5 strategies to help children with autism and feeding difficulties

By Amanda Regan, CHOC clinical dietitian

Picky eating is something often seen in children as they grow and explore new foods, but research shows that children with Autism Spectrum Disorder (ASD) can be five times more likely to develop feeding difficulties. This is often caused by sensory processing difficulties, which can cause a child to be sensitive to different tastes, textures, smells, appearances and even temperatures of food. Many children with ASD also tend to prefer foods that are processed and high in carbohydrates, rather than fruits and vegetables. Kids with ASD may also have a hard time focusing during mealtimes, causing them to consume inadequate amounts of calories and nutrients.

Managing these types of feeding difficulties can feel overwhelming for any parent. However, it is important to stay calm and make sure mealtimes don’t turn into a battle ground. If you have a child or loved one with ASD, here are some strategies that you can use.

Rule out medical problems

Sometimes children may refuse foods because they’re struggling with another condition, such as food allergies or constipation. If your child has extreme food selectivity, it is important to seek advice from your pediatrician to rule out any other medical conditions. Your pediatrician can also help refer you to any other services your child may need, such as feeding therapy, a GI specialist, or a dietitian.

Take small steps

Taking baby steps to introducing new foods can make a huge difference. You can start this by familiarizing your child with new foods even outside the kitchen. Try teaching your child about the new food or go to the grocery store together to buy it. Later, you can start to ask your child to take small steps to eating it by smelling, licking, touching and finally tasting the food.

Expose and repeat

Remember, sometimes it can take 15 to 20 times before any child accepts a new food. If your child consistently refuses a new food, try to serve it in a different way. It’s also important to remember that sometimes kids just simply don’t like a certain food. If your child continues to reject a food after 15 to 20 exposure times, don’t be discouraged, and move on to offering a new food.

Something old and something new

When introducing new foods, pair them with other foods your child already enjoys. This can help your child to feel more comfortable during the meal. Your child may also want some sense of control when it comes to choosing foods. Try to allow some options, such as letting them pick which veggie they want to try, or which preferred food they want to pair with the new food.

Minimize pressure

Adding pressure to eating or force feeding can make mealtimes even more stressful for you and your child. Try to maintain a positive atmosphere during meals. Children with ASD may need extra time to expand their diet variety. This means it is important to be patient and allow your child to take bites of new foods at their own pace.

Explore autism resources at CHOC.

Celebrate National Nutrition Month: Personalize your plate

By Sabrina Chen, CHOC dietetic technician, registered

MyPlate has been widely used to give a visual representation of how much we should eat of each food group. It’s important to jazz up our diets and personalize our plates to our lifestyles, personal tastes and goals. Each year, the Academy of Nutrition and Dietetics celebrates National Nutrition Month. This year’s focus is on personalizing your plate. Take this month as a time to reflect on your personal goals to reach a healthy lifestyle.

Food is a wonderful way to bring people together and showcase different foods of various backgrounds and cultures. Don’t be afraid to try different cuisines you are unfamiliar with — you never know what your new favorite meal might be! You can also experiment with different ways of cooking to switch up the flavor or even save time.

Implementing healthy nutrition habits doesn’t have to be boring or repetitive. Try incorporating a new vegetable every week or switching up your protein from animal sources to non-animal sources such as tofu or lentils. Plan your meals ahead of time with a variety of nutritious foods every day.

Here are a few ideas that might help you personalize your plate and incorporate new-to-you foods:

  • Whole grains: Chapatti, tortillas, buckwheat noodles, wild rice
  • Vegetables: Bok choy, napa cabbage, okra, daikon radish
  • Fruits: Kumquats, papaya, Korean pears, dates
  • Dairy: Fortified soy milk, low fat cottage cheese, fresh cheeses
  • Proteins: Fish, adzuki beans, tofu, lentils
  • Healthy fats: sesame seeds, macadamia nuts, walnuts and avocado oils.

