Explore Food Textures

One consistent theme in food selectivity relates to food textures. It is possible that sensory sensitivity experienced by children with ASD may add to their difficulty with food texture and food selectivity. The following are some potential solutions for texture sensitivities:

• • Give children foods that match their texture preferences, rather than focusing on preferred flavors. For example, it is recommended that children with ASD eat more fish as they tend to lack Omega-3 fatty acids due to faster breakdown of the acids than the general population. However, if the child dislikes the texture of fish, try substituting foods that match the child’s texture preference, such as fish burgers, or ground walnuts or flaxseeds on yogurt and salad.
• • Slowly introduce foods with new textures over time. For example, give the child a small bite of new food to see if the child likes the texture or smell. If the child does not completely refuse it, continue providing it in slightly larger quantities over time to help the child develop an acceptance or preference for it.

Introduce Children to New Foods Gradually

Gradually introducing a child to a new food can expand diet variety, and parents are encouraged to involve the child in the food selection process. The website ChooseMyPlate.gov from the U.S. Department of Agriculture (USDA) suggests that when assembling a meal, there should be choices of healthy foods from all five food groups: grains, protein, fruits, vegetables, and dairy. When eating a healthy, balanced meal becomes part of the child’s routine, it will help establish a foundation for safe and healthy eating behaviors and increase the predictability that children with autism like.

Typically developing children may have to try a new food 10 or more times over several months before deciding whether they like it. A child with ASD likely will take considerably longer to gain familiarity with a particular food due to the new experiences that come with the action (e.g., new taste, smell, image, etc.). The most important points to remember when introducing new foods are to be patient and to determine what the child enjoys and dislikes. Avoid introducing too many foods at once, which might overwhelm the child. Take into account “the rule of 3,” which means offering only three foods at a time—two that the child already likes, and one that the child has not tried or did not like before.

If the child refuses to try a certain food, keep offering different foods. It is best to avoid spending a lot of time on a food that the child does not like, particularly if the rejection comes from smell or texture as opposed to just taste. In addition to taste, texture and smell are important for children with autism. For example, if the child likes the texture of a raw apple, try introducing cooked apple. If the child accepts cooked apple, then introduce cooked potato, as they have similar textures. Keep notes on what and how much the child eats, as well as refuses to eat, at mealtime. Make notes of strategies used and the child’s behavior during mealtimes. Refer to these notes to continue offering foods that the child eats and to use strategies that work. These notes might also be helpful when seeking guidance from primary care physicians.

Include Non-Preferred Foods with Preferred Foods

Caregivers can simultaneously present a preferred and non-preferred food to increase the range of food that children eat. For example, small bits of broccoli can be mixed in the child’s favorite soup.

Create a Specific Routine

As mentioned, children with autism tend to engage in repetitive behaviors. Rather than attempting to correct these behaviors by only removing undesirable habits, parents should establish new practices that are more beneficial. This can be accomplished by having a specific place for meals, such as a child-sized table or high chair, and consistent times for meals every day. Further, a statement such as “It’s time to eat” or a brief song could signal that it is mealtime. This could help with the transition from another activity to a meal. Mealtime could begin with a bite or two of preferred food to encourage eating immediately, followed by non-preferred foods as explained in suggestions 3 or 4, and then offer another bite or two of preferred food to encourage meal completion. Conclude with access to a preferred activity or choices of preferred activities (e.g. reading a book, drawing, coloring or going for a walk, playing a game) to reinforce eating a meal.

Use Positive Reinforcement

Positive reinforcement is crucial to feeding time and is important for encouraging the mealtime behaviors we want to see. When a child tries new food, offer specific praise. For example, a parent could say, “Sarah, I like how you just tried that piece of broccoli!” Being specific helps children understand what we liked that they did, and increases the chance they will engage in that behavior again to gain our positive attention. Rewarding them with extra time on activities that they enjoy, such as playing educational games on the computer or a tablet after they have tried new foods, could also help encourage more of that behavior.

Keep Mealtimes Focused and Reduce Distractions

A good recommendation is to keep mealtime comfortable and supportive. Specifically, try using a high chair or child-sized table to ensure that the child is comfortable during mealtime. Keep distractions minimal, such as turning off the television or setting the toys aside while eating.

