Some children like everything or almost everything. Many children are pickier or have a period in which they eat more selectively. There are also different degrees of selective eating. There are children who only eat a certain color or not a certain color, there are children who do not want to eat anything mixed together. One child wants to eat a lot, while another does not or only eats in a quiet environment. Some don’t like sauces, others don’t like chunks. Many children with autism are selective eaters. Children with autism are three times more likely to develop a selective eating pattern. As a parent you can be very concerned about this. After all, you want your child to be healthy and eat healthily. Why do many children with autism develop an eating problem?
- Eating problems
- Long-term eating problems
- Autism
- Factors influencing eating problems in children with autism
- 1. Sensory Information Processing
- 2. Autistic thinking
- 3. Autistic fears around food
- 4. Oral motor skills
- 5. The sensorimotor versus logical phase
- What does a child with autism and an eating problem pay attention to?
- Eating problems in autism
- The difference between eating problems and eating disorders
- Too little to eat
- Eating too much
- Autism-specific eating
- are you worried?
Eating problems
Not eating enough, eating too much or eating too little varied food can affect the health, growth and development of children. For many children this is a temporary problem and fortunately the physical consequences are not too bad. For example, a child who is sick and groggy will naturally have less appetite. As soon as it feels better, it makes up for the damage. It may take some time before the appetite is restored, sometimes four to six weeks, but it is important to give your child space for this. A child who eats too much may experience a growth spurt. For example, it first grows in width and then shoots into the air. Regular monitoring shows the trend. This allows you to intervene early enough and you do not have to pay more attention to it than necessary. A selective eater is someone who only wants to eat 10 to 15 different types of food. He or she refuses certain foods altogether, for example does not like vegetables at all, and can become very angry or afraid when the food or meal does not go as expected. A selective eater can also have a food obsession. He or she then insists on always having applesauce or grated cheese with it, for example. Some selective or picky eaters also build up an aversion to food that was previously on the list at a certain point. Then nothing takes its place. The diet can thus become increasingly restricted.
Long-term eating problems
Research shows that with long-term eating problems, weight growth slows down first, followed by height growth. If a child starts eating ‘normally’ again after a short period of time, for example due to illness, growth is often caught up later. If children miss certain nutrients for a long time, deficiencies can arise. In practice, you often see iron deficiency first, which results in anemia. It is not yet sufficiently known what the consequences of everyday eating problems are, or whether there is a possible connection with later eating disorders. Parents do report more health problems if their child is a picky eater, but most parents still rate their child’s health as highly satisfactory.
Food diary If you are concerned about your child’s eating behavior, you can, for example, keep a food diary for a week. This way you can see what your child is getting, and maybe it won’t be too bad after all. You can also see whether there are any possible bottlenecks in view of the guidelines for a healthy diet. And if you call in the help of an expert, you have a good basis for a conversation.
Eating problems always take a toll on the family. Tension and anxiety compete for the foreground. You don’t want to force your child, but you do want him or her to eat healthily. How do you do that? That is not an easy task. Certainly not if your child has autism. It turns out that the risk of eating problems for a child with autism is greater than for a child without autism.
Autism
Children with autism grow up differently than children without autism. This is because their information processing is different and their sensitivity to stimuli can be higher or lower. Information and stimulus processing work together. And food addresses both. Both information processing and stimulus processing play a role in the development of eating problems. But there are more factors that influence the development of eating problems. Some children with autism are picky eaters even as babies (for example, a baby with autism may refuse the breast if mother wears a different perfume than usual), but it often starts when children are two to three years old. Their world is getting bigger and their fears can increase with it. If you don’t understand the world, and the world doesn’t understand you, it can be difficult to navigate. Then all understanding and help is welcome.
Factors influencing eating problems in children with autism
There are several factors that play a role in the development of eating problems in children with autism.
- The sensory processing of stimuli
- Autistic thinking about food (detailed thinking; fixed links; overgeneralization)
- The autistic fears around food
- Oral motor skills
- The sensorimotor versus logical phase
1. Sensory Information Processing
Through our senses we receive information about our own body and about the world around us. Our senses help us to respond well and appropriately to the demands and expectations of the environment. If the senses receive too much information, this is called overstimulation. This can be aimed at all senses, but can also apply specifically to one sense. For example, you hear everything and the slightest sound hits you very loudly. You then react very intensely to specific sensory observations.
All known senses play a role when eating: hearing, tasting , seeing, feeling and smelling. These are the external senses, which help you perceive the outside world and influence your inner world. But conversely, you also have internal senses, which help you from within and say something about your inner world. The vestibular sense provides information about our balance and is located in the inner ear. The proprioceptive sense provides information about the position of your body and measures muscle tension. The interoceptive sense provides information about internal stimuli such as hunger, thirst, fatigue, the urge to urinate, pain or your heart rate.
All senses participate when it comes to understimulation or overstimulation in the case of autism. Under- or over-stimulation means that your subject is oversensitive to certain (sensory) stimuli. A child with autism may not be able to sense when he is hungry or thirsty. Or he doesn’t feel it when it’s too cold or too hot. Or signals come in too strong, causing children to always feel hungry, for example. The body is therefore not necessarily a good indicator for people with autism. This makes it difficult for the child to find stability within himself. And this also sometimes makes it difficult for parents to properly attune to the child.
