Dealing with food refusal in children with autism

Autism Spectrum Disorder (ASD) affects 1 in 44 children (CDC, 2022). Along with social and communication differences, many children on the spectrum experience selective eating, picky eating autism, or feeding difficulties.

These challenges often include rejecting certain foods entirely or following rigid eating patterns. This can cause frustration for families and lead to poor nutrition if left unaddressed.

Research shows that up to 70% of autistic children demonstrate food selectivity compared to only 16–25% of neurotypical children (Bandini et al., 2010).

Understanding the causes behind food refusal helps parents create practical solutions that support healthy eating habits.

Key Takeaways for Parents

✔ Up to 70% of autistic children experience selective eating or feeding difficulties

✔ Causes include medical conditions, sensory issues, rigid habits, and anxiety

✔ Practical strategies include social eating, positive reinforcement, and structured food choices

✔ Professional support, such as feeding therapy, is essential for severe cases

With patience and the right approach, many autistic children can expand their diets and improve mealtime experiences.

Is Food Refusal Common in Children with Autism?

Food refusal is not exclusive to autism, but it is significantly more common. Children with ASD frequently show:

• Avoidant eating patterns

• Sensory-based food aversions

• Strong brand or food-type preferences

• Anxiety around unfamiliar meals

These behaviors contribute to feeding difficulties and restricted diets, often focused on a narrow group of foods like cereal, crackers, or fruit snacks.

What Causes Selective Eating in Autistic Children?

Feeding challenges often have multiple, overlapping causes. The main contributors include medical, behavioral, sensory, and psychological factors.

1. What Medical Issues Trigger Food Refusal?

Children with autism and neurotypical children may share similar medical causes for avoidant eating, such as:

• Food allergies, causing discomfort or negative associations

• Gastrointestinal problems, including stomach cramps and constipation

• Acid reflux, leading to pain after meals

• Swallowing difficulties

• ADHD, affecting attention and mealtime regulation

Studies show up to 70% of autistic children experience gastrointestinal issues linked to feeding problems (McElhanon et al., 2014).

2. How Do Routines and Habits Affect Eating?

One of the prevalent traits of kids with autism is their obstinate refusal to shift from specific rules or habits. This behavior often makes the already challenging effort of trying different meals even more difficult. Kids with autism may allow only one particular food brand. This can make it hard to introduce new food brands or delicacies. In addition, they may not even want to eat anything sometimes, let alone try a different meal.

Neophobia, or fear of new foods, often worsens picky eating autism and increases selective eating behaviors.

This is a situation where the children show aversive reactions or fear when a new meal, mealtime, or meal environment comes around. Since children with autism thrive with schedules and organization, it can be taxing for them to adapt to new rules.

3. What Role Do Sensory and Motor Challenges Play?

Oral sensory aversion and oral motor difficulties significantly impact eating in autistic children.

Oral Motor Challenges:

• Children may struggle with weak chewing abilities.
• Poor muscle coordination increases the risk of choking.
• Difficulty chewing impacts their ability to handle certain food textures.

Oral Sensory Aversions:

• Children may show extreme sensitivity to food texture.
• Temperature differences (hot or cold) can trigger food refusal.
• Strong flavors may lead to gagging, spitting, or complete food rejection.

4. Can Psychological Factors Influence Food Refusal?

Parental reactions during mealtimes also matter. Negative experiences, such as:

• Pressure to eat

• Harsh language

• Visible frustration

…can increase feeding anxiety and lower a child’s confidence in trying new foods.

How Can Parents Manage Food Refusal in Autistic Children?

While every child is unique, evidence-based strategies can reduce selective eating, improve nutrition, and ease family mealtimes.

Take care of the health issues

The first step in helping your child try new and varied food is to tackle the medical causes. Take your child to a doctor or a specialist to diagnose and recommend treatments for underlying health concerns. This may include dental evaluation for cavities, constipation treatment, other gastrointestinal disorders, oral motor, oral sensory evaluation, etc.

Early diagnosis and treatment often reduce feeding difficulties.

Stronger when together

Children are prone to imitation, and this also applies to children with autism. In light of this, eating together at a table can help reduce anxiety in a child struggling to eat. When the child sees others eat, there is a high chance that the child will want to try it out. It will also reduce the anxiety associated with being alone, in front of the television, or on a parent's lap.

Everybody loves rewards

Rewards motivate children and can encourage positive eating behaviors.

Announcing a reward for children when they overcome a task such as eating, will go a long way to help them try new and varied food. However, the incentives must be something enticing to the child to convince them.

Use stories: Storytelling is a powerful way to engage anyone, not just children. When it comes to kids, telling them funny and inspiring stories helps to boost their imagination and relax their minds. You can use stories to help explain how the food will help your child achieve their dreams and grow stronger.

This builds confidence and reduces picky eating autism patterns.

Relaxation before mealtime

Many autistic children experience anxiety before meals, especially when unfamiliar foods are involved.

Some of the many reasons include the fear of unfamiliar food and disgust. When this occurs, some parents tend to force the child to eat, and it causes the child to suffer anxiety as mealtime approaches. However, these fears are so powerful that they can eliminate hunger and appetite.

Parents should help the child relax before mealtime. Some ways to induce this relaxation are storytelling, playing favorite games, and singing favorite songs together before mealtime.

Eye-catching food designs

Visually appealing food increases a child’s interest and appetite.

For example, you can shape the food into triangles, stars, and other cute and relatable shapes. Also, mixing colors enticing to the child will go a long way.

Playful food designs spark curiosity and reduce resistance.

Give your child options

Offering food choices reduces food refusal and can help children with picky eating autism feel more in control.

For example, when introducing a new food, your child should be able to choose between two new options. So instead of just coming up with a particular food flavor, you can ask them to choose between this flavor or another.

Check your child's posture

Many autistic children have limited body awareness, which can cause discomfort during meals.

As a result, they can also suffer discomfort in their stomach and back. That may make sitting at the dining table difficult for your child.

You can help support their posture by providing extra support by putting pillows behind their back if this makes them more comfortable.

Postural instability can cause mealtime discomfort, worsening feeding challenges.

Consult Feeding and Behavioral Specialists

You can also talk to a therapist to receive professional advice on other steps. For instance, you may need a behavior therapist or a psychologist to assess your child's behavior and advise on the best approach.

When Should You Seek Professional Help?

Contact a healthcare provider if your child:

• Eats fewer than 15 different foods

• Loses weight or struggles with growth

• Experiences severe mealtime anxiety

• Shows signs of medical discomfort

Early intervention prevents nutritional deficiencies and reduces family stress.

Final thoughts

Food refusal is common in autistic children and can negatively affect their health and nutrition.

Some of the main tips covered earlier in the article include:

• Food refusal is a common challenge for parents of children with autism. You’re not alone in this.
• There are many possible causes of food refusal, including sensory issues, anxiety, and communication problems.
• Some strategies can help overcome food refusal in children with autism.
• It is essential to work with a doctor or therapist to determine the cause of food refusal and create a treatment plan.

By introducing new foods in comfortable ways, parents may help their children learn to eat and perhaps enjoy a more diversified diet. You can work with a feeding specialist or a feeding therapy clinic for professional guidance.

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