Nutrition and Autistic Children

Proper nutrition is a big concern for parents of children with autism. I hear it all the time from other parents that their child has a very limited diet. I say it all the time about my son. We say that our child is a “picky” eater. But what many of us don’t know is why and what we can do about it. I was hoping to answer these questions in this article. I can’t provide the ultimate, do this and your child will be fine answer, but I can give you the information you need to determine a course of action to address this issue with your child.

As with most areas of concern with our children, addressing the eating habits of a child with autism is complicated. I’ve narrowed down the reasons why our children are picky eaters to the three most common factors.

1. Sensitive to Food Textures
2. Trouble Chewing
3. Intolerance to Food Types (this is one of the main reasons that the Gluten Free Casein Free or GFCF diet is used with children with Autism)

Sensory Integration is a common issue for autistic children. Whether they avoid or seek out sensory input, it is an issue most children have to live with their whole lives. When we think of sensory problems, we usually think touch, sight and hearing are the areas affected. Taste can also be affected. A child with autism can have an overly developed since of taste and therefore be picky about what he/she will eat.

The ability to chew food properly can affect the choices a child makes for food likes and dislikes. If a child has trouble chewing meats, vegetables, and fruits, these become food groups that are not accepted by the child. Easy to chew items or items that do not require chewing like mashed potatoes, French fries, chips, breads, yogurt, ice cream, and cookies are easy to chew or can dissolve in the mouth and swallowed after a minimal amount of chewing are put on the acceptable list.

Then you have the food that the body doesn’t tolerate well. These are foods that the child may or may not be allergic to. The body does not have to be allergic to a food in order to have an intolerance for it. When you think about it, a lot of us have a specific food that we just can not eat because it wreaks havoc on our digestive system. We are not allergic to it; our digestive system simply has a hard time with that food item. But, we love it and we will eat it because it tastes so good to us. In some cases, we grave it and just can’t resist, even knowing how our bodies are going to respond. Image eating nothing but that one food for days, weeks, months and even years. Ouch!

For many autistic children, it is not just one food, but whole food types that have the same affect on them. This is commonly found to be true in foods that contain gluten and casein. Their bodies love this food, crave it, but eating foods that contain gluten and/or casein can have a negative affect on their body. It is a cycle that is hard to break, because our child is fixated on those foods and we have difficulties weaning them off of them. Add to that, parents who implement a GFCF diet also discover other intolerances. Their child can be sensitive to certain food dyes and preservatives.

What can we do to help our picky eater? First, we need to determine the reason our child has a limited food repertoire. If you’re lucky, there is one reason and it can be easily addressed. You may also find that it is a combination of the three listed above. Don’t you just love how easy our lives are?

The first two can be addressed by an occupational therapist and by yourself at home with oral therapy. Your therapist can help you determine if it is a chewing problem or a sensitivity to textures, or both. Once determined, a course of therapy can be drawn up that can be done with the therapist and at home. Developmental Delay Resources (DDR) has some really good information about oral therapy.
Here is a wonderful story that was emailed to me about how Oral Motor Therapy has helped with addressing a sensitivity to textures:

“Hi Tammy, happy to introduce myself - Jackie Olson - mom of son with autism and SID.

Eating has always been such a big issue with us - as an infant, I thought my son was going to die because he refused to eat! I met with a few doctors and finally a very helpful OT explained to me that he was rejecting textures and couldn't swallow them. So, my son literally lived on McDonald's French fries for over two years - and they had to be McDonalds - and they had to be super hot. He didn't talk, so he would just scream until he got them.

Being concerned about his nutritional needs - I took him to an OT who worked on textures, smells, tastes, etc - but it was a LONG journey - and I needed him to be healthy - so I turned to supplements and my good ol' juicer. My son would drink anything - broccoli, carrot juice, etc., but only in smooth liquid form. And he'd swallow liquid vitamins/supplements - once he got used to them the battles stopped.

I don't want to be a commercial for anyone, but I do really love and believe in Kirkman - at www.kirkmanlabs.com - I can literally see a difference when my son does not have his vitamins and supplements.

We also worked on desensitizing his mouth - using an electric toothbrush both inside his mouth and outside on his cheeks. Oral exercises helped as well - we had him blow with pinwheels, whistles, chew on a chew tube to build muscle strength.

My son is now 7 and still eats a small variety of foods. Most are starch; tortillas, chips, pizza, plain pasta - but we still do supplements and vitamins. Since he now goes to school we deal with the teacher not understanding that he physically can't and won't eat other foods - but as mom with kids with autism know - we've got our battles cut out for us!”

