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.

A day in the life of a pediatric psychologist who supports children with autism

As a pediatric psychologist, Dr. Jina Jang spends her work days supporting children who are receiving care at the Thompson Autism Center at CHOC, a centralized place for children to receive early diagnosis, advanced therapy and the possibility to reach their full potential.

Dr. Jina Jang, CHOC pediatric psychologist

Follow along for a day in the life of Dr. Jang

6:45 a.m. – If my alarm goes off before my 2-year-old wakes me up, it’s a lucky day. I get ready, feed my dog, and ensure my kid’s bag is ready for daycare. I go over my daily schedule with my mother, who helps with daycare drop-offs. If I have time, I usually stop by a coffee shop to pick up some much-needed caffeine.

8:15 a.m. – I arrive at the Thompson Autism Center at CHOC before my first patient is scheduled and quickly check messages and emails. On days that I arrive a little earlier, I will usually sit for a few minutes to admire the beautiful artwork throughout the center. A bubble theme is woven throughout the center’s artwork, and CHOC’s mascot, Choco Bear, is even hiding in a few of the bubble images. This artwork was among the many special considerations made when the center was being built. The center is designed throughout to ensure sensory experiences and transitions, lighting, stimulation spaces, signage and artwork are best suited for people with autism spectrum disorder (ASD).

Dr. Jang enjoys admiring the artwork in the Thompson Autism Center at CHOC, which was designed throughout to ensure sensory experiences and transitions, lighting, stimulation spaces, signage and artwork are best suited for people with autism. | Photo taken before COVID-19.

8:30 a.m. – My first patient arrives for an in-person evaluation. Today, we have a patient who was referred by their pediatrician for an ASD evaluation. We had an intake session via telehealth yesterday. This is a new hybrid appointment model designed to help limit in-person contact as much as possible during the COVID-19 crisis, but ensure we still see patients who need in-person testing. This morning, we will conduct testing to assess the child’s overall developmental functioning. We will also assess for symptoms of ASD using standardized observation and interaction.

10:30 a.m. – I have a phone consultation with one of my patients’ applied behavior analysis (ABA) therapists. Children with ASD often have many different care providers and it is important for us to work closely with them to ensure collaborative care with continuity and compassion.

11:30 a.m. – I conduct a therapy session via telehealth with a patient as part of the center’s co-occurring conditions program.  Children with ASD often have other medical conditions as well, and this program helps patients get all the care they need in one visit.  I am co-treating this patient with Dr. Jonathan Megerian, a pediatric neurologist and the Center’s medical director. Having all providers at one visit not only reduces the amount of stress and other barriers for our patients,  but it also allows us providers to map out the best treatment plan for our patients.

At the Thompson Autism Center at CHOC, children with co-occurring conditions may be seen by pediatric specialists and psychologists to help treat their ASD and other underlying conditions. Seeing all providers at one visit can not only reduce the amount of stress on the family, but it also allows providers to talk together and map out the best treatment plan for a child. | Photo taken before COVID-19.

12:30 p.m. – Time for lunch! Before the pandemic, I would go out to lunch with my colleagues or pick up takeout for us to eat together. These days, I usually just eat alone in my office. Dr. Megerian is usually my lunch buddy. He is not only a great mentor but a fun friend. He has guided our team every step of the way, providing invaluable guidance and advice. I feel truly blessed to have such an amazing work family. Although we can’t share a meal in the same room due to physical distancing precautions, we still try to get lunch together. Today, he picked us up chicken sandwiches from a restaurant next door.

1 p.m. – When I have some time between appointments, I catch up on notes and review reports from my psychology trainees to provide feedback. The trainees are pursuing post-doctoral fellowships and honing their training and education to work with children with ASD in the future.

1:30 p.m. – I have a meeting with the team. Today, we evaluated our current assessment flow with the entire team, including our wonderful medical assistants, nurses, resource specialists and social workers. As a new center, it is important for us to continuously evaluate our clinic flows and assess what is working and what needs to change. Also, I am in communication with the entire team, which also includes other psychologists and financial coordinators, all throughout the day.

The Thompson Autism Center at CHOC’s highly trained clinical team includes pediatric neurologists, psychiatrists, psychologists, developmental behavior pediatricians, occupational therapists, speech language pathologists, applied behavior analysis (ABA) therapists, child life specialists, social workers, nurses and more. | Photo taken before COVID-19.

