Fact sheet: information on eating and feeding problems in a child with Autism, a common Autism Spectrum Disorder


Parents of children with neurotypical development will often encounter mild feeding problems at some point in their development. But parents of children with autism or Asperger's syndrome may need a lot more support as these problems can be more severe. Strategies will usually need to be different too. For example, withholding food until a fussy eater is hungry enough to eat is a dubious strategy at best - for a child on the autism spectrum, such a strategy could be dangerous. 'Fussy eating' in greatly complicated by the autism spectrum due to sensory problems. Click here to read about how this affects the strategies used.


This fact sheet covers a wide range of eating feeding issues:

• Learning to sit at the table for meals

• Assessment of eating and feeding issues

• Gastrointestinal tract problems

• Diets for biomedical intervention

• Pica - the eating of non-nutritious substances

• Regurgitation and re-eating of food

• Anorexia nervosa


Learning to sit at the table

Sitting together to eat is a social custom across virtually all cultures. As autism and Asperger's syndrome affect social interaction skills, it is not surprising that a child may be less inclined to stay at the table during a meal. Determining the reason your child is not able to sit at the table will help in deciding what to do to address your child’s needs.


Some children need to organize their bodies with a little physical activity before they are asked to sit at a table. Sometimes a timer needs to be set to show more concretely that sitting is expected at mealtime, at least for a few minutes until the timer rings. The length of time a child is expected to sit may be gradually lengthened so success is built up slowly. It helps if the expectation to sit and eat at the table can be structured in small steps and paced so the child is successful.


Some children can sit and eat quickly at the table but will not be able to sit and wait for others before being served and/or after they have finished their food. This inability to wait can sometimes be addressed with special waiting toys or activities. Sometimes items to focus on while waiting are helpful. Even some older children and adults on the autism spectrum have a need to develop waiting strategies to use at mealtime while eating with others. In this situation, bringing something to read or a pocket sized game to focus on while waiting, is a positive coping strategy for older children and adults, too.


Importance of assessment

Medical, behavioral, and environmental factors, including sensory problems, must be considered when feeding and eating problems occur in young children. Medical assessments can include evaluation of oral motor function including swallowing studies, assessments of food sensitivities and allergies, medications and their effect on eating, and a profile of the child’s diet and resulting nutritional issues. A multi-disciplinary approach is common, with occupational therapists, speech and language pathologists, and nutritionists or dieticians along with doctors and nurses taking part in a feeding assessment.


abnormal gastrointestinal functioning

It has been claimed that up to fifty percent of children with autism experience persistent gastrointestinal tract problems, ranging from mild to moderate degrees of inflammation in both the upper and lower intestinal tract. This has been described as a syndrome, autistic enterocolitis, by Dr. Andrew Wakefield; this diagnostic terminology, however, has been questioned by medical experts. Constipation, often with overflow, or encopresis, is often associated with developmental disorders in children, and is often difficult to resolve, especially among those with behavioral and communication problems. Click here strategies to deal with constipation.


Treatments of abnormal gastrointestinal functioning have led to varying degrees of improvements in the symptoms of Autism Spectrum Disorders, including behavior, communication and social skills. A range of biomedical interventions have been suggested, including the gluten-free casein-free diet, probiotic diet, Feingold diet and vitamin supplements. It should be stressed that anecdotal evidence suggests there is no magic cure for everyone, as parents report a great range of effects from dramatic improvement to none at all for various biomedical interventions.


diets for biomedical intervention

Different diets seem to help some people with Autism Spectrum Disorders. A gluten-free, casein-free diet seems to be where many families start when exploring a gastrointestinal connection between their child’s behavior and their diet. Families often anecdotally suggest they find their child’s self- imposed restricted food choices do expand significantly when they start a gluten-free, casein-free diet. The Specific Carbohydrate Diet (Gottschall, 2002) is also gaining a lot of interest among families of children with Autism Spectrum Disorders. It is best to read the latest research and information, and find a knowledgeable medical professional to work with if you are considering a particular diet, gut healing treatment and/or supplements for your child. This approach certainly does not work for everyone, is very individualized and is a substantial commitment to most families if or when they begin.


behavioral issues

Eating disorders are complex and continue to be studied among various populations. Eating disorders such as failure to thrive, rumination, pica, obesity and anorexia nervosa can affect children with Autism Spectrum Disorders. Children experiencing these problems are at risk for serious health and growth problems that can lead to life threatening consequences.



Pica is an appetite for non-nutritive substances (e.g., coal, soil, chalk, paper etc.) or an abnormal appetite for some things that may be considered foods, such as food ingredients (e.g., flour, raw potato, starch). In order for these actions to be considered pica, they must persist for more than one month, at an age where eating such objects is considered developmentally inappropriate. The condition's name comes from the Latin word for the magpie, a bird which is reputed to eat almost anything. Pica is seen in all ages, particularly in pregnant women and small children, especially among children who are developmentally disabled, where it is the most common eating disorder.


Pica in children, while common, can be dangerous. Children eating painted plaster containing lead may suffer brain damage from lead poisoning. There is a similar risk from eating dirt near roads that existed prior to the phase out of tetra-ethyl lead in gasoline or prior to the cessation of the use of contaminated oil (either used, or containing toxic PCBs) to settle dust. In addition to poisoning, there is also a much greater risk of gastro-intestinal obstruction or tearing in the stomach. This is also true in animals. Another risk of dirt eating is the possible ingestion of animal feces and the accompanying parasites.


