Fussy eating for autistic children

Mealtimes can be particularly challenging for families with autistic children.

With many autistic children experiencing some challenges with eating, it's no surprise that families often dread these moments. However, there are evidence-based strategies that can help ease these challenges and create a more positive mealtime experience for everyone. 

Why can autistic children struggle with eating?

A variety of things can cause autistic children to have eating challenges. Children with autism thrive on routines and find unfamiliar things or unexpected changes distressing, which makes it challenging for them to try new foods or eat familiar foods that look or feel different. It also makes it hard for them to eat something they usually eat at one time in the day at a different time, making introducing new foods or eating in new places difficult.

Many children with autism have sensory sensitivities, which affect what they are and are not comfortable eating. For example, they may only eat foods with a specific colour, texture or temperature. Some autistic children enjoy a particular food so much that they will eat that food to the exclusion of all others. They might also only eat foods similar in appearance, taste and texture to their favourite food.

Some autistic children are more prone to gastrointestinal issues, which impact their eating habits. If your child gains weight slowly or frequently experiences tummy pain, constipation or diarrhoea, speak to a GP or paediatrician to make sure they do not have an underlying medical issue.

Addressing any eating challenges your autistic child has is essential to ensuring their diet does not impact their growth and development. Working on fussy eating sooner rather than later can help your child develop a more varied diet and become less anxious about new foods, which can reduce their anxiety in the many different settings and situations where food is present.

Different approaches to fussy eating

Create positive associations with food

One key strategy for helping autistic children overcome eating challenges is to create positive associations with food. This involves making the environment in which new foods are introduced welcoming and enjoyable for the child. Placing the child’s favourite toys or activities in the dining area or playing their favourite movie, TV show, or music can create positive associations with eating. Having sensory toys nearby can also help children remain calm and engaged when exposed to new foods.

By associating new foods with enjoyable activities, children are more likely to feel comfortable and open to trying them. This approach can also reduce mealtime conflicts, making the experience more accessible for children and their families.

Expose the child to new food gradually

One effective method for introducing new foods to autistic children is gradual exposure. This involves slowly and systematically exposing the child to new foods without immediate pressure to eat, helping them to become more comfortable around unfamiliar foods. It relies on patience and persistence, allowing the child to discover the look, smell, and texture of new foods at their own pace. Here is how this approach works:

1. Place the new food in the same room as the child but at a distance. If the child notices the food and seems concerned, reassure them that they don’t need to touch or eat it.
2. Once the child is comfortable with the food being in the same room as them, move it closer, such as on the table where the child is sitting. Again, reassure them they don’t need to touch or eat it.
3. When the child is comfortable with the food being nearby, encourage them to interact with it. This could include touching, smelling, or licking the food.
4. Gradually encourage the child to take small bites of the new food. Over time, increase the size of the bites until the child is eating the entire food independently.

Try the 'first, then’ approach

Another practical approach to supporting autistic children with eating challenges is the 'first, then' approach. This method uses the child's existing ‘safe foods’ as an incentive to expand their palate. Here is how it works:

1. Place the child’s safe food and new food on separate plates.
2. Encourage the child to eat or interact with the new food (e.g., touching, licking, smelling) before having some of their safe food as a reward.
3. Repeat this process until the child is comfortable eating the new food, at which point you can gradually phase out the safe food.

Making the new food similar to the safe food can make this approach more effective. For example, if your child eats watermelon but not rockmelon, try placing watermelon near the rockmelon. Make sure your child is allowed to explore the new food for as long as they need to; as long as they are safe, let them explore the food in a way that makes them feel comfortable.

Share meals

Sharing meals and snacks with your child can model healthy eating habits and help avoid rewarding fussy eating behaviours with separate meals. Make sure that the meals you share include foods your child already likes alongside new options.

Introduce new foods outside of mealtimes

Introducing new foods outside the pressure of mealtimes can sometimes be more successful with autistic children. Activities such as visiting the grocery store, looking at pictures of new foods, or preparing meals together can reduce a child’s anxiety around new foods. Allowing children to interact with food without the expectation to eat it (e.g., touching or sniffing a new vegetable) can also help.

Change the presentation of new foods

Small changes in how food is presented can encourage children to try new things. Try cutting up a piece of fruit rather than serving it whole or putting a new food on your child’s favourite plate or in their favourite lunchbox. These small adjustments can make new foods much less intimidating.