2 p.m. – Now I’m meeting with our assessment team about the young patient I met with earlier today. After meeting with the psychology team, this patient and family also met with one of our developmental behavioral pediatricians and also had speech and occupational therapy evaluations. Our amazing child life specialist helped ease any fear or anxiety the child and family may have felt throughout their appointment. The purpose of this team meeting is to discuss test results and diagnostic impressions, and make recommendations as a multidisciplinary team.

2:30 p.m. – Next, we meet with the patient’s family to provide feedback. As a team, we typically provide feedback on the same day as assessment. This child received a diagnosis of autism and global developmental delay. It is never easy to be the first ones to tell a parent that their child has developmental delays. However, our goal is to provide families with comprehensive testing results and treatment recommendations without a delay. We understand that this new diagnosis may be overwhelming and stressful for our families. After a diagnosis, they get connected with our social workers and personal service coordinator to continue support with additional resources.

The Thompson Autism Center at CHOC offers a true family-centered approach. Support groups for parents, grandparents and siblings offer a place for families to support one another and learn everyday tips on how to juggle doctors, school, work and family life. | Photo taken before COVID-19.

3 p.m. – On to another therapy session.  Now, it’s a patient with ASD, attention deficit hyperactivity disorder, and sleep difficulties. For this patient, we created some tools and systems to help.

Many of our patients and families have experienced disruptions to their daily routines due to the COVID-19 pandemic. It’s crucial that we help families and children cope with disrupted routines; establish “new” routines; teach “new” norms like wearing masks and keeping distance; and teach families strategies to manage any increased challenging behaviors.

4 p.m. – My last session is a follow-up meeting with a patient with ASD who is also experiencing separation anxiety. We have been working on exposing the child to small, controlled moments of separation with hopes that will reduce anxiety over time.

4:30 p.m. – I have a one-on-one meeting with Matthew Lazari, the center’s executive director. My check-in meetings with Matt usually involve picking his innovative and smart brain to address any challenges we might have. Today, we talk about screening candidates for a new psychologist position.

5 p.m. – I send messages to patients through CHOC Link, a portal for CHOC patients and families to communicate with caregivers. I also check emails and check my schedule for tomorrow. With that, I say goodbye to my colleagues and head home to my family.

Can children outgrow autism?

A study recently published in the Journal of Child Neurology suggests that children may outgrow autism. We spoke to Dr. J. Thomas Megerian, pediatric neurologist and clinical director of the Thompson Autism Center at CHOC, about what parents should know about these findings.

What does this study’s findings mean for parents?

Many parents ask me, “Will my child outgrow autism?” and I always tell them that what we hope for is that with services and growth, the child will improve so much that after as little as a few years, they no longer meet the criteria for Autism Spectrum Disorder (ASD). Outgrowing the label may mean they have learned to compensate or overcome some challenges like socialization or repetitive movements. They may have little features left of ASD, and what symptoms they do have, may cease to interfere with their development or daily lives. When they have progressed to the point where they have outgrown the label, any remaining traits may be so small that only a parent would notice, but a new person who has just met the child wouldn’t pick up on anything.

However, I advise my patients’ parents that if and when their child outgrows the label of autism, they may still have other co-occurring issues like anxiety, attention deficit hyperactivity disorder (ADHD) or learning disabilities that require ongoing care.

So yes, indeed this study should give parents hope surrounding a child’s ability to outgrow the autism label, despite their other potential ongoing issues.

In some instances, schools may suggest a decrease in services because a child has improved and outgrown the label of autism. That same child may still be struggling with organization or learning certain subjects. Parents may be in a position to say that just because their child has outgrown the autism label doesn’t mean they do not have a need for additional support.

What does life look like for a child previously diagnosed with autism who is no longer on the spectrum?

Learning disabilities, obsessive compulsive disorder, and attention deficit disorder are common among children with ASD. Rates of other disorders are common among children with autism, including: gastrointestinal disorders, ear infections, seizures and anxiety. They may clear up later in life or become better managed, but they don’t necessarily go away at the same time as their autism label.

Residual symptoms of these co-occurring diagnoses may last into adulthood. For example, a child may outgrow their ASD label but still have anxiety that can be managed by cognitive behavioral therapy.

Why is early detection and early intervention of autism so important?

Early detection and intervention help many kids outgrow the autism label in the future due to improvements with socialization and repetitive behavior. It’s important for people to remember that just because they have lost the autism label, doesn’t mean they don’t have other diagnoses or disorders that may require ongoing treatment.

There’s no question that early intervention makes a big difference in helping kids with the potential to outgrow their ASD diagnoses achieve that milestone even sooner. The trajectory has changed for many of those kids.