Encouraging a Healthy Diet in Children with ASD
by Rynae Golke
For many healthcare providers, diet is a pressing concern when it comes to treating children with Autism Spectrum Disorder (ASD). “How do I ensure he’s getting the nutrients he needs when he only eats chicken nuggets and oyster crackers?” and “How do I get him to eat other foods?” are some of the most common questions parents ask during clinic visits. Not only can it be very challenging to accommodate the child’s picky eating habits at home, at school, and while out and about, but many parents worry their child may be missing key vitamins and minerals as a result of their limited diet. In addition, internet propaganda suggests children on the Autism spectrum should avoid gluten and casein – proteins found in wheat and milk – to improve their daily life, which puts parents under added stress to jump on the bandwagon. Furthermore, parents are often judged by others for allowing their child to eat the way they do, or refuse a meal in public.
Empathy is key
How can you support these parents as a healthcare provider? First and foremost, show empathy. Managing the diet of a child with an Autism Spectrum Disorder is extremely challenging for a multitude of reasons:
- They often exhibit strong aversions to certain tastes and textures in their mouth.
- Trying to force an child with Autism to eat something he or she has an aversion to can worsen related behaviors.
- They often struggle to function at their highest capacity in a dining setting, with multiple people and noises in the room.
Many parents’ questions about diet and nutrition are riddled with guilt and worry. Let parents know they aren’t alone in their struggles and these challenges are very common – almost unavoidable – for families of children on the spectrum. When you connect with parents empathetically, you bring comfort, build rapport, and gain their trust.
Discourage bandwagon diets
Assure parents that evidence suggests that gluten-free, casein-free (GSCS) diets may be a trending topic in Autism communities but have not withstood the test in clinical research studies. According to a study done by the University of Rochester and funded by National Institute of Mental Health under the STAART Network, children demonstrated no change at all in behavior or function when these foods were reintroduced to them after a six-week hiatus. You can also encourage parents to consult their healthcare team before making significant dietary changes if they’re uncertain about new recommendations.
Encourage the introduction of new foods
The best diet for children with ASD is a balanced diet. A common response parents have to the battle that accompanies dinner time is to throw in the towel on adding new foods and instead prepare the same thing – a peanut butter and jelly sandwich, for example – three times a day to acquiesce their child’s requests. While children with ASD are often reluctant to try new foods, the effort to introduce new foods should not be discontinued. These steps can assist in making meal time easier for children with ASD and their families:
- Ensure all eating happens at the table, including snacks. Establishing a routine eases stress on the child.
- Don’t allow snacking one hour before each meal to ensure the child comes hungry and ready to eat.
- Make favorite foods available but contingent. For example, offer a child who favors only hot dogs a hot dog, but only after he has eaten one piece of broccoli. Stand firm but non-confrontational on the subject. If he leaves the table, allow him to leave, but ensure that when he gets hungry the agreement remains the same: one piece of broccoli and then he can have the hot dog. Once he has eaten one piece of broccoli, stay true to your promise and give him the hot dog. Tomorrow, try two pieces of broccoli. Introduce only one new food at a time and give it as much time as needed to become familiar.
Rule out digestive problems
Children with ASD are at a higher risk of digestive problems like constipation, diarrhea, and acid reflux, all of which may increase their aversion to certain foods and make meal time more challenging. However, many of these problems go unnoticed because they present differently in the child with Autism than they do in the general population. Always evaluate for digestive problems to ensure you have explored every possible culprit for dietary problems before making a decision about treatment.
While vitamins and minerals can be beneficial for children with ASD, it’s important to note that not all children with ASD will require supplements. Some may get everything they need from their diet, while others may be lacking in some areas. Encourage parents to allow their healthcare provider to do a thorough exam and make the decision about supplementation to ensure supplements are chosen and administered carefully.