Case Challenges

Picky Eating and Food Aversion, From Typical to Extreme

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


April 04, 2016

Management: Picky Eating and Autism

In children with autism, sensory processing challenges and resistance to change can contribute to picky eating. Up to 80% of children with developmental delays, including autism spectrum disorders, will experience picky eating.

Because of the family's vegetarianism, Bryan's dietary sources of iron are limited. His appetite is low, which can be associated with low iron levels.[13] The laboratory tests confirm iron deficiency anemia, and you begin replacement therapy.

The evidence to support a restrictive diet for children with autism is conflicting.[14] Removing casein and gluten will remove most of Bryan's "safe foods" and is likely to result in lower intake. Dairy products are a significant source of calories, protein, and essential nutrients for Bryan, although lacking in iron. The pediatric dietitian should help Bryan's parents with food selection and offering new foods.

The OT can help with behaviors and transitioning to a routine, including meals and snacks every 3-4 hours and incorporating milk into those eating opportunities. The OT (or qualified SLP) can also work on sensory challenges and help Bryan's parents bridge to new foods with familiar foods, trying strategies that may include food chaining; behavioral techniques; fading; and for some children, exploration and rating of new foods. A trial of dietary intervention is not unreasonable and can be considered with the support of the pediatric dietitian and OT, hopefully after Bryan is able to eat a greater variety of foods.


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