Understand the patterns of picky eating

Does your child like noodles, ground beef, and tomato sauce separately, but refuse to eat spaghetti when it is served all together? Maybe they don't like food that touches? Or only certain brands? Does your child think that everything is slimy? 

There's been a lot of research on children's picky eating habits and several patterns emerge... 

There are a few things you should know about picky eating:

1. Picky eating is a normal part of child development. Depending on how you measure it, up to 50% of parents consider their children to be picky eaters. Having said that, picky eating can look a little more peculiar in children with ASD.

2. Parents of children on the spectrum may be more sensitive to what their kids eat and don't eat compared with parents of typically developing children. Parents of kids with ASD have reported their kids were pickier eaters even though the kids ate the same amount as kids with typical development.

3. It's true some picky children will grow up to be picky adults, but other children grow out of their picky eating - at least to some extent. Having said that, it is not uncommon for parents of 11 and 12-year-olds to have problems with picky eating.

4. Picky eating doesn't always cause health problems. Picky eating causes health problems when (a) the child isn't getting enough calories to sustain growth, (b) the child is only eating junk food, or (c) the child's diet is so limited key nutrients are missing.

5. Some children with ASD have feeding disorders- which are much more serious than picky eating. Feeding Matters is a great resource for families who have children with feeding disorders.

6. Some medications can cause either loss of appetite or overeating which might make an otherwise good eater a picky eater.

It can feel random what kids will and won't eat, but there are many common patterns when it comes to picky eating. New food, food that touches, food with multiple components, food with different textures, and bitter food are the most likely to cause problems. But when we stop and think about what's going on in the brains of children when they eat- these patterns actually make sense. 

There's a common theme among the patterns of picky eating. When kids can't anticipate how food tastes- they don't want to eat it. Have you ever bit into something you thought was one thing, but it was actually something else? It automatically tastes kind of gross. That same basic premise underlies most of the patterns of picky eating. Adult brains are much better at anticipating and planning for change and novel experiences. These things are difficult for children and especially children with ASD. And kids with ASD already like consistency and repetition so expanding diet can be doubly tricky for them.     

Question:  what about sensory issues? How do they play a role? 

Sensory issues can play a huge role. Children can be hypersensitive to texture- so food can be physically uncomfortable in the mouth. Hypersensitivity to smell and taste can make familiar food seem new because these kiddos can notice even small changes in preparation and presentation. Hypersensitivity to smell and taste can even make food revolting. Sometimes hypersensitivity can make food or the eating environment overstimulating and overwhelming which can cause picky eating and problems with mealtimes in general.

Question:  How can I get help for picky eating? 

First, make sure it is necessary to address picky eating. If picky eating isn't causing health problems- you may not have to do anything. Especially if you are working on several other goals and your child is maintaining appropriate growth- it may not be a priority for your family right now.  If you're not sure whether not your child has clinical levels of problematic feeding - this questionnaire was designed to promote early identification of feeding disorders.

If you do want to address picky eating, there are professionals who can help you. There are three main types of feeding therapies for children on the spectrum who have clinically severe feeding issues. All of these therapeutic approaches should be done by trained professionals as part of a feeding therapy program. Many food clinics offer sensory-based interventions such as "systematic desensitization" where children are gradually exposed to new food. This method assumes the underlying reason for picky eating is anxiety or fear related to food or food being overwhelming to the sensory system- the SOS method is a well-researched type of sensory-based therapy. The second, common form of feeding therapy is ABA-based.  ABA feeding therapy uses the basics of applied behavior analysis (e.g. functional behavioral analysis, reinforcement, and stimulus fading) to address feeding difficulties. ABA-based feeding therapy has the most research supporting its effectiveness for kids on the spectrum. The third type of feeding therapy is relational - you're trying to rebuild the child's relationship with food as well as the person who is doing the feeding. Steps+ and the Get Permission Approach are two methods of relational feeding therapy.  

If you're seeking help for your child's eating, here a few questions that you can ask clinicians to help you feel confident you're working with someone good. There's no magic right answer to these questions, but any clinician you work with should be able to answer them and the answers should make sense to you.  

• What kind of therapy do you recommend? What does this therapy look like? How does it work?

• How have you been trained to implement this therapy?

• What do you consider to be a reasonable outcome for this therapy?

• How do you evaluate progress?

If you want to address picky eating, but don't feel like a food clinic is necessary, see our guide for the stress-free way to eat healthier.

If your child is clinically underweight,  you can have it written into their 504 plan or IEP that they have snacks throughout the day, increased time at lunch, or a specialized lunch environment if any or all of these things will keep them at a healthy weight.

Question:  Do parents play a role in picky eating? 

They can. Parents (and siblings) can be great role models. Parents who have more varied and healthy diets tend to have kids who have more varied and healthy diets. Some parents are really great at finding just the right moment to introduce a healthy snack. For example, they only bring a fruit or vegetable snack for the car after school. On the other hand, parents can sometimes do things that make the problem bigger. They might accidentally set the expectation that the kiddo won't like a food ("You can give that to him but he won't eat it"). They can be really controlling about what kids eat which often has the opposite of the intended effect. So parents do play a role. Having said that, sometimes children develop a problematic relationship with food early on. These children could become picky eaters or have more serious feeding disorders. 

Question:  Why will my kid only eat one brand of chicken nuggets? 

Do you like Coke or Pepsi? McDonald's or Burger King? What's your favorite brand of blue jeans? Shoes? Kids have preferences too. They just care about different things.  

References

All content is original to Mealtimes on the Spectrum, but is based on the following scientific literature:

• Lockner, D. W., Crowe, T. K., & Skipper, B. J. (2008). Dietary intake and parents' perception of mealtime behaviors in preschool-age children with autism spectrum disorder and in typically developing children. Journal of the American Dietetic Association, 108, 1360-1363. doi: 10.1016/j.jada.2008.05.003

• Silbaugh, B. C., Penrod, B., Whelan, C. M., Hernandez, D. A., Wingate, H. V., Falcomata, T. S., & Lang, R. (2016). A systematic synthesis of behavioral interventions for food selectivity of children with Autism Spectrum Disorders. Review Journal of Autism and Developmental Disorders, 3(4), 345-357.  doi: 10.1007/s40489-016-0087-8

• Taylor, C. M., Wernimont, S. M., Northstone, K., & Emmett, P. M. (2015). Picky/fussy eating in children: Review of definitions, assessment, prevalence and dietary intakes. Appetite, 95, 349-359. doi: 10.1016/j.appet.2015.07.026