Web Only ArticleMarch 9, 2011

Tricks for Picky Eaters

Understanding and expanding your autistic child’s diet

The opening (dinner) bell rings. The opponents start out tentatively, bobbing, weaving, dancing. Each waits for the other to make the first move. At last, there’s some action — it’s your carefully prepared casserole flying over your head, hitting the wall directly behind you with a loud plop. The judges silently shake their heads, scoring a point for your toddler as he triumphantly takes round one.

Dramatic? Maybe. But many parents swear that their meals feel more like a prize fight than prized family time.

Small children are often picky eaters, and refusing new foods is common. Children on the autistic spectrum, however, take pickiness to almost unbelievable extremes. They’re what I call “self-limiters,” often eating fewer than five different foods. Generally, the list includes bread, pizza, chicken nuggets, French fries, and milk. Other than the fries, these foods all contain gluten, casein, or both.

Proponents of the opioid excess theory of autism contend that these children limit themselves to foods that, when improperly broken down, give them a “high” resembling that of opioid drugs. Removing these foods can cause serious withdrawal symptoms, including irritability, diarrhea and even fever. Talk about comfort food! By now, parents of these kids have probably heard of the benefits that may result from removing gluten and casein — but they’re certain that their picky offspring would surely starve.

Most parents who have been through this process, though, will agree that it was worth the effort. If your child doesn’t have severe sensory issues that affect food choices, removing gluten and casein nearly always leads to a spontaneous broadening of the diet. It can take weeks, or even longer for older children, but once the offending proteins clear the system completely, most kids will try new foods and add many to their diets.

Opioids aren’t the only issue affecting food choices for autistic children. Our senses are vital to our enjoyment of food — smell bread baking and your mouth waters; bite a piece of cake and you savor the “mouth feel” as well as the flavor. But children on the autistic spectrum often have severe disturbances in several of their sensory channels. This dysfunction renders them unable to process sensory information, and it can affect the way they experience food.

Such children often make food choices based on a single characteristic. If a child’s tactile sense is overly sensitive, foods of particular textures or temperatures are intolerable. To children with overly acute olfaction, ordinary cooking smells may seem disgusting. For others, an insensitive nose may mean that food simply is not appetizing. Appearance of food is critical for some children — it could taste awful, but if the food looks right, these kids will eat it. In other cases, the common autistic “need for sameness” causes a child to eat only a few familiar foods.

Understanding how all these difficulties contribute to the extremely limited diets of autistic children is helpful, but it doesn’t change the fact that a broader diet is healthier for your child. Although introducing new foods presents a significant challenge, it can be done — you’ll just need to have a few tricks up your sleeve.

To get started, be sure to introduce new foods before removing old ones. The old foods shouldn’t suddenly disappear, replaced by unfamiliar substitutes. Another way to increase your chances of success is to determine what food trait is limiting your child’s diet. If texture seems to be the limiting factor, then introduce new foods that are similar in texture to foods that she already accepts. If your child eats only crunchy foods, start adding crunchy gluten- and casein-free foods. Or, if she refuses to chew, you can make puddings, purees, and even yogurt from suitable ingredients.

I often hear from parents who made gluten-free chicken nuggets that everyone but their picky child enjoyed. But when I question them further, I find out that no nugget actually crossed the child’s lips — he simply refused to try them. In this situation, it isn’t really accurate to say that the child didn’t like the food. Appearance was the limiting factor. Because the nugget didn’t look right, he didn’t eat it. For this type of child, you’ll need to study the favored brand of nugget and make yours look exactly the same in size, shape, and color. You may even want to head out to your child’s favorite fast food restaurant and ask for some of the nugget envelopes or boxes. Most store managers will oblige.

Once your child has accepted your nuggets from this packaging, start removing a few from the package to your child’s plate while he watches you. Leave the package next to the nuggets at first — your goal is to accustom your child to eating them right off the plate. Before long you’ll probably be able to forgo the deception of the fast food packaging.

If your child is a confirmed “milkaholic,” a similar trick might work. There are several excellent milk substitutes on the market that provide the required vitamins and minerals, but if your child refuses to drink them she may not be getting the calcium she needs. My favorite substitute is DariFree. Not only does it taste great, but it looks more like milk than most other choices, which is very important to many self-limiting children.

When you first make the switch, try adding just a tiny bit of milk substitute to the regular milk carton. Each day, increase the proportion of substitute that you add until there’s no milk left in the carton. Some children may need to get their milk substitute from a milk carton indefinitely. For the truly stubborn, adding a little chocolate flavoring may be the shortest route to a successful switch.

Once you get started, you’ll likely be able to come up with your own tricks, appropriate to your child. One enterprising mother told me that she grinds chicken before forming it into nuggets for breading and frying. She realized that she needed to duplicate the “reconstituted” texture of fast-food chicken nuggets in order for her child to accept it. Because chicken nuggets were the only form of protein her child would eat, she was willing to go to the trouble.

The process of switching to a gluten-free, casein-free diet can be frustrating, so keep your eyes on the prize. Once your child starts accepting new foods, you’ll no longer have to worry about whether she’s getting enough nutrition to grow and develop. Your mealtimes will be more relaxed, without that prize fight atmosphere — and everybody will win.    LW

Lisa Lewis, Ph.D., is author of Special Diets for Special Kids and co-founder of A.N.D.I., the Autism Network for Dietary Intervention.

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