Many people with autism are very visual. Fruit and vegetables are natural products and can therefore look and taste slightly different each time. This causes some children to refuse this food . Research shows that not only fruit and vegetables are often refused, but also mixed food (such as lasagna) and food with a soft texture (for example cooked food, such as broccoli and tomato). The texture is how the food feels in the mouth. This can be smooth, soft, grainy, hard, and so on. Selective or fussy eaters often have a preference for a certain structure and prefer a monostructure, so no food with multiple textures. For example, they prefer to eat chicken fillet, poached or from the oven, than a chicken burger with a crispy crust, because it is hard on the outside and soft on the inside. Carbohydrate-rich foods, such as pasta, rice and bread, are often eaten well by selective eaters. This is food with a relatively neutral taste, smell and color.
2. Autistic thinking
Autistic thinking can be divided into three concepts: fixed links, overgeneralization and detailed thinking. Autistic thinking can really get in the way of your child. If a child once caught a cold after eating an orange, he or she can still link these two separate events. The result is that the child no longer wants to eat oranges because he is afraid of getting sick again (fixed links). Or because it doesn’t like apples and oranges, it thinks it doesn’t like fruit at all (overgeneralization). The child may also focus on a certain unimportant detail and lose sight of the context (detail thinking).
3. Autistic fears around food
Many people are afraid to try new things. ‘What a farmer does not know, he will not eat’, goes the well-known proverb. In addition, you really have to get used to new flavors. On average, you have to taste something 16 times before you get used to a certain taste. This certainly applies to people with autism. They suffer more than average from neophobia: the aversion to everything new, and in this context the fear of unfamiliar food, i.e. food neophobia. Sometimes this fear can take on serious proportions. You cannot say that the child will eat it if he is hungry enough. A child with autism cannot eat even if he is very hungry. Not really!
In addition, relatively many children with autism have a fear of contamination. When food touches each other, the taste, color, smell and texture changes. Children with autism may have difficulty with this. A compartment board can provide a solution, so that different foods cannot touch each other and, for example, sauce and pasta or potatoes can be served and eaten separately.
Many toddlers, from about 18 months, and preschoolers suffer from neophobia and fear of contamination. While a baby still puts everything in its mouth that comes near it, from around 18 months onwards children become more aware of what they put in their mouth. A logical development, because they will discover the world themselves and must learn to judge what is good and safe. The downside is that children only want to eat what they know. ,I don’t like it,, is quickly said after a brief look at the strange or unfamiliar food. It is somewhat part of this age phase, which can last until children are five or six years old. By eating a varied diet as a parent/guardian and by introducing children to all kinds of food, you help children get through this neophobic phase. Most children naturally become less fixated on the appearance and details of food because they realize that all food can be divided into food categories. An apple does not have to be discovered and experienced again and again, but falls into the category of apple or fruit.
For children with autism, this phase often lasts longer than for other children. In addition, older children with autism can also suffer from this ‘suddenly’. You cannot always tell the age of a child with autism from the outside. As Martine Delfos, psychologist and Dutch autism expert, argues, a child with autism has a rainbow of different developmental ages, depending on the different areas of development (Delfos, 2017). For example, a child with autism can be far ahead cognitively and yet lag behind in motor skills. This spectrum of different mental ages sometimes makes it difficult to connect well with the child.
4. Oral motor skills
Children with autism may have weaker oral motor skills, for example because they breathe through their mouth rather than through their nose. They may have weaker jaw and tongue muscles, or drool more. Some children are very sensitive in their mouths and, for example, (almost) cannot tolerate a toothbrush. Learning to talk can also be difficult(er). Certain sounds may be more difficult to form, such as ‘k’ or ‘g’. These are posterior guttural sounds and for some children with autism the hypersensitivity in the mouth can be so great that it can cause a spitting reflex.
Weaker oral motor skills can cause problems with chewing. Children with autism may also have difficulty swallowing. Sometimes they find it difficult to know how many times you have to chew something before you can swallow it. Chewing too long makes the food dirty, chewing too short makes it painful to swallow. If you, as a parent, suspect that your child has abnormal oral motor skills, you can contact a (preverbal) speech therapist. He or she can give your child exercises, such as holding a piece of paper between the lips at least once every day for a minute. A speech therapist also looks at the sitting posture, because children can sometimes have difficulty sitting upright because they have lower muscle tone throughout their bodies. Sometimes pediatric physiotherapy is a solution.
5. The sensorimotor versus logical phase
In her book ‘O dear, I eat’ (2017), Karen den Dekker cites the research of Gertrude Zeinstra, in which, based on the ideas of the pedagogue Jean Piaget, she classifies two ways in which children between 4 and 12 experience food. For children this age, all food means eating, whether they are quick snacks or nutritious meals. That is why it is important to structure eating behavior. Make rules for young children about when they can eat and snack. State the difference, but do not judge it as healthy or unhealthy.
