In conversation with Mei Man – Community Paediatric Dietitian

Why can mealtimes be such a challenge with Autistic children?

Eating is a really difficult thing. It’s a multi-sensory experience. It’s the sound that food makes when you’re chewing yourself. So if you know your child likes loud noises and likes, they might be the same child that prefers those crunchy foods because when they’re eating it, you get that feedback of that loud sound.

We talk a little bit about the eating environment. If it’s really not, that can be really challenging because there’s just so much going on. So, actually, some children do better when they’re eating in a quiet space or not being able to smell other foods as well. That can be another challenge.

And going back to food being or eating being multi-sensory experience. You’ve got the sound, the taste, the what’s going on in the environment whilst you’re eating, and how a food looks. That can affect whether you’re likely to want to try it or not.

So I think we often feel that eating is something we do every day. What’s the problem with it? Actually, if you break down what eating is, it’s a huge thing because you’re having to think about what you’re going to eat from what’s in front of you and assess how it looks.

That’s the first thing when you look at food, you’re assessing how it looks, and then it might be the smell, then it might be the texture, how it feels in your mouth. And that’s before you even get to the taste of the food. So that’s why I think eating can be just a really challenging thing that we don’t think enough about.

Should I blame myself for my child’s fussy eating?

That’s the first thing I’d like to say about selective eating. Fussy eating is never the parent’s fault. It’s not your fault. The selective eating that often occurs in autistic people is beyond this kind of fussy eating. It’s much more internal and much deeper than that. And it isn’t caused by parents. It is linked to this need for routineness, familiarity, and sensory preferences. So the first thing I’d like to say is it’s never the parents’ fault.

If mealtimes are really stressful for you, for your child, or for the whole family. That’s another point that I would highly recommend getting help, because if everyone’s coming to the meal feeling already quite stressed, that is not the ideal situation and ideal for your body to be wanting to eat or eating or learning about new foods. And that’s the first thing we would try to tackle. Trying to minimise the stress around mealtimes to make mealtimes happier for everyone, not only the child but the parent too.

What works for your child now might not necessarily work in the future, but conversely, especially with diet, even if it doesn’t work now, it’s worth trying at a later date, because children are constantly developing, they’re growing.

And what’s really common amongst selectivity is that between the ages of five and roughly kind of pre-puberty, it can be really difficult to implement change. It’s not impossible. But from my experience and from some research that’s out there, in that kind of 5 to 10 years age group, implementing change can be a bit more challenging.

And I don’t know what it is about that pre-puberty, whether it’s hormone-driven, whether it’s having some more social awareness and being aware of what other people are eating and being aware of what food kind of means. So if friends are getting sweets on the way home or going to get food from the fish and chip shop, wanting to be a part of that, and that sometimes is a time in children’s lives where their diet naturally widens, and it’s something that’s driven internally rather than anything that parents implement.

Why is it so hard for my Autistic child to eat a varied diet?

It’s partly linked to the need and preference for routineness and familiarity, and also, sensory sensitivities play a big part in that as well. So we’ll find that children often have preferences, for example, for crunchy foods. Or they might have preferences for certain coloured foods. And it often tends to be those beige coloured foods or foods that are very predictable.

So every time that you open the package, for example, you know exactly how it’s going to be. And that’s why fruit and vegetables are the most challenging food group, because every time you open a packet of blueberries, you don’t know what size they are going to be. They’re going to be sweet. They’re going to be squishy, they’re going to be sour.

Whereas every time you open a packet of, say, crisps, generally there’s a predictability about the flavour, the texture, even what it looks like. And that’s why sometimes fruit and vegetables, introducing more of those, can be more challenging than more of these processed foods.

How would I try and add variety to my child’s diet?

So I’d always assess what your child’s already eating and make small changes towards the goal that you’re working towards. And actually, what we do often is talk about food chaining. So use all the food that your child already accepts, and then try to implement change towards the food that you would like them to eat. So if we go, for example, from crisps to fruit and vegetables. So it might be that they will eat potato crisps, potentially introducing some root vegetable crisps, which have a similar taste and texture, will also come out of the packet, but within that, you might get some different colours. So you might get beetroot crisps, you might get parsnip crisps, which look a little different.

They might taste a little bit different, but it might be easier to go from potato crisps to root vegetable crisps than say going from potato crisps to something like broccoli. And if they’re accepting the vegetable crisps, will they accept those similar vegetables but roasted. So again, the colour’s the same, the flavour’s the same, but the texture and the shape might be a little bit different.

So it’s making those small steps and chaining towards the food that you’re working towards. The reason why I always recommend being a preferred food alongside a new food. It gives a chance and motivation to come to the plate. It also gives you, as parents the reassurance that even if they only eat their preferred food, they’ve eaten something and then they’re not hungry.

But it gives you the opportunity to then start teaching them about that new food. So by offering their preferred safe foods, you’re not giving in. You’re not pandering. You’re making sure that your child has had some food, and they’re not based on something that they’re that’s acceptable for them. Introducing vitamins, minimum supplements. That can be almost what I call a quick win, especially if it’s in a format that your child might accept quite easily.

So adding a liquid vitamin into some squash that they already drink or into some juice, whereas food changing you might get somewhere with it and you might introduce some changes, but then you might need to revisit it at an estate when your child tried, there is often chance that might not get there, and food chaining doesn’t work for everyone all the time.

And some of these strategies you might need to revisit. It’s being led by your child.

Is trying to introduce these new foods worth the constant fight?

I think we should all try to be eating a healthy, varied diet, and with that, you’re going to be getting benefits such as getting the minerals your body needs. So even though your child’s diet is quite restricted and they’re eating enough to be growing well, are they getting enough white connection? So bitter means and minerals, particularly iron and calcium, they can be the more difficult ones to get in.

And so even though there might be eating enough food to be growing, well, they might not be getting enough iron. So they might be a bit iron, which might link to being tired, having no energy. And even that can cause a poor appetite as well. And that’s why it’s important to try and support children to widen their diets, to make sure they’re just getting all of the bits and minerals and the nutrients that their body needs to grow well to develop well.

How do I know if I need specialist help?

The point that we would offer some intervention is if your child’s diet isn’t varied enough. So if they’re missing whole food groups from their diet, so you’ve got your psyche carbohydrate foods, this energy fruit and vegetables which give us vitamins, minerals and fibre, protein foods, growth, dairy, and calcium. And you’ve got your kind of facts and high sugar foods as well.

If you’re a child’s diets very limited and they’re eating less than 20 different foods, it’s quite difficult to get all of the nutrients that your body needs. If you’re eating less than 20 different foods, or you’re skipping whole food groups if they’re not eating any, dairy foods or any plant based alternatives for to five calcium, that’s a point where you might need to get some more support, to get some tips on how to incorporate those foods into your child’s diet, it is looking at the diet as a whole.

You don’t look at a snapshot in a day. You’re looking over a week. Actually. Are you getting foods from different food groups over a week? And if you are, and if your child is growing well as well and they’re well in themselves, then I generally say you wouldn’t need to worry if you are at all worried about the growth, or they’ve got any particular gastro symptoms that you might be worried about.

So if they’re constipated, that might be because they’re not getting enough fibre in their diet. It might be because they’re not getting enough through it. Then there are the points where you might be more worried and might seek some help.

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