Picky Eating and Feeding Difficulties

In Chapter 28 we looked at nutrition in general terms. In this chapter, we'll focus specifically on picky eating -- what's behind it and how to approach it in practical ways.

What Lies Behind Picky Eating?

Picky eating is often misread as "being fussy." In reality, for children with autism, this behavior usually stems from a genuine difference in how they experience the senses (see Chapter 8). The way a certain texture feels in the mouth, the intensity of a smell, or a color that simply looks "wrong" can be a real and powerful source of discomfort for these children. On top of that, insistence on sameness (Chapter 7) can create strong resistance when a particular brand, package, or way of serving food changes.

The Gradual Exposure Approach

Forcing, threatening, or leaning on rewards and punishments usually doesn't work with picky eating, and it turns mealtimes into a source of tension for everyone. Instead, occupational therapists and dietitians recommend a "gradual exposure" approach: a new food is first simply placed on the plate (with no pressure to eat it), then introduced step by step -- touching it, smelling it, bringing it to the lips, taking a tiny bite. This process can take weeks, or even months.

Info Box -- The "Food Bridges" Strategy

Using a food your child already accepts (say, a particular brand of crackers) as a "bridge" to a new food with a similar texture, color, or taste is an effective way to slowly widen the range of foods they'll eat. For example, a child who loves french fries might be introduced to a steamed carrot stick that has a similar shape and texture.

Setting Up Mealtimes for the Senses

The sensory environment at the table -- noise level, how strong the smells are, the lighting -- can also affect a child's willingness to eat. Turning mealtime into a calm, predictable routine, using a visual meal schedule, and letting your child choose their own plate or fork (which gives them a sense of control) can all improve cooperation.

When to Seek Advice

If your child's range of accepted foods is fewer than 5 to 10, if their growth curve is dropping off, or if they completely avoid entire food groups (all vegetables, for instance, or all proteins), ask for a referral to a pediatric feeding specialist (dietitian). This situation calls for professional support to prevent long-term nutritional deficiencies.