The scant research that has been done on the root causes of Pica suggest that the majority of those afflicted tend to suffer some biochemical deficiency and more often iron deficiency. Often the substance eaten by those with the disorder does not even contain the mineral they are deficient in. In cases where a biochemical deficiency is the problem, Pica is generally not discovered until the deficiency is addressed. Once the deficiency has been identified and treated with vitamins or minerals, the Pica is usually resolved. If a mineral deficiency is not identified as the cause of Pica, it often leads to a misdiagnosis as a mental disorder. If the deficiency continues to go unnoticed it can become severe if the root of the deficiency is a disease or internal problem.

Treatment emphasizes psychosocial, environmental, and family guidance approaches. Treatment options include: discrimination training between edible and nonedible items, self-protection devices that prohibit placement of objects in the mouth, sensory reinforcement involving screening (covering eyes briefly), contingent aversive oral taste (lemon), contingent aversive smell sensation (ammonia), contingent aversive physical sensation (water mist), brief physical restraint, and overcorrection (correct the environment, or practice appropriate alternative responses).


This involves associating negative consequences with eating non-food items and good consequences with normal behavior. Medications may be helpful in reducing the abnormal eating behavior, if pica occurs in the course of a developmental disorder, such as intellectual disability, or pervasive developmental disorder. These conditions may be associated with severe behavioral disturbances, including pica. These medications enhance dopaminergic functioning, which is believed to be associated with the occurrence of Pica.



Rumination is the persistent regurgitation, re-chewing, re-swallowing, or occasionally vomiting of previously eaten foods and is a second behavioral problem of eating that can have serious health consequences. In some animals, known as ruminants, this is a natural and healthy part of digestion and is not considered an eating disorder. However, in other species (including humans), such behavior is atypical and potentially dangerous as the esophagus can be damaged by frequent exposure to stomach acids.


The causes of rumination are not clear but are thought to begin due to gastro-intestinal disorders and continue due to the self-stimulatory rewards the individual experiences. Rumination is a relatively rare disorder; the best course of action is an appropriate medical assessment and treatment. Behavioral interventions may be appropriately designed and implemented once medical issues have been thoroughly addressed. Behavioral issues, when severe, will also need to be assessed and treated medically.


Rumination is also associated with eating disorders such as anorexia nervosa, and can be the result of one's apprehension and nervousness after eating a normal meal. For those with purging behaviors, rumination can take place when the option of getting rid of a meal via throwing up is not available (thus, one might feel worried and visibly upset).


Anorexia nervosa

Anorexia nervosa is a psychiatric diagnosis that describes an eating disorder characterized by low body weight and body image distortion. Individuals with anorexia often control body weight by voluntary starvation, purging, vomiting, excessive exercise, or other weight control measures, such as diet pills or diuretic drugs. It primarily affects young adolescent girls in the Western world and has one of the highest mortality rates of any psychiatric condition, with approximately 10% of people diagnosed with the condition eventually dying due to related factors. Anorexia nervosa is a complex condition, involving psychological, neurobiological, and sociological components.


Anorexia is a life threatening condition that can put a serious strain on many of the body's organs and physiological resources. The first line treatment for anorexia is usually focused on immediate weight gain, especially with those who have particularly serious conditions that require hospitalization. In particularly serious cases, this may be done under as an involuntary hospital treatment under mental health law, where such legislation exists. In the majority of cases, however, people with anorexia are treated as outpatients, with input from physicians, psychiatrists, clinical psychologists and other mental health professionals. It is important to note that many recovering underweight persons (who are more or less forced against their will into recovery by parents or other relatives) often harbor a hateful dislike for those who they feel to be robbing them of their treasured emaciation. Often when well-meaning friends or relatives compliment the recoveree on how much healthier they look, the recoveree's mind replaces "healthy" with "fat."


Drug treatments, such as SSRI or other antidepressant medication, have not found to be generally effective for either treating anorexia, or preventing relapse although it has also been noted that there is a lack of adequate research in this area. It is common, however, for antidepressants to be prescribed, often with the intent of trying to treat the associated anxiety and depression.


Bulimia nervosa

Bulimia nervosa involves at least two binges per week for an extended period of time. Episodes of binge eating are followed by purging, periods of fasting, or performance of strenuous exercise - indeed, "exercise bulimia," in which a person eats normally but then engages in strenuous exercise, is an inverse form of bulimia. People with binge eating disorder, by contrast, do not purge, fast or engage in strenuous exercise after binge eating. Additionally, people with bulimia are typically of normal weight or may be slightly overweight (the purging, etc., have little to no effect on the subject's body fat), whereas people with binge eating disorder are typically overweight or obese.


Treatment is most effective when it is implemented early on in the development of the disorder, and is usually very similar to that of anorexia nervosa. Unfortunately, since this disorder is often easier to hide and less physically noticeable, diagnosis and treatment often come when the disorder has already become a static part of the patient’s life. Historically, those with bulimia were often hospitalized to end the pattern and then released as soon as the symptoms had been relieved. However, this is now infrequently used, as this only addresses the surface of the problem, and soon after discharge the symptoms would often reappear as severe, if not worse, than when they had originally been.


Click to shut autism information fact sheet on eating and feeding issues

Click here for the full range of Asperger's and autism fact sheets at www.autism-help.org
Click here to read the Fussy eaters fact sheet
This autism fact sheet is licensed under the GNU Free Documentation. It is derivative of an autism-related articles at http://en.wikipedia.org

Parents of children with Autism or Asperger's syndrome may need a lot of support to help develop good eating and diet regimes for their child