“There is no one-size-fits-all approach to nutrition and health” as said by the Academy of Nutrition and Dietetics. The recommended serving size of each food group can vary depending on various factors like age, gender and activity level. What works for other people, may not work for you. You can receive personal nutrition advice from a registered dietitian or dietetic technician, who can also provide tips on following a healthy diet.

To help get you started on diversifying the food on your plate, here is a delicious recipe for Japanese-inspired sesame soba noodles.

Japanese-inspired sesame soba noodles

Ingredients

Sesame dressing

  • ¼ cup rice vinegar
  • 2 tablespoons tamari, more for serving
  • ½ teaspoon toasted sesame oil
  • 1 teaspoon grated ginger
  • 1 garlic clove, grated
  • ½ teaspoon honey

Soba noodles

  • 6 ounces soba noodles
  • Sesame oil, for drizzling
  • 2 avocados, sliced
  • Squeezes of lemon
  • 2 cups blanched snap peas
  • ¼ cup edamame
  • 1 watermelon radish or 2 red radishes, very thinly sliced
  • 1/4 cup fresh mint leaves
  • Sesame seeds

Instructions

  1. Make the dressing: In a small bowl, combine the vinegar, tamari, sesame oil, ginger, garlic and honey. Set aside.
  2. Bring an unsalted pot of water to a boil and cook the soba noodles according to package directions. Drain and rinse well in cold water. This helps to remove starches that cause clumping. Toss the noodles with the dressing and divide into two to four bowls. Squeeze fresh lemon juice onto the avocado slices and add to the bowls along with the snap peas, edamame, radish, mint, and sprinkle with sesame seeds. Drizzle with more tamari or sesame oil, if desired.

Fueling your body for the virtual CHOC Walk

By Emilee Ten Eyck, clinical dietitian at CHOC

In light of the COVID-19 pandemic, this year’s  CHOC Walk in the Park has adapted by becoming a virtual event. The beloved community event, now in its third decade raising much-needed funds for CHOC, will be reimagined. Virtual fundraising efforts culminate in a virtual celebration, after which, supporters are invited to take a safe walk in their communities.

In order to prepare our bodies for physical activity, it’s essential we we have adequate nutrition and hydration. Here are a couple of tips for families to ensure their bodies will be fueled and ready for the walk:

1. Drink water throughout the walk

Our bodies are made up of water and it’s one essential part of any diet. When we don’t drink enough water, our body cannot function as well as it normally does, and we become dehydrated. CHOC recommends children drink the number equal to their age of eight-ounce cups. An example would be a 5-year-old should drink five 8-ounce cups every day. For children over the age of 8 years old, it is recommended that they drink 64 ounces of water every day. During physical activity, the body requires more water due to the body heating up.

2. Water is the most appropriate drink for hydration during the walk; sports drinks may not be needed

Most children only need water for hydration during exercise. It is recommended that water be the drink of choice for high intensity exercise lasting less than one hour or casual physical activity. If plain water doesn’t seem as appealing to drink, you can always add crushed fruit or herbs to give different flavors.

Some fun combinations to try are:

  • Berry Mania (strawberries, blueberries and raspberries)
  • Strawberry and Mint
  • Tropical Splash (pineapple and orange)
  • Citrus Explosion (orange and lemon)

3. If you are going to eat one to two hours before the walk, try to pick foods that are easily digestible.

Eating too large or too heavy of a meal will cause an upset stomach if you work out afterwards. Try to pick foods that are easily absorbed in the body and will not weigh you down. Some examples of good pre-walk foods are fresh or dried fruits, oatmeal, trail mix or whole grain cereal and low-fat milk.

You can always make your own trail mix to prepare for the CHOC Walk by mixing different nuts, seeds, cereals, dried fruit and other items. Here are some examples of family-friendly trail mixes:

  • Tropical — dried pineapple, cashews, dried coconut, banana chips and pretzels
  • Sweet and Salty — popcorn, peanuts, raisins, dried fruit, almonds, sunflower seeds and chocolate candies

4. If walking for more than 90 minutes, bring a small snack to eat during the walk.

After 90 minutes of exercise, your body would benefit from a small snack of fruit, vegetables, trail mix or a granola bar to keep your energy level up.

