Research estimates that 60% or more of children with autism spectrum disorder have, do, or will experience difficulties with food acceptance or eating. These feeding difficulties often look different from individual to individual. While many of these mealtime challenges are unique to the person, there are a few categories of feeding difficulties that most often occur: picky eating or mildly selective eating, challenging behaviors at mealtime, severe feeding difficulties, limited independence at mealtime, as well as medical factors related to eating.
It is important to note that before beginning any behavior-based feeding program, medical factors such as cavities, chewing challenges, swallowing difficulties, and other medical factors must be eliminated before addressing food acceptance from a behavioral approach. Working closely with your child’s pediatrician, pediatric dentist, BCBA and ABA team, Speech and Language Therapist, and Occupational Therapist are vital to success in these areas.
Picky Eating
Many children—regardless of diagnosis—may experience periods of “picky” or selective eating. These periods may look like a child only wanting to eat certain foods or having a favorite food that they often want to eat. These periods of picky eating for many children are something that they grow out of and may not be of concern unless things persist or worsen as described in the next sections.
Challenging Behaviors at Mealtime
Challenging behaviors at mealtimes can be difficult for the child and your family. These challenging behaviors can make mealtimes become stressful, chaotic, and frustrating. Family gatherings, going out to dinner, and other mealtime-related celebrations may become too much to attend.
Challenging behaviors at mealtimes may look like your child crying, pushing away new foods, throwing food off the table, dropping out of their chair, running away or leaving the table, or altogether avoiding mealtimes.
Severe Feeding Difficulties
Severe feeding difficulties can begin as early as birth if related to medical factors diagnosed by your child’s pediatrician, but food avoidance is often learned and behavioral for many children. Children may learn to use challenging behaviors to avoid foods that are not their most preferred foods. This may lead to a child who historically ate a healthy range of foods beginning to have a shrinking number of foods that they consistently eat. When a child reaches this point of feeding concerns, it is important to discuss with your child’s pediatrician, pediatric dentist, BCBA and ABA team, Speech and Language Therapist, and Occupational Therapist to eliminate medical factors that might be hindering your child’s food intake.
Medical Factors
There are several medical factors to consider when assessing why your child may be engaging in food avoidance or selective eating. Some of these medical factors include but are not limited to:
- cavities or other dental issues
- swallowing difficulties
- chewing concerns
- Gastroesophageal Reflux Disease (GERD)
- oral motor dysfunction
As well as other factors to eliminate prior to treatment with your child’s pediatrician and pediatric dentist.
Positive Parenting Strategies to Improve Feeding Concerns
- Ask for help from professionals. Discuss your concerns, behaviors, and mealtime challenges with your child’s pediatrician, pediatric dentist, BCBA and ABA team, Speech and Language Therapist, and Occupational Therapist. Professional help can direct you with the next steps and ways to mitigate these mealtime challenges.
- Mealtimes should be routine-oriented and predictable. Have a set space, time, and routine at mealtime. This might look different from family to family, but creating rituals and routines promote good eating habits. Sitting at a table or in a shared space with your child can create positive routines around mealtime.
- Limit grazing and snacking opportunities. If your child has free access to snacks and grazes throughout the day prior to mealtimes, this will reduce the likelihood that your child is hungry come mealtime. This can shape up some negative behaviors around mealtimes and lead to your child eating only “snack” foods. So limiting these snacks can make sure your child is hungry come mealtime.
- Be a positive model for your child! The first thing to do when beginning a behavior-based feeding program with a family is to discuss what foods the parents eat most often! If you never eat broccoli, your child likely won’t eat it either! We want to model the good, flexible eating habits we want your child to develop. Offer some of the meals you have made for the whole family during mealtimes and normalize different foods by eating them yourself.
Supporting children with feeding challenges is a journey that takes patience, collaboration, and consistency. While every child’s needs are unique, families are never expected to navigate these concerns alone. By working closely with medical providers and therapeutic professionals and by creating predictable, positive routines at home, you can help your child build healthier, more confident eating habits over time. With the right support and a team approach, meaningful progress is not only possible, but achievable.
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This article was written by Board Certified Behavior Analyst Daniel Childress. Daniel is a Regional Director with The Autism Clinic at Hope and has been working in the field of Applied Behavior Analysis for 14 years.