Use Augmented and Alternative Communication

Even if some children with autism are classified as “nonspeaking” due to language delays, they still use some types of sounds, speech, or nonverbal communication for certain purposes. In these cases, research supports the use of Augmented and Alternative Communication (AAC) to help children convey their thoughts and emotions. AAC can vary from hand gestures (such as pointing), signs, pictures, and alternative communication devices. Parents and caregivers might worry that AAC will reduce the child’s motivation to speak, but there is significant evidence to suggest the opposite.

Research has shown that AAC does not interfere with speech; rather, it increases the child’s ability to learn speech. Using AAC also advances children’s communication skills because it gives them as much control as possible, allowing them the freedom to express themselves more accurately and more quickly. For example, during feeding time, a child might point at something to indicate that he or she wants to know what it is, but is struggling to find a word for it. Caregivers can help by verbalizing and labeling the items. This way, children will learn the right words and use them in conversation. Also, different hand gestures can mean different things with practice. For example, having children put their hands on their tummy can signify they are hungry or would like some more, while crossing both arms can mean full or stop.

Alternatively, caregivers might use flash cards and print pictures of healthy foods from which children could select the food they like to eat. This link from the National Heart, Lung, and Blood Institute includes pictures of different foods, as well as guidance to teach children about healthy and unhealthy foods: https://www.nhlbi.nih.gov/health/educational/wecan/downloads/gswflashcards.pdf

If the child likes using tablets or smartphones, there are many apps that can be downloaded and used for communication. Simply search “AAC Communicator” online to see the listing of apps, their ratings, and reviews. Free apps such as LetMeTalk, CoughDrop, and JABTAlk are great examples based on their diverse range of pictures and symbols. It is important to note, however, that the AAC strategy is not meant to replace verbal speech and should only be used as a tool to bridge nonverbal and speech communication.

Have a sleeping routine

Eighty percent of children with autism experience sleeping problems. Sleeping is a very important aspect of human functioning, and lack of sleep can cause irritability, slowed development, slowed cognition, fatigue, and might also cause gastrointestinal disturbances. The cause of sleeping difficulties among children with autism is not very well understood, but there are strategies to help regulate a child’s sleeping schedule.

• • Establish a bedtime routine (e.g., brushing teeth, putting on pajamas, and reading a book every night before bed)
• • Have regular sleeping and waking times every day
• • Avoid caffeine and naps late in the afternoon
• • Sleeping should take place in area that is dark, quiet, and comfortable for the child

Introduce Smaller Amounts of Food with Frequent Meals and Snacks

Instead of providing three large meals, as is typical, smaller and more frequent portions with five to six scheduled meals and snacks may be provided for children with autism. This way, their intake is spread throughout the day, and they may feel full and less irritable. Additionally, if the child rejects a specific food, it is only a small amount that is rejected instead of an entire meal. However, it is important to set a schedule to offer the frequent meals and snacks and avoid all day snacking.

Use Positive Role Modeling

Be a positive role model by leading the way with all activities. When introducing a meal, eat it with them and say something positive about the food. For example, parents could say that they like the texture of the food in their mouth, or that they are really enjoying the food’s savory taste. Children tend to imitate adults who are around them, so it is important to show positive behaviors for them to model. If the child has older siblings, try to get them involved with being a positive role model as well.

Work Together with All Caregivers and Support Each Other

Raising a child with autism requires a lot of patience, preparation, and intentionality, especially considering the challenges with routines, such as the ones outlined in this article related to eating. Research has shown mothers of young children diagnosed with autism are more likely to experience stress and depressive symptoms than mothers raising typically developing children. There are numerous benefits when fathers participate actively in caregiving activities with their children, such as reading books, singing songs, bathing, feeding, or responding to the child’s cry. Father’s involvement can boost mom’s mental health, reduce stress, and promote the child’s ability to learn new words and communicate. Parents can also seek additional support from other caregivers (e.g., child care providers, teachers, other family members). Research has shown that caregivers who are more coordinated and less conflicted during mealtime experience reduced stress and fewer disruptive mealtime behaviors. Therefore, it is critical that parents and caregivers discuss their approach and practices for feeding children to prevent conflicts at mealtime and to have agreed-upon strategies to address conflicts. Be open to new ideas and try a wide variety of strategies to find what works best for oneself, the child, and the family.