growth and development. A team approach ensures that the child’s dietary needs are met while addressing behavioral and sensory feeding challenges. Strategies for Parents to Try at Home Parents can also implement some strategies at home to help their child with autism become more comfortable with a variety of foods and reduce picky eating behaviors. Here are some tips: 1. Be Patient and Persistent Introducing new foods to a child with autism takes time, and it’s important to be patient. Research shows that it can take up to 10-15 exposures to a new food before a child will accept it. Offer new foods without pressure, and celebrate small victories, such as touching or smelling the food. 2. Start Small and Gradual Start with small changes to your child’s preferred foods. For example, if your child only eats chicken nuggets, try introducing a different brand or slightly altering the texture. Gradual changes are less likely to overwhelm your child and lead to food refusal. 3. Offer Choices Giving your child a sense of control over their food choices can reduce anxiety around mealtimes. Offer two or three options for each meal so that your child can choose what they feel comfortable eating. Ensure that at least one of the options is a food they already enjoy. 4. Stay Consistent Consistency is key for children with autism. Try to maintain regular meal and snack times each day, and avoid making mealtime too stressful. If your child refuses a new food, avoid pressuring them, and try offering it again at a later time. 5. Positive Reinforcement Use positive reinforcement to encourage your child to try new foods. Praise them for small steps, such as touching or smelling the food, and offer non-food rewards for making progress, such as extra playtime or a favorite activity. When to Seek Help While picky eating is common in children with autism, it’s important to seek help if your child’s eating habits are causing significant nutritional concerns, weight loss, or family stress. If your child has a very limited diet, experiences extreme anxiety around mealtimes, or refuses entire food groups, it may be time to consult a pediatric occupational therapist or feeding specialist. Conclusion Picky eating in children with autism is often a multifaceted challenge involving sensory sensitivities, rigid routines, and communication barriers. However, with patience, the right strategies, and support from professionals such as occupational therapists, children can expand their food preferences and reduce the stress associated with mealtimes. As a pediatric occupational therapist, I have seen firsthand how individualized feeding therapy can make a positive impact during mealtime!