Case Challenges

Picky Eating and Food Aversion, From Typical to Extreme

Katja J. Rowell, MD; Jenny H. McGlothlin, MS, CCC/SLP


April 04, 2016

High-Functioning Autism

Bryan, a 5-year-old who is new to the area comes in for a first-time visit. His mother shares that he was diagnosed at age 3 with autism spectrum disorder, and is "high functioning."

Bryan's mother provides a detailed medical history, including extensive past therapies (speech, occupational, and applied behavioral therapies). He had gastroesophageal reflux as an infant, and took lansoprazole for 2 years. Bryan's eating behaviors have been consistently fussy. He tested negative for celiac disease and allergies. His mother is concerned about the lack of variety in his diet, and he is refusing more and more foods that he previously ate.

Bryan rarely asks to eat. He will eat only white or brown foods—mostly crunchy carbohydrates and a few freeze-dried fruits, but no vegetables. He drinks 3-4 cups of a specific brand of chocolate milk daily, and most enjoys macaroni and cheese and quesadillas cut into squares. Bryan's parents are vegetarian, but Bryan refuses the beans and lentils that make up a large part of their diets.

Bryan starts kindergarten soon, and his mother worries about him eating in an unfamiliar and stressful school setting. His behavior overall is improving. They have not done specific therapies around eating.

On examination, Bryan demonstrates only fleeting eye contact and makes repetitive hand movements. He answers questions adequately, if a bit awkwardly. He is at the 75th percentile for height and weight, and his growth is stable. The exam is otherwise unremarkable.


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