Understanding and Approaching Feeding Disorders in Children with Autism

A pediatric feeding disorder (PFD) is defined as “impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction.” At the International Pediatric Feeding Disorder Conference, PFD’s were discussed for their occurrence in children with autism and how it can mask medical issues associated with these disorders due to underlying behavioral, communication, and sensory challenges. Compared to the 4.8% likelihood of PFD’s in typical children, autistic children had an alarming rate of 70.4%. Below are the different ways in which PFD’s are effected in autistic children and ways to manage them. 

Medical Aspect: 

Includes any impaired structural function of the GI, cardiorespiratory, and neurodevelopmental systems 

• Specifically, GI difficulties are common and include chronic abdominal pain, constipation, chronic diarrhea, and GERD 
• Issues can be missed because they are passed off as anger, aggression, or agitation, attributed to autism instead of an underlying illness 

Solution: Physicians should help families observe the child’s behavior and identify patterns and symptoms that could point to a medical issue 

Nutritional Issues: 

Includes malnutrition, overnutrition, micronutrient deficiency or toxicity, and dehydration. 

• Common challenges are restricted dietary variety, especially fruits and vegetables 
• Studies have found decreased vitamin intake in autistic children, specifically zinc, calcium, and fiber which lead to learning and motor deficiencies. Deficiencies in fiber have led to chronic constipation 

Solution: Identify deficiencies early on and develop a plan to improve nutrition and intake, as well as the child’s overall appetite and interest in eating 

Psychosocial Domain: 

Includes psychosocial disorders, developmental, social and environmental factors, and mental and behavioral issues in children and their caretakers 

• Autistic children lack the ability to communicate their difficulties in feeding and the sensorimotor skills and sometimes, their diagnosis is not made until later 
• This leads to a mismatch in expectation from the child and what the child can actually accomplish so the child becomes angry and learns avoidance behavior and aversion to food 

Solution: Parents must make modifications for portion size, types of foods, and how to engage with the child, and not just write off their child’s behavior as part of the spectrum. If there is a concern for autism, early on, they should review that with their physician. 

Understanding and approaching feeding disorders in children with autism 

Feeding Skill Deficit 

Includes impairments in oral and pharyngeal sensory-motor functioning and altered oral experiences such as injury, neurological deficit, and limited feeding experience 

• Autistic children have impaired processing and experiencing sensations which make it difficult to experience new foods 
• Postural instability makes it difficult to focus on chewing, swallowing, and feeding when the child is focusing on being upright 

Solution: Parents can assist with the feeding of the child and take advice from the physician in order to decrease the stress of apraxia or weakness