Diet & nutrition
Feeding issues among children
with autism are far too common.
They may eat a limited food
selection, show anxiety or tantrums
when presented with new foods,
and/or have ritualistic eating
behaviours, such as not wanting
different types of food to touch one
another. In fact, research has
shown that children with autism are
five times more likely than their
neurotypical peers to have such
mealtime challenges.
As well as sensory, textural and
environmental control factors,
children with autism often suffer
from medical issues related to
food. This may involve problems
with digestion and absorption, food
and chemical sensitivities,
oxidative stress, compromised
immune function, mitochondrial
disorders, impaired detoxification
systems and a higher than normal
bacterial, viral and parasitic load.
Dealing with these issues need
not be complicated. For example,
many children we see in our clinics
are low in iron and zinc, among
other nutrients. A deficiency in
either of these nutrients can cause
poor appetite, poor sleep, PICA
(eating non-food items), anxiety,
obsessive-compulsive disorder,
shortness of breath, and dizziness
that leads to poor balance. In many
cases, simply correcting these
nutrients through diet and targeted
supplements can make a
significant difference in alleviating
these symptoms.
Your child’s brain development,
detoxification system,
gastrointestinal health, immune
function and general growth and
development are highly dependent
on the macronutrient content of
foods. These macronutrients
include protein, carbohydrates,
fats, vitamins, minerals, amino
Can’t eat, won’t eat
Food refusal is a common scenario in the homes of families
whose children have autism. Stella Chadwick offers advice
to parents on how to recognise and deal with eating issues
30 Au t i s m | e y e I s s u e 4 2 2 0 2 1
acids and fatty acids. There can be hyperactivity, increase focus,
a vicious cycle, where poor or
limited food choices impact body
and brain health, which in turn
impact mood, behaviour, cognition,
and the ability to sleep and focus.
As a parent or caregiver, you want
to gently expand a narrow diet with
sustainable, practical and
achievable methods.
Make sure the problem
is not medical
Gastrointestinal distress is
common among children with
autism. They may refuse to eat
because they fear it may cause
pain. If you suspect this to be the
case, ask your GP for a referral to
a gastroenterologist for a
thorough investigation.
Constipation is a symptom we
often see in our clinics; this alone
can cause a lack of desire to eat
and a congested system, with
poor nutrient uptake. Chronic
constipation that fails to respond to
basic treatment can have a
multitude of causes, including poor
hydration, lack of fibre, low
hydrochloric acid in the stomach,
low level of enzymes, and in
extreme cases nerve damage to
the colon or impaction. There are
other possibilities, too, that would
need to be discussed with your
medical professional.
Consider food
intolerances
Some children with autism are
extremely sensitive to processed
sugar, additives and preservatives,
which tend to be the foods they
crave. Gluten and dairy are other
well-known intolerances, and
removing these foods while
ensuring a nutritionally rich and
diverse diet has shown to improve
bowel function, reduce
reduce behavioural problems, and
improve communications and
sleep. An excellent book on this
topic is Autism: Exploring the
Benefits of a Gluten-and Casein-
Free Diet (see panel, page 33).
It may surprise you that some
children have difficulty processing
certain compounds in ‘healthy’
foods, such as:
Phenols, found in large
quantities in foods including
berries, cherries, some apples,
grapes, tomatoes and peppers (for
more information, see the article on
phenols in the winter 2021 issue of
Autism Eye Magazine)
Oxalates, found in foods
including spinach, carrots,
beets, chard, almonds and chia
seeds (for more information, see
the article on oxalates in the
winter 2020 issue of Autism
Eye Magazine)
Histamine, found in foods
including aged meats and cheese,
fermented foods such as
sauerkraut, and in tomatoes, citrus
fruits and avocados (for more
information, see the article on
histamine in the Winter 2017 issue
of Autism Eye Magazine).
Many intolerance issues related
to the compounds above are due
to an unbalanced and unhealthy
gut ecosystem. If this is the case,
it can be difficult to solve, as it
Set realistic
(small) goals
and celebrate the
smaller steps
towards an eventual
larger target”
www.autismeye.com
Common problem: means navigating complex food
but there are challenges to create a dietary
strategies to tackle programme that is actionable.
food refusal Parents should therefore work with
a qualified professional when
implementing elimination/
challenge diets.
Stella Chadwick is the
founder of Stay calm and patient
Brainstorm Health Staying calm over such a stress-
and an experienced inducing problem as food refusal
nutritional and may be difficult, but you need to
biomedical consultant avoid turning mealtimes into
who specialises in battles. Set realistic (small) goals
working with adults and celebrate the smaller steps
and young children towards an eventual larger target.
on the autism Children should only be
spectrum. www. expected to sit and eat for a limited
brainstormhealth. time. Start with one minute per year
co.uk of age and increase this by one to
two minutes each day. Using a
timer can be a great way to
implement this. In general, the time
should not be more than 20
minutes and much less if the child
is younger. For example, a two-
year-old should only be expected
to sit and eat for 12-15 minutes.
www.autismeye.com Au t i s m | e y e I s s u e 4 2 31
 Diet & nutrition

FURTHER Conversely, there are kids who touch each other. Using a dividing drink through a curly straw, or
READING take forever to eat. This is when we plate can be a simple, fun, and using an electric toothbrush.
use the timer the other way around. effective way to help alleviate the
If your child routinely sits for 30 stress. Also, making food shapes Know when to seek help
minutes or more, start reducing the and using colourful utensils can If you have ruled out medical
“You have been a family to me, my life time by a minute or two each day add to the excitement of eating. issues and have tried all the tips
was falling apart. Now I have dreams, until you reach the appropriate that normally work for children and
time for their age. Consider food texture your child is still struggling to eat,
and the skills to achieve them.” - Student It’s common for children on the then consider that your child is not
Help them feel in control spectrum to have sensory issues. just a ‘picky eater’ but potentially a
A home from home residential school with a curriculum
Autism: Many children with autism like to This can affect the type of foods ‘problem eater’ with complex
aimed at preparing our young people for successful,
Exploring the have routines and control what is they like to eat – to the point that needs. This is when a team of
independent living. Day places also available.