Involve other family members

Involving other family members can make healthy eating a less anxiety-inducing experience. Making family meals where everyone tries new foods can help an autistic child feel like they are sharing a big experience with other people. Having other family members, such as siblings, model the process of trying new foods can encourage autistic children to try them as well. 

Important things to remember

Use positive reinforcement

Whatever approach you take to address fussy eating must always include positive reinforcement. Praise your child for any step towards trying a new food, even if it’s just smelling or touching it. Encouraging your child reinforces good eating habits and encourages your child to continue trying new foods or developing good behaviours. Over time, this positive association can also reduce anxiety around new foods.

Here are some examples of how you can give encouragement and praise to a child with autism:

• Descriptive praise: Verbal praise that explicitly states what the child has done well. For example, ‘Well done for touching that piece of broccoli!’ Using the child’s name before giving the praise is even more effective.
• Visual supports: Using reward chats or visual supports can help to communicate to your child that their behaviour is good. For example, creating a reward chart where your child receives a star or sticker each time they interact with a new food helps communicate their progress to them.
• Other rewards: Providing your child with rewards, such as their favourite toy or activity, after they successfully interact with or try a new food can help create positive associations with trying new foods. 
• Nonverbal praise: Gestures that show you are happy, excited or proud, such as a thumbs up, high five, big smile or clapping. Keep in mind that these nonverbal cues can be challenging for young autistic children to understand, so reflect on your own child’s comprehension before using them. 

Maintain a routine

Offering meals and snacks at consistent times or on consistent days of the week can help improve appetite and reinforce the importance of healthy eating. A structured routine can make mealtime a predictable part of your child's day, reducing anxiety around eating.

What to avoid when addressing fussy eating

Navigating eating challenges requires a gentle, patient approach in a supportive environment. Although it can be frustrating and upsetting when your autistic child is experiencing eating challenges, it is essential never to force a child to eat food. Force-feeding a child can cause them to lose trust in you and any progress in their eating to regress. Moving at your child’s pace while respecting their comfort level, as slow as this pace may be, is always the best approach. 

Both your and your child’s mood and energy levels play an essential role in the success of trying new foods. If there are days when you or your child is not in the right headspace to address eating challenges, it is better to take a break and try again another time. Trying to address eating challenges when one or both of you are tired or upset is unlikely to be productive.

Finally, it is vital to remember that every child is unique. Comparing your child’s eating habits to other children you know can cause unnecessary upset and stress for you and your family. Regardless of what others say, as long as your child is safe and comfortable, you are doing the right thing. 

Signs of significant eating concerns

While families at home can address many eating challenges, some situations may require external support. Here are some signs that it might be time to seek medical attention for your child:

• Difficulty gaining weight or experiencing weight loss.
• Regular gagging, choking, or coughing during meals.
• Issues with vomiting or more than one incident of nasal reflux.
• History of a traumatic choking incident or eating and breathing coordination problems.
• Crying during most meals or frequent mealtime conflicts.
• Avoidance of all foods with a specific texture or within a specific food group.
• Eating fewer than 20 foods and not replacing avoided foods with new ones.

If your young child has not met the following developmental milestones, seek medical support:

• Has not transitioned to baby food purees by 10 months.
• Has not eaten table food solids by 12 months.
• Has not transitioned from breastfeeding or bottle feeding to a cup by 16 months.
• Has not weaned off baby foods by 16 months.

Although adolescents are at greater risk, young children can also develop eating disorders. Avoidant Restrictive Food Intake Disorder (ARFID) and Pica are eating disorders some autistic children develop at a young age and require immediate medical intervention - you can learn more about these conditions and how to seek support here.

Professional support options

Autism families should never have to navigate eating challenges alone. Professional support can be incredibly helpful for autism families, as they can provide evidence-based strategies and expertise to help alleviate the stress of mealtimes and improve your child’s diet. 

Most families will need to see their general practitioner (GP) to receive a referral to a specialist who can support their child with eating. A GP can also offer advice and strategies in your appointment or telehealth session. Many families with children who have eating challenges are referred to a dietician or nutritionist who can provide expert advice and support families in creating a balanced and appealing diet plan for their autistic child. 

Other professionals can offer support to autistic children struggling with eating. Behaviour specialists can address any behaviours of concern that are preventing your child from trying new foods or making mealtimes difficult. Speech pathologists can address any oral-motor issues that could make actions like chewing or swallowing difficult. Occupational therapists can also address various eating challenges, from physical barriers to eating safely to emotional or behavioural difficulties involved with eating or participating in a meal.