“Are Chicken Nuggets a Vegetable?” and Other Mealtime Musings: Selective Eating in Autism

May 3rd, 2022

by Whitney Sukonick, MA, LPA, BCBA, LifeLong Interventions Director, ASNC Clinical Department

One of the first jobs of parenting is to keep your child healthy and nourished by ensuring they eat a variety of nutritious foods, alongside the extra treats and occasional Happy Meal that accompanies childhood. Before having children, many of us felt like this would be the easy part. Three meals a day, snacks sprinkled in between; water, fruits, vegetables, healthy carbs, protein. Simple, right?

Like many things that come along with this parenting journey, we quickly learned how wrong we were to assume anything would be that straightforward! Picky or selective eating is something that many families navigate with their children. Battles at dinner time, dessert negotiations, and late-night internet searches of “can my child live off pizza alone?” – this is the reality for many caregivers who feel like they are at their wit’s end.

Picky eating is common for many children, regardless of their developmental trajectory. But for children with autism, food selectivity can become extreme and can last well beyond early childhood. The prevalence of feeding problems in children diagnosed with autism is estimated to be more than five times higher than that of neurotypical children and can range in severity from inadequate nutritional intake, to being under or overweight, to the need to supplement nutrition medically using a gastrostomy tube. For both parents and children, this can be a stressful and scary experience.

The reasons behind extreme food selectivity in individuals with autism aren’t always fully understood. For some, sensory aversions to specific characteristics of certain foods may contribute. For others, a need for sameness and predictability in their diet may be a controlling variable. Differences in communication, emotional regulation, and executive functioning can make expressing emotions and opinions around mealtime incredibly difficult for everyone involved. And most importantly, it’s imperative to remember that underlying medical conditions such as reflux, allergies, oral motor challenges, or intolerances may also be a contributing factor and should be ruled out before any behavioral approach is taken to address selectivity.

Luckily, there are some basic strategies that can help both you and your child as you try to increase their comfort with new food groups:

Explain the importance of healthy eating.

For some children with autism, it may be helpful to simply explain to them ahead of time why it’s so important to eat a varied diet of healthy foods. Remember to keep the messaging positive! There are no bad foods, only foods that are better in moderation while others we can enjoy all the time. Using something concrete and visually supported like a social narrative can be helpful in explaining these concepts. Make sure your child knows when they can expect to have their favorite foods and when you’ll encourage them to try new ones. It can be helpful to let your child know exactly which foods you’d like to try together and how they might expect them to smell, look, and taste.

Keep the pressure off.

For autistic children and adults, extreme food selectivity can be a result of anxiety and fear. Taking a no or low-pressure approach can lower everyone’s stress level, resulting in an improved relationship with food and mealtime for your child. Avoid withholding preferred foods and instead offer novel foods to try alongside of their usual meal. Encourage your child to inspect the food, take a bite of it, or even just leave it on their plates as they get used to the idea of trying something new. Be responsive to their cues and if you notice them becoming agitated or upset, validate their feelings and let them know how proud you are of them for trying. Don’t get discouraged if it doesn’t go well the first few times; this is a new experience for everyone. Over time, as trying new foods becomes part of the new routine, your child’s comfort level may increase.

Let them take control (where possible).

Embedding choice into mealtimes is a powerful tool for increasing your child’s sense of control and autonomy. Children hear “no” much more often than they hear “yes” throughout their day and as a result, many things can feel out of their control. This is especially true for a child with autism, who may have many unmet sensory, regulation, or communication needs that contribute to the desire to exercise increased control over their day. Offering a choice between which types of food will be included in their meal, how many bites they’ll take of a new food, or even which place they’ll sit at for dinner time can be empowering ways to put them in control of their meal in a safe and healthy manner.

Make it fun!

For children with very restricted diets, mealtime and eating in general can be associated with feelings of stress, anxiety, and fear. So, remember to make eating and exploration of new foods fun! Cook a new meal together, plant your own garden and cook the healthy foods you grow, explore a nearby fruit or vegetable patch to pick your own, or even just take them along for grocery shopping when possible. Remember to offer your child plenty of choices along the way and provide lots of opportunities for positive feedback and encouragement!

Safety first.

It’s important to work closely with your child’s physician as you try to address food selectivity. For some children with more extreme feeding needs, it will be essential to seek the support of a team of professionals who can oversee your child’s care and monitor their safety closely. For many children with significant selectivity and food refusal, various contributing factors must be evaluated and addressed before it is safe to proceed with treatment. For example, children may have oral motor needs such as muscle weakness or lack of proper chewing skills. For others, esophageal or gastrointestinal issues may need to be alleviated before feeding needs can become the priority. These complex needs are best addressed by an integrated care, multi-disciplinary team of professionals who are well trained and experienced in this specialty.

Not all autism service providers are qualified to address feeding issues, so it’s important that you ask questions about their background, training, and experience and when in doubt, wait for the right professional or team of professionals to become available to meet these needs for you and your child.

For information about providers in your area and how to connect with them, please contact our Autism Resource Specialists by calling 800-442-2762 or our Clinical Team by emailing clinical@autismsociety-nc.org.

Related Articles by the Autism Society of North Carolina

“Food is Yummy! Get in My Tummy!” Managing Food-Seeking Behaviors

The Impact of Nutrition on Physical and Mental Health

Integrated Care: Why It Matters and How to Achieve It