 5. Have a balanced meal post-walk

The meal after completing the CHOC Walk is just as important as preparing for the walk. Your body needs a balance of nutrients to recover from exercise. It is recommended to have a low-fat protein source (chicken, salmon, eggs or lean meats), a source of grains (brown rice, pasta, whole-grain bread), fruits and vegetables after working out. Protein is important for the body to build and maintain muscle mass.

Fiber for kids: High fiber recipes for kids

By Christina Sharkey, clinical dietitian at CHOC

Adequate and proper nutrition is important for a child’s normal growth and development and since January is National Fiber Focus month, this is a great time to make sure that you and your family are getting enough fiber in your diet. Fiber is a beneficial part of our diet because it helps keep us full longer, control blood sugar levels, reduce cholesterol and promotes regular bowel movements.

Incorporating fiber in your child’s diet: How much fiber does your child need?

Here’s how much fiber your children should be eating every day:

AgeMaleFemale
1-3 years14 grams14 grams
4-8 years19.6 grams16.8 grams
9-13 years25.2 grams22.4 grams
14-18 years30.8 grams25.2 grams

Source: The Institute of Medicine, based on 14gm/1000 calories/day (for age)

High-fiber foods for kids

As a parent, you may be concerned that your child isn’t getting enough fiber. Offering foods that are naturally high in fiber makes it easy to reach the recommended intakes.

Foods that are naturally high in fiber include:

  • fruits
  • vegetables
  • whole grains
  • legumes

High-fiber snacks for kids

Some examples of snacks and other foods that are high in fiber include:

Grains

FoodServingAmount of fiber
Cooked oatmeal1 cup4 grams
Cooked brown rice1 cup3 grams, vs. just 0.7 grams in white rice
Cooked whole wheat pasta1 cup5.5 grams, vs. just 2.5 grams in regular pasta
Air popped popcorn3 cups3.5 grams

Legumes and Nuts

FoodServingAmount of fiber
Cooked kidney beans, lentils or black beans½ cup6.5-7.5 grams
Cooked edamame½ cup4 grams
Almonds1 ounce3 grams

Vegetables

FoodServingAmount of fiber
Cooked broccoli1 cup4 grams
Avocado½ of a piece5 grams
Raw jicama½ cup3 grams

Fruit

FoodServingAmount of fiber
Raw raspberries or blackberries½ cup4 grams
Raw pear1 piece5.5 grams
Raw orange1 piece3.7 grams
Raw banana1 piece3.3 grams
Raw medium apple1 piece4.8 grams

Source: U.S. Department of Agriculture

How to increase fiber in your child’s diet

If you’re looking for more ways to increase the amount of fiber in your child’s diet, here are some tips:

  • Leave the skins on fruits and vegetables.
  • Use whole wheat flour in place of white flour.
  • Replace white bread and cereals with whole grain options. Look for whole wheat, rye, oats or bran on the ingredient list.
  • Add fruit to whole grain cold or hot cereals.
  • Add fruit, nuts or whole grain granola to yogurt.
  • Add vegetables to scrambled eggs, omelets or pasta.
  • Aim to offer whole grains that have at least 3 grams of fiber per serving.
  • Foods that are labeled as a “good source of fiber” have at least 2.5 grams of fiber per serving. If you’re not sure how to read nutrition labels in the products you buy, check out this guide.
  • Choose whole fruit instead of juice.
  • Include fruit and vegetables with every meal. Aim for 5 or more servings of fruits and vegetables a day.
  • Put veggies, like lettuce, tomato or avocado, on sandwiches.
  • Add beans to soups and salads.
  • Add bran to baked goods.
  • Offer air-popped popcorn, whole-grain crackers, fruit, or vegetables as healthy snack options.

