Feeding and Nutrition for Children with Autism Spectrum Disorder (ASD)
The prevalence of autism has increased to one in 54 children in 2020. With prevalence on the rise, there comes an increased need to raise awareness. By bringing awareness to the unique nutritional challenges that children with autism face, we may be able to influence their overall health, behavior, and general quality of life.
The Autism Society continues to increase awareness, encourage acceptance, and promote change during Autism Acceptance Month (AAM) every April. Autism Speaks is another organization committed to helping those with autism reach their full potential and spread kindness through World Autism Month.
Nutrition in children with autism is impacted in a variety of ways but often includes inadequate nutrition, poor growth, feeding difficulties, gastrointestinal (GI) problems, and food allergies or food sensitivities. In fact, one study looking at children with ASD found that over half of these children had nutritional deficiencies.
The Autism Treatment Network (ATN) has researched nutrition and found that children with ASD often choose less healthy food options and more than 50% of these children are on vitamin supplementation to compensate for what is missing in the diet. We aim to bring awareness to a few of these common challenges.
Common Nutrition Concerns for Children with ASD
Bone Health has been studied in children with ASD and it was found that boys with ASD have a lower bone density in their hips and lower back than those without ASD. Although boys with and without ASD were close to the same size and weight, the boys with autism participated in a lower amount of exercise. To help promote bone health in this population, it is recommended to encourage exercise and increase protein, calcium, phosphorus, and vitamin D consumption.
A DHA study on children with ASD found these children had lower amounts of docosahexaenoic acid (DHA) and a lower omega-3 to omega-6 fatty acid ratio when compared to children without autism. DHA is an omega-3 fatty acid that is important in the developing brain. It has been determined that children with ASD do not commonly consume seafood, a major source of omega-3 in the US diet. Research has shown supplementation with DHA may be helpful in improving social withdrawal and restricted interests and behaviors in children with ASD.
Iron is another nutrient that is of concern in this population. Evidence has found that children with autism are more likely to have an iron deficiency when compared to those without ASD. Iron is essential in helping the body use oxygen and is needed for growth. Common signs of iron deficiency include increased tiredness, dizziness, and skin that appears dry and pale.
Vitamin/Mineral Supplementation may be needed in children with ASD due to restricted diets, inadequate intake and the concerns listed above. While vitamin and mineral supplementation can be helpful, standard multivitamins may contribute to an overall imbalance of nutrient intake and may also be refused due to the form or route of administration. These “one-size-fits-all” formulations often provide nutrients that are already adequate in a child’s diet but not enough of the vitamins or minerals that are insufficient in the diet. Individualized supplementation or other approaches to meeting vitamin and mineral needs may be more appropriate for children with ASD.
Feeding Difficulties for Children with Autism
Feeding difficulties are increased five-fold in children with ASD and are well-recognized in this population. One of the more common reasons for this is food selectivity or restricted food preferences, usually due to sensory issues related to food textures, smell, taste, packaging, color, and presentation.
Other feeding-related challenges may include lengthy mealtimes, fear of new foods, and negative behaviors at mealtime related to resistance towards mealtime routines, expectations, or non-preferred foods. Stress at mealtimes can often be increased because many children with ASD have difficulty identifying and describing what they dislike about certain foods.
Experts have made suggestions to help with coping during mealtime. Here are some tips:
- Set a visual plan and consistent schedule for mealtimes. Discuss with your child ahead of the mealtime to help reduce the stress around the conversation and allow your child time to settle into the plan.
- To help increase the comfort with the new food, experts suggest having your child help to pick out the new food with you at the grocery store. To help with consistency, it may be best to serve the new food with two familiar, favorite foods.
- Going slow can help ease your child into the process. Start with smelling or licking the food the first time it is offered and then transition to “one-bite”. Be patient as this process can take time.
- To promote flexibility with eating, establish a “plan A” and “plan B” for when the first option is not available.
- Offer praise and consider a reward for trying a new food or for completing a task. Avoid negative feedback or scolding when your child refuses new foods.
- For children who are set on a specific brand or food label, an occupational therapist who works with the ASD population recommends taking the food out of its package as soon as you put away the groceries. She recommends transitioning the food to clear containers and rotating brands as often as possible to avoid children getting “stuck” on certain tastes, appearances, and textures.
Gastrointestinal (GI) Problems and Food Sensitivities
It is common for children with ASD to have gastrointestinal problems, particularly diarrhea, chronic constipation, inflammation in the GI tract, and stomach pain. Research suggests that these GI issues may be related to a deficiency in digestive enzymes (that help break down food), food sensitivities or food allergies, and a change in the bacteria that live in the GI tract.
Many studies have found that some children with ASD have an unusual immune response to certain food proteins. The proteins that have been most commonly identified are gluten (found in wheat, barley and rye products), casein (found in dairy products), and sometimes soy. In fact, some studies have found children with ASD are more likely to be sensitive to food allergens than other children their age without autism. A few studies suggest this could be due to children with ASD having looser junctions in the intestines, making it easier for things good or bad to pass through.
Another concern for health care providers and parents who care for children with autism is that these GI issues can have an impact on behavior, nutrition, and quality of life. Due to some children’s struggles with effective communication, it may be difficult for parents and children to identify the relationship between feeding difficulties and discomfort experienced with eating.
Special Autism Nutrition Diets
The most common diet used in children with ASD is a Gluten-Free, Casein-Free (GFCF) diet. While some research supports the use of these dietary restrictions, other studies did not find them to be beneficial.
Like many specialized diets, effectiveness may be specific to the individual following the diet. What works for some children, may not be effective for others. In the instance where diet restrictions are beneficial, these specialized diets can impact total adequate nutrient intake in diets that are often already limited.
Finding nutrition sources to replace gluten or casein can be difficult for children who may already be hesitant to try new foods. It is important to find what allergens or sensitivities are affecting your child so he or she can feel better. Working with your child’s physician and/or dietitian to identify any food allergies or sensitivities and creating a nutrition plan that best fits them is important in achieving adequate nutrition, decreasing symptoms, and improving quality of life.
How Ajinomoto Cambrooke can Support You and Your Child
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