FEEDING DIFFICULTIES ARE ONE OF THE MOST COMMON PROBLEMS IN CHILDREN WITH AUTISM. ALTHOUGH EATING MAY SEEM LIKE A SIMPLE ACT, IT IS A COMPLEX ACTIVITY FOR CHILDREN WITH AUTISM. EXPERTS RECOMMEND GETTING TO THE ROOT OF THE PROBLEM FIRST WHEN IT COMES TO NUTRITIONAL PROBLEMS.

Food rejection and eating only limited food groups are much more common in children with autism compared to individuals with typical development. Uniform nutrition or selective nutrition can reach dimensions that can lead to malnutrition in some cases. Since adequate nutrition in childhood is very important for growth and development, nutrition is an area that needs early intervention. Nutrition-related problems frequently encountered in autism can be summarized as follows:

- Food refusal and pickiness,

- Problems in chewing and swallowing; chewing food for a long time or accumulating it on the cheeks without chewing,

- Loss of appetite, overeating or undereating, having various obsessions during meals, eating fast, 

- Pika, that is, the eating of non-food objects (earth, paint, pencils, erasers, etc.)

What causes nutritional problems?

During feeding, all kinds of sensory systems such as touch, sight, taste/smell and hearing actually accompany this action. While performing this action, which is accompanied by so many senses, many children with autism may have difficulties in processing the senses and may develop nutritional problems related to this. The results of the research show that 77.4% of children with autism reject foods due to the structure-texture of food, 49.1% due to taste, and 11.3% because of its shape, while revealing that there are also those who reject foods because of their color. Another study shows that 69% of children with autism are reluctant to try new foods and 46% have various rules about their eating habits.  

In which cases are feeding behaviors a problem?

If your child is under the weight he/she should have for his/her age and is experiencing health problems, if he/she eats a monotypic diet with little nutritional diversity, if your child's anxiety increases during or before eating and if he/she exhibits problem behaviors, you should definitely seek support from a specialist. Interdisciplinary work, in which professionals such as special educators, occupational therapists and pediatricians collaborate, is very important to progress on the right path in nutrition, as in every subject.

Is diet a solution for autism?

Many types of diets such as gluten-free diet, casein-free diet and ketogenic diet are applied in individuals with autism. There may be children with gut problems, as well as children, who may benefit from trying a gluten- and casein-free diet. Restlessness caused by intestinal problems in these children can also lead to problem behaviors. When these problems are resolved with diet, a decrease in behaviors that are indirectly problematic can be seen. While research in this area continues, we do not yet have any well-founded scientific evidence that gluten-free and casein-free diets directly improve autism.   Therefore, it is important to note that a gluten- and casein-free diet is not risk-free for children with autism. Such diets can lead to nutritional deficiencies for children. This can bring different problems.  

What should be done to intervene in nutritional problems?

1. First of all, it is necessary to check whether the causes are caused by other health problems. A doctor's examination should be made for difficulties in chewing due to tooth structure, food allergy or gastrointestinal disorders.

2. Preliminary stimuli presented before mealtime should facilitate the child's eating difficulty. When the child's meal time approaches, relaxing activities can be done together and the transition to food can be facilitated.

3. Positive environmental cues for eating behavior should be regulated. Just as wearing a bag on your child's back or arm gives the impression that you are going out, sitting together at the dinner table should give the impression that you are going to eat.

4. Distractions in the environment should be minimized. It is important not to keep factors that will make it difficult for the child to eat.

5. Teaching eating behavior should follow a sequence from simple to difficult. For a child who never sits at the dinner table, the priority is to sit at the table, and then it is aimed to increase the sitting time of the child, while at the same time teaching should be continued by giving small pieces of food.

6. Meal times should be determined and consistent with the hours. Junk food or snacks should not be eaten as much as possible outside of these hours.

7. Food choices should be flexible. While doing this, it can be a good way to change the shape of the foods that the child loves and always prefers. For example, if you always cut French fries into slices and fry them, the next time you cut them into rounds, give them in small balls and then mash them.

8. It should be ensured that the child comes into contact with the food that he/she was previously afraid of or avoided eating by creating games or activities. The child should be involved in the preparation of the meal and should be spoken to in accordance with the child's level of language development. 

9. The child should be given the opportunity to eat on his/her own. Thus, the acquisition of skills such as using cutlery is facilitated and the opportunity is provided for the child to gain independent eating behavior. Too much protective attitude should not be displayed with the concern that the environment will be polluted.

10. During eating, the child's problem behaviors should be ignored as much as possible.The focus should be on the eating behavior, diverting the child's attention away from the negative behavior.

11. The child's positive behaviors should be reinforced. If the child sits at the table for longer than usual, or if he/she has a preference for food he/she has never preferred before, these behaviors should be reinforced and increased.

If the child receives special education services, nutrition skills should be included in the individualized education plan and the special educator should work in coordination.

MERYEM ÇAVGA, SOBE Foundation Child Development and Educator 

RESOURCES USED

Ateş, N. (2016). Evaluation of Meal Behavior and Nutritional Status and Mothers' Autrexia Tendencies in Children and Adolescents with Autism. Master's Thesis, Gazi University, Institute of Health Sciences, Ankara.

Autism Speaks. Exploring Feeding Behavior inAutism. https://www.autismspeaks.org/toolkit/atnair-p-guide-exploring-feeding-behaviorautism.

Gök Dağıdır, N. (2018). Demonstration of Nutritional Habits in Children with Cerebral Palsy and Autism and Evaluation with Biochemical Approaches. Master's Thesis, Gazi University, Institute of Health Sciences, Ankara.

The Republic of Turkey Ministry of Health, General Directorate of Public Health. (2019).A Guide to Healthy Eating Recommendations for Individuals with Autism Spectrum Disorder. Ankara.