High-fiber recipes for kids

Besides just adding fruits and vegetables to your meals and snacks, consider trying these fun high-fiber snacks and recipe ideas. Many of these can be made in advance for busy days.

Chia Pudding

Yield: 4 servings

Fiber: 6 grams/serving

Ingredients:
  • 1 cup of vanilla-flavored unsweetened almond milk
  • 1 cup of plain low-fat Greek yogurt
  • 2 tablespoons pure maple syrup, plus optional 4 teaspoons for serving
  • 1 teaspoon pure vanilla extract
  • Kosher salt
  • ¼ cup Chia seeds
  • 1-pint strawberries, hulled and chopped
  • ¼ cup sliced almonds, toasted
Directions:
  1. In a medium bowl, gently whist the almond milk, yogurt, 2 tablespoons maple syrup, the vanilla, and 1/8 teaspoon of salt until just blended. Whisk in the chia seeds; let stand 30 minutes. Stir to distribute the seeds if they have settled. Cover and refrigerate overnight.
  2. The next day, in a medium bowl, toss the berries with the remaining 4 teaspoons of maple syrup. Mix in the almonds.
  3. Spoon the pudding into four bowls or glasses; mound the berry mixture on top and serve.

Recipe via Food Network

Blueberry Morning Glory Baked Oatmeal

This baked oatmeal recipe includes lots of fiber and can be made in advance for busy mornings!

Yield: 1 pan (6 servings)

Fiber: 6 grams/serving

Ingredients:
  • 2 cups old-fashioned rolled oats
  • 1/3 cup unsweetened shredded coconut
  • 1 medium apple, grated
  • 1 medium carrot, grated
  • 1 teaspoon ground cinnamon
  • 1 teaspoon baking powder
  • 1/4 teaspoon salt
  • 2 cups milk of your choice (I used almond milk)
  • 1/4 cup pure maple syrup
  • 1 egg
  • 1 teaspoon pure vanilla extract
  • 1 cup fresh blueberries, divided. If using frozen berries thaw them slightly.
  • 1/4 cup pecan pieces for topping, optional
  • 1/3 cup coconut flakes for topping, optional
Directions:
  1. Preheat the oven to 375 degrees Fahrenheit. Grease an 8×8 – inch baking dish with cooking spray.
  2. In a medium bowl, combine the oats, coconut, apple, carrot, baking powder, cinnamon and salt. Set aside.
  3. Whisk together the milk, maple syrup, egg and vanilla in a small bowl. Set aside.
  4. Arrange 1/2 cup of the blueberries along the bottom of the baking dish. Pour the oat mixture over the top of the blueberries evenly. Pour the milk mixture over the top of the oat mixture as evenly as possible. Tap the baking dish on the counter a couple of times to evenly distribute.
  5. Top the oatmeal with the pecans, remaining blueberries and coconut flakes.
  6. Bake 35-45 minutes or until golden brown and set. Cool on a wire rack and serve.

Recipe courtesy of Flavor the Moments

Roasted Chickpeas

If you are looking for something crunchy, a great high fiber snack is roasted chickpeas. Adding different flavorings can add some variety, and this is a great way to replace chips.