Benefits of a happening to them. At mealtimes, crunchy foods are considered too therapists may need to be involved.
Gretton School is a specialist, therapeutic day and Gluten-and this means they could benefit from loud when consumed, or softer According to Elizabeth Strickland,
residential school for learners aged 5-19 years with Casein-Free wanting to be included in the foods are unbearable in the mouth. the author of Eating for Autism,
a diagnosis of autism. Diet, by Paul planning, shopping for, choice and Work around this by cooking, problem feeders have the following
Whitely, Mark arrangement of food. chopping or blending food – or key characteristics:
To find out how our residential option could support your Earnden and It’s also important to allow your adding it to a sauce. If crispy or Eat fewer than 20 foods and
child or to arrange a school visit please contact us: Elouise child to decide whether to eat and keep reducing the number of foods
T: 01223 277438 Robinson, how much to eat. This will probably they will accept
E: admissions@grettonschool.com Routledge, be the most challenging for a Pressuring a Refuse to eat foods from entire
www.grettonschool.com/admissions parent to implement, as it is our categories of texture
£28.99/$38.90
child to eat and
instinct to feed our kids come what Eat the same favourite food
Part of the Cavendish Education Group
may. Pressuring a child to eat and offering a reward, every day but burn out and stop
offering a reward, such as a such as a dessert after eating the food completely
dessert after a certain number of Cry and/or throw a tantrum when
bites, does not work. It can put a a certain number of offered a new food
lot of pressure on kids and make bites, does not work” Won’t tolerate a new food on
them even more picky. their plate and are unwilling to
This doesn’t mean that you let touch or taste the food
Eating for the child do and eat whatever they crunchy food is preferred, look to Very inflexible about particular
Autism: The want, but we need to make some replace unhealthy options with foods (for example, they will eat
10-Step simple rules to help: those that offer maximum nutrition only McDonald’s French fries, not
Nutrition Plan, 1 For a child with autism or other but have the right texture for your Burger King’s).
by Elizabeth additional needs, new foods can child. There are recipe ideas on Helping your child to expand
Strickland, be alarming. Don’t expect a child our www.brainstormhealth.co.uk the range of food they accept, and
A highly specialist school with day and Lifelong Books,
£12.99/$14.99
to progress straight to eating a
food without first looking, touching
website that may inspire you.
You can do all this alongside the
to learn to try new and unfamiliar
foods, may be a lengthy process,
residential places available for children and smelling it. In this instance,
‘playing with your food’ is to be
longer-term work of expanding food
choices, allowing you to become
but an important one if you want
your child to be healthy in the short
and young people with autism. encouraged, so the item becomes
less intimidating and more familiar.
more relaxed about meeting your
child’s nutritional needs.
and long term. In very few cases
you may require the help of a
2 Persevere and serve the ‘new’ Children who struggle specialist team, but for the most
We offer a caring and nurturing environment with a food with ‘known’ foods multiple physically to eat – such as those part parents can make great
high staff to pupil ratio. times before it may be accepted. with poor muscle tone in their progress following some simple
This can mean showing that food gums – may also like to warm up rules, ensuring that you
Our waking day curriculum extends learning upwards of a dozen times. to eating by preparing the mouth congratulate yourself and your
through fun-filled, engaging activities. 3 Many children don’t like foods to with blowing bubbles, sucking a child each step of the way.
Children are supported to thrive in a beautiful
community setting in the heart of Chester
city centre. REFERENCES
R Lefter, A Ciobica, D Timofte et al (2019): ‘Descriptive Review on the Prevalence of Gastrointestinal Disturbances and Their Multiple
Our personalised, evidence-led approach supports Associations in Autism Spectrum Disorder’, Medicina (Kaunas). 56(1):E11.
our pupils’ development and wellbeing. BO McElhanon, C McCracken, S Karpen et al (2014): ‘Gastrointestinal Symptoms in Autism Spectrum Disorder: A Meta-analysis’,
Pediatrics. 133(5):872-883
M Lee, J Krishnamurthy, A Susi et al (2018): ‘Association of Autism Spectrum Disorders and Inflammatory Bowel Disease’, J Autism Dev
VISIT ABBEYSCHOOL.COM TO BOOK ONTO A VIRTUAL OPEN DAY Disord. 48(5):1523–1529
L de Magistris, A Picardi, D Siniscalco et al. (2013): ‘Antibodies against food antigens in patients with autistic spectrum disorders’,
Biomed Res Int. 2013:729349.
To find out more, please contact our Principal, Dr Katy Lee at F Torrente, A Anthony, R B Heuschkel et al. (2004): ‘Focal-enhanced gastritis in regressive autism with features distinct from Crohn’s
principal@abbeyschool.com or call: 01244 960 000 and Helicobacter pylori gastritis’, Am J Gastroenterol;99 :598– 605.
P Whiteley, D Haracopos, A M Knivsberg, et al. (2010): ‘The ScanBrit randomised, controlled, single-blind study of a gluten- and
casein-free dietary intervention for children with autism spectrum disorders’, Nutr Neurosci. 13(2):87-100.

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