Another form of therapy can be the ABBLS reinforcer model. The following is a short story about how this was successful with one child:

“My son has autism and he basically lived on the Banquet chicken nugget TV dinners and cheese for about a year. The way we were able to expand his eating habits was first setting up the reinforcer model we learned from ABBLS. The foods he wanted were the reinforcers for trying other foods. We would watch him closely to see which foods he really liked and start offering them more regularly. Honestly though, his school was able to introduce more foods successfully than we were. He learned to watch the other children at school and would try things they were eating. He now eats a pretty well rounded diet as he developed likes for several foods.
Sabrina Sumsion”

I really enjoyed this story from a mom who is also a health professional. You can read more about her on her blog www.EamonsJourney.blogspot:

"My 3 year old son Eamon would live on chicken nuggets alone if I let him. Of course, this certainly does not offer him all the food groups that he needs for his growing body. I had to get creative. He will not touch vegetables to save his life. So, I took a page out the book, The Sneaky Chef and I sneak veggies into the foods that he likes. Eamon likes to bake with mommy. He happens to love baked goods like banana bread, pumpkin bread, brownies...what kid wouldn't right? So, what I do is I take either jars of baby food peas, spinach, etc or if there are leftovers from the previous night's dinner, I puree them. I tell Eamon that we are adding the coloring to the mix. He loves to add coloring!! He has no idea what it really is. He loves to eat his very own creations and I love that I have snuck in his vegetables.
We found this wonderful fruit drink that we call Carrot Juice. It is by Apple & Eve, called Fruitables. Orange Passion is the flavor we have stocked up on. It contains grape, pear, apple, orange, mango, passion fruit, pineapple, carrot, sweet potato, butternut squash and pumpkin! It is loaded with Vit C and is a great source of anti-oxidants. So, with those two interventions, I feel confident in knowing he is getting his veggies in him.
I supplement with the following multi-vitamins. L'il Critters Gummy Vites have no artificial colors, flavors or preservatives and contains no wheat, milk, eggs, peanuts, tree nuts or soy. Since Eamon is very responsive with negative behavior post consumption of artificial colors, I watch this one closely. Eamon likes to make choices and giving him choices seems to keep him focused to the task at hand, taking the vitamins. So, we alternate with Finding Nemo Vitamins by NatureSmart. Also free of anything artificial, these contain DHA as well. I have been added the Omega- 3 Gummy Fish CVS brand...nothing artificial added. I noticed a marked improvement when taking one a day. With two a day, his behavior was off kilter...one a day works for him. So, find what works for your little one.
Cheese. I never jumped on the GF/CF diet plan. He does not seem to have the gut issues that other children on the spectrum might have. I ensure that he is getting his calcium intake by adding cheese to his lunch. I take a cookie cutter that is season based and cut out the shape from the cheese slice. It makes it a little more fun!
I am investigating ways to increase my sneaky chef creative genious...LOL. I am leaning towards pureed chick peas and kidney beans and adding them to the baked goods...so let your own creativity soar!!
Professional Opinion: Nutrition that comes directly from food is the best source of nutrients. The body absorbs nutrients from food much more readily than through supplementation. Also, don't discount the possibility of an oral sensory issue. My son has an under-sensitive oral sensory issue, so I wake up his mouth in the morning with "bubble juice". Basically, it is half juice and half seltzer water. Also, a vibrating tooth brush was used for a while to wake up his mouth....and we always encourage the use of a straw to get the mouth working. My son loves pepper...so if you have similar issues, we make pepper fries, pepper eggs, pepper chicken nuggets...he gets to add the pepper. Try a little bit of everything and find what works for your child's individual needs.
I hope this is what you are looking for. I am going to be adding your blog to our blog roll at www.EamonsJourney.blogspot.com when I hit the send button. Please let me know if you will be able to use this and when and where it will be posted...I will share it on facebook and on my blog.
Tiffani Lawtin, RN”

I had the opportunity to interview Judy Converse, MPV, RD, LD, licensed, registered dietician specializing in pediatric nutrician for learning and developmentally disabled children. She has a book out called “Special-Needs Kids Eat Right: Strategies to Help Kids on the Autism Spectrum Focus, Learn, and Thrive. Her website is www.NutritionCare.net. I will be reading her book and will post my review of it when I am done. Judy told me that she believes that there are “physiological reasons for eating habits” and that we need to “redirect the appetite with nutrition care tools” and address the “oral tactile defensive” issues our children have. She told me that she covers all these issues in her book and parents can find the information they need to help address the underlying issues of poor eating habits. We discussed how difficult it is for a lot of us to find a good nutritionist or doctor with experience in nutrition with autistic children. Her response was to write this book and to write articles for her website that parents can take to their doctor to educate him/her. It is Judy’s belief that there is no one reason for our children’s poor eating habits, but a collection of reasons and they all need to be determined and addressed in order to improve a child’s eating habits.

Another book that is a good source for understanding nutrition and the importance of proper nutrition for the body and brain is “The UltraMind Solution” by Mark Hyman, M.D. I am currently reading this book and have found it full of helpful information about the role of vitamins and nutrients in our diet. I’ll do a full review of this book when I am done.

Both Dr. Mark Hyman and Judy Converse believe that there are benefits of a GFCF diet. They also believe that it is important to understand that just eliminating gluten and casein may not be enough. Preservatives, food dyes, food types that have been over processed and have “enriched with” on the label or may contain toxins, such as tuna fish which is known to contain mercury, are examples of additional items that may need to be eliminated from an individual’s diet. They both have a test in their book that you can take to help determine what areas of vitamin deficiency you may be dealing with in your child, too.

I know that this is a lot of information. I did not intend to write such a long article, but there is so much that goes into determining if your child is getting the proper nutrition and how to help a picky eater. I would love it if you would share your own story in the comments. We are not alone in this struggle. Many of us struggle every day with the issue of nutrition with our autistic child. Unfortunately, it is an extremely important issue and also a difficult one to obtain help with.