Yield: 6 servings

Fiber: 6.5 grams/serving

Ingredients:
Chickpeas:
  • Three 15-ounce cans of chickpeas
  • 3 tablespoons vegetable oil (I use avocado oil)
Taco Seasoning:
  • 3/4 teaspoon chili powder
  • 1/4 teaspoon ground coriander
  • 1/4 teaspoon ground cumin
  • 1/4 teaspoon granulated garlic
  • 1/4 teaspoon granulated onion
  • Kosher salt
Vinegar-Lime Seasoning:
  • 2 teaspoons distilled vinegar
  • Zest of 1 lime
  • Kosher salt
Onion-Garlic Seasoning:
  • 1 teaspoon granulated garlic
  • 1 teaspoon granulated onion
  • Kosher salt
Directions:
  1. Preheat the oven to 400 degrees Fahrenheit.
  2. Put a few layers of paper towels on your work surface. Strain and rinse the chickpeas in a strainer, then shake off as much water as possible. Transfer them to the layer of paper towels, top with more paper towels and pat them gently and roll them around a bit to dry. Discard any papery skins that have peeled off or are about to peel off. Slide the chickpeas onto a large, rimmed baking sheet and let stand at room temperature for at least 30 minutes.
  3. Roast the chickpeas, stirring them occasionally to keep them from burning in spots, until a little shriveled and crispy, about 45 minutes. Start checking them at around 35 minutes to make sure they are not burning.
  4. Meanwhile, make the seasoning mixes. For the Taco Seasoning: Mix the chili powder, coriander, cumin, granulated garlic and onion and 1/2 teaspoon salt in a small bowl.
  5. For the Vinegar-Lime Seasoning: Mix the vinegar, lime zest and 1/2 teaspoon salt in a small bowl.
  6. For the Onion-Garlic Seasoning: Mix the granulated garlic and onion and 1/2 teaspoon salt in a small bowl.
  7. When the chickpeas are done, divide them evenly among three medium bowls. Toss each batch with 1 tablespoon of the oil, then toss 1 batch with each of the seasoning mixes.
  8. Return the chickpeas to the baking sheet, keeping each batch separate. Roast them for three minutes, just to cook the seasonings slightly. Let cool completely on the pan on a rack, about 30 minutes, then transfer to airtight containers. The chickpeas will keep for one day and will soften slightly as they sit.

Recipe courtesy of Food Network

Hearty Navy Bean Soup with Ham

This homemade soup recipe, from my own grandmother, has a hearty amount of fiber. Pairing this with warm whole-wheat bread and roasted carrots is perfect.

Yields: 6 Servings

Fiber: 8 grams/serving

Ingredients:
  • ½ pound navy beans, washed well
  • Ham bone and any small bits of leftover ham
  • 1 medium yellow onion chopped and sautéed in 2 tablespoons olive oil
  • ¾ cup shredded raw russet potatoes
  • ¾ cup chopped celery and ¼ cup chopped celery leaves
  • About 2 teaspoons of salt, depending on amount of ham used
  • ¼ teaspoons ground black pepper
  • ½ cup drained tomatoes (fresh or canned) cut into medium size pieces
  • ½ cup fresh green onion tops

*Note: the tomatoes and scallions may be omitted, but they help add some color and vegetables to the soup!

Directions:
  1. Soak the navy beans with 6 cups of warm water. Let stand overnight.
  2. The next day, pour beans and water in which they were soaked into a large pot. Add more water if needed to cover the ham bone.
  3. Combine all ingredients except for tomatoes and green onion tops.
  4. Cook soup in a covered pot over low heat for about 1.5-2 hours or until the beans are very soft.
  5. If using a ham bone, pull out bone and allow to cool briefly before removing any remaining ham bits and cutting into bite size pieces. Add the ham back to the soup and discard the bone.
  6. During last 10 minutes of cooking, add tomatoes and green onions and cook slowly uncovered.
  7. When done, taste, and season further if necessary.
  8. If soup appears thick, add a little water or stock of your choice. If soup appears thin, cook uncovered for a few minutes.

Recipe courtesy of CHOC dietitian Christina Sharkey’s grandmother

Sweet Potato and Black Bean Tacos

Try a twist on tacos by swapping your typical meat for a plant-based protein that is high in fiber.