In the sensorimotor phase, which runs from approximately 2 to 7 years, children react very sensitively to the color and appearance of food. Children between 7 and 11 are in the logical phase. They judge food more on texture and taste. They know that there is a difference between snacks and food and can name the tastes, sweet, salty, bitter and sour.
What does a child with autism and an eating problem pay attention to?
A child with autism and an eating problem notices a lot. Many things surrounding food can influence the development and/or maintenance of an eating problem. This includes: the packaging, the store where the shopping is done, the store staff, the brand, the texture and structure of the food, the color, the smell, the taste, the temperature, the number/quantity, the shape . And then we haven’t even talked about the time and duration of the meal, everything that takes place before and after the meal, the table company, the sitting position, the cutlery, the size of the plate and the way of serving. If the child with autism is tense, tired or grumpy, this can make an even greater impression, because overstimulation occurs more quickly. It can be quite a quest to discover what exactly it is that your child (mainly) responds to.
Eating problems in autism
Children (and adults too) with autism can suffer from three types of eating problems, which can also be related:
- Too little to eat
- Eating too much
- Autism specific food
The difference between eating problems and eating disorders
An eating disorder is a serious and complicated psychiatric illness, according to the Novarum website. An eating problem is less serious than an eating disorder because it does not control your entire life. However, despite the milder symptoms, an eating problem can also have serious consequences. Especially if there is obesity or underweight, especially for growing children.
The DSM- 5, the manual for psychiatric disorders, includes a special category for very great difficulties with (selective) eating: the ARFID. This stands for Avoidant/Restrictive Food Intake Disorder. This diagnosis is only made when an unreasonable fear of food of a certain taste, texture or color is avoided to such an extent that it is accompanied by weight loss, growth disorders and/or a serious nutrient deficiency. This disorder mainly occurs in children or young people, but can also occur in adults.
Other eating disorders such as these can be diagnosed using the criteria in the DSM-5, namely Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder (BED), Other Specified Feeding and Eating Disorder and Unspecified Feeding and Eating Disorder, as well as the newer Orthorexia Nervosa, which has not yet been included in the DSM-5 manual, are eating disorders that are more common in young people or adults.
An eating problem can lead to an eating disorder, but that certainly does not have to be the case.
Too little to eat
Some children with autism do not notice that they are hungry. It can also be too busy for them, causing them to experience too much stress. This suppresses the hunger stimulus and prevents them from eating. This also applies to adults with autism. So it may very well be that your child hardly eats at school. If you ensure that the child eats enough at home before and after school, this does not have to be a problem.
It is important to explain to your child that he or she needs building materials to grow. You can visualize this using the Wheel of Five or the prescribed amount of drink. If your child eats bread, you can, for example, make a laminated meal overview depending on the age. For example, for breakfast you can have a sandwich and a cup of drink. After eating, your child can check the sandwich he or she has eaten and drink the glass. This way you and your child can ensure that they eat and drink enough to grow properly. A sticker sheet can also work well. Hang it near the table and make sure that your child can stick at least three stickers every day: one for each meal. Success? Prepare a basket with small treats, do something together or let your child put a sticker for every three stickers earned on a sticker sheet for a larger gift or activity.
Eating too much
A child with autism who is constantly hungry also occurs. Children do not feel when they have eaten enough. Or they take such large bites that they only get the signal too late that they are full. It is also important to make a eating schedule with your child based on the Nutrition Center’s guidelines for good nutrition and to visualize this as much as possible.
Autism-specific eating
Many children have a preference for special food, such as bland food (such as pasta), crunchy or soft food (many children find a combination of both difficult), lukewarm or cold food, unmixed food (potatoes, meat and vegetables separately or pasta and sauce separately) and food that you don’t have to chew for too long. Children with autism often go a step further. For example: only eating 10 different foods, always wanting to eat the same brand, wanting to eat only a certain color of food, always wanting to eat the same amount of something, being extra sensitive to the color, texture, taste, smell of food. All mentioned factors are related to the theme of autism-specific food. As parents, it is important to look with your child at what exactly is going on and what can change or be adjusted. For this it is important to make a good plan of action before you start implementing all kinds of changes. After all, this only leads to more anxiety and that can have a negative impact on eating.
are you worried?
As a parent you may worry about the health of your child. Is it eating enough? Isn’t it eating too much? Does it eat healthy and varied enough? These are all questions that are not easy to answer for a child with autism and eating problems. By regularly measuring and weighing your child, for example at the doctor’s office, you can keep track of his or her growth development. Keeping a food diary or food diary gives you insight into the severity of the eating problem. If you are very concerned about your child, it is a good idea to discuss your concerns with your doctor. It can then also be determined whether it is useful to take a blood test, for example to find out whether your child is deficient in certain vitamins or minerals. If necessary, a referral can be arranged through a pediatrician or child psychiatrist to a specialized center for food refusal and a selective eating pattern in the Netherlands: Seyscentra, with locations in Gelderland (Malden), Utrecht (Haarzuilens), South Holland (Zwijndrecht) and Limburg (Maastricht). .