Yield: 4-6 servings

Fiber: 7-10 grams/serving

Ingredients:
Roasted Sweet Potatoes:
  • 1-2 medium sweet potatoes, cut into ½-inch cubes (~2 cups cubed)
  • 2 tablespoons avocado oil
  • ½ teaspoon kosher salt
  • 1 teaspoon chili powder
  • ½ teaspoon ground cumin
Beans:
  • 2 tablespoons avocado oil
  • ½ medium yellow onion, diced
  • ½ teaspoon kosher salt, plus more to taste
  • 1 clove garlic, minced
  • 1 jalapeno, stemmed, seeded and minced
  • 1 15-ounce can low sodium black beans, drained and rinsed
  • Apple cider vinegar or water, as needed
Serve with:
  • 10-12 tortillas
  • ½ cup tomatillo salsa verde
  • Fresh cilantro
  • Lime wedges
  • ¼ cup crumbled cotija cheese (can substitute with parmesan or feta cheese)
Directions:
  1. Heat oven to 425 degrees Fahrenheit.
  2. In a medium bowl, toss the sweet potatoes, 2 tablespoons oil, salt, cumin and chili powder. Spread on a baking sheet in an even layer. Roast for 15 minutes, then use a spatula to flip the potatoes over. Roast for another 15 minutes or until sweet potatoes and have puffed up and have crisp, roasted edges.
  3. While the sweet potatoes are roasting, heat 2 tablespoons of oil in a medium pan over medium heat. Add the onions and ½ teaspoon salt and sauté until soft and translucent, about 5-7 minutes. Add the garlic and jalapeno, and sauté for 2 more minutes. Fold in the beans and cook. Stir occasionally until the beans are soft and seasoned, about 10-15 minutes. If beans seem dry or bottom of pan starts to sizzle, add a splash of apple cider vinegar or water as needed. Taste and season as needed.
  4. Warm the tortillas.
  5. Serve the tacos. Layer the tacos with sweet potatoes and black beans. Serve with avocado slices, minced cilantro and cheese.

Recipe courtesy of Simply Recipes

Healthy snack ideas for the whole family

By Kelsey Childs, clinical dietitian at CHOC

Does it seem like your children are snacking all the time? Do you find yourself snacking more during the pandemic as you work from home during COVID-19? You are not alone. With families spending more time than ever at home during the pandemic, many people have noticed an uptick in snacking.

Snacks aren’t always a bad thing

Snacks play an important role in the diets of growing children. Snacks provide energy to sustain children between mealtimes. According to research, snacks may provide around 30% of a child’s daily caloric intake. In general, children should consume three meals per day and up to two or three snacks per day. However, if children are consuming more than three snacks per day, or if they are snacking multiple times between meals, this can lead to reduced appetite and intake at mealtimes.

Many snack foods advertised toward children are high in sugar and low in fiber and protein. Without fiber and protein, these snacks may not keep children full and satisfied until the next mealtime, which can lead to even more snacking.

If you’re looking for new ideas for healthy snacks that are great options for the whole family, here are some important health benefits to keep in mind and my favorite healthy snack ideas. And if you’re looking to get kids involved in the kitchen, here’s some tips.

Look for snacks that are good sources of protein, including:

  • Greek yogurt
  • Hummus
  • Nuts or nut butter (peanut butter, almond butter, sunflower seed butter, etc.)
  • Eggs
  • Cheese
  • Milk
  • Turkey or ham slices

It’s also important to offer snacks that are great sources of fiber, including:

  • Fruits —apples, bananas, berries, pineapple, peaches, pears, oranges, grapes, melon, etc.
  • Vegetables —carrots, cucumbers, bell peppers, broccoli, zucchini, celery, etc.
  • Whole grains —whole-wheat bread, whole grain crackers, whole grain cereal, etc.

To provide a healthy, satisfying snack, aim to include a source of protein and fiber at each snack opportunity. Below are healthy snack ideas that are rich in protein and fiber:

  • Veggie sticks with hummus
  • Whole wheat pita bread slices with hummus
  • Banana topped with nut butter
  • Greek yogurt served with fruit
  • Cottage cheese topped with fruit or tomato slices
  • String cheese and strawberries
  • Apple slices served with a hard-boiled egg or a small handful of nuts
  • Cooked egg with a side of fruit
  • Whole grain crackers topped with turkey slices
  • Smoothie made from Greek yogurt, milk, frozen fruit and spinach leaves