Diet & nutrition

What you can do to help children

move on from this eating disorder
Children do not usually safe foods. The hidden lunch. They certainly
‘just grow out’ of foods will usually be cannot cope with
negative responses to noticed and trigger school dinners, and
food. If not addressed a disgust response. the packed lunches will
in childhood, the Mealtime arguments not include anything
disorder can persist should be avoided that looks like a fruit
into adulthood, whenever possible. or a vegetable. So
especially in those with It’s important ‘lunch shaming’ is a
ASD. Unfortunately, to understand why common report from
the disorder can often children are refusing parents; children have
be missed by health food in this extreme been known to refuse
professionals if the way. These children to take the foods they
child seems to be are not being naughty. can eat in their lunch
growing well and has Perhaps this is easier boxes because of
appropriate weight. for parents of children comments on how

For some children food

What their appearance with autism to accept ‘unhealthy’ these foods
masks is that they are than it is for parents of are. But children with

refusal isn’t just feeding only on their

‘safe’ foods.
neurotypical children
because they are more
this disorder have to be
able to eat ‘their’ foods

pickiness, it’s a medical Children can

increase the range of
used to coping with
‘desire for sameness’
to maintain weight gain.
Depending on

condition called foods they will accept,

but this depends on
and understanding
that this is part of the
the age of the child,
desensitization
Avoidant and the age of the child
and whether they are
child’s condition. programmes need
to be put in place.
Restrictive receptive to certain
types of intervention.
‘Healthy’ eating
However, one thing
Health professionals
who might help
Food Intake To some extent it is that is difficult for all would be speech-and-
more important in the parents is to educate language therapists
Disorder. early years to know professionals they who specialise in
what not to do rather meet along the way. dysphagia (swallowing
Dr Gillian than what to do. For One particular difficulty difficulties);
example, because is that of schools’ occupational
Greville-Harris children with this ‘healthy eating’ therapists; and

offers advice
disorder are very aware programmes. A child psychologists who
of changes in the with ARFID might specialise in this type

Fear of food
appearance or taste of only be able to accept of eating disorder.
their known foods, it is biscuits, crisps and For older children,
never a good idea to try possibly some bread, a specific reward-
and ‘hide and disguise’ if parents are lucky, to based or cognitive
healthy foods in their include in their packed programme might help.

Nearly half of all children on the
autism spectrum are reported by
their parents to have a problem
with food acceptance. Usually,
their child will only eat a limited
range of foods.
This sometimes starts in
Dr Gillian Greville- infancy with the introduction of
Harris is a consultant solid first foods. In these early
clinical psychologist years the child will develop an
at the Birmingham idea of which foods they like, and
Food Refusal Service, which tastes and textures they
www.foodrefusal.co.uk can handle.
The feel of solid foods in the
mouth, or the need to touch
foods, can be difficult for some
children. It could even be that the
child has never managed to move
on to solid food at all, but will only
take milk from a bottle, or puréed
or smooth foods such as yoghurt.
New food rejection
For other children the problem
might not start until later. They
might refuse more and more
foods as they go into a period of
new food rejection (neophobia).
This is common in any child at
around the age of two years.
This stage of rejection, the
food neophobia stage, is a time
when most children will refuse
new foods, as well as foods that
Some children
develop a
pattern of eating
that is typified by
disgust and anxiety
around foods”
they have accepted before. As
each new food is rejected, and
foods that were eaten in the past
are pushed away, the dietary
range of these children can
become very narrow. This has an
Don’t want it: if impact on the child’s health and
food rejection on social functioning, especially
is more than a at meal times.
passing phase Most children move out of this
and is actually stage, usually by the age of five
a medical years or so, and will once again
disorder, you agree to try new foods. Some
should seek children, however, fail to move
professional on. They develop a pattern of
help to handle it eating that is typified by disgust
and anxiety around foods.
Disgust response
These children will only accept a
limited range of ‘safe’ foods. Any
other foods trigger a disgust
response, a reaction that can
One particular
difficulty is that
of schools’ ‘healthy
eating’ programmes”
reflect a real fear of food and of
being anywhere where new foods
might be offered. This response to
food is now medically recognised as
Avoidant and Restrictive Food
Intake Disorder (ARFID)1.
Based on our clinical
experience, children who would
receive a diagnosis of ARFID
display these behaviours:
l A diet made up of very few
foods – often only 5-10 items,
usually dry, beige carbohydrates.
l An extreme fear of new foods
(the neophobic response). These
children will show an enhanced
disgust response to foods and
will be unable to even put them in
the mouth.
l Foods are refused because of
their sensory properties. This may
include the look, taste, feel in the
mouth and smell of food. This fear
can be so extreme that they will
gag or vomit when presented with
food they cannot eat.

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Specialist autism support
It is never a
good idea to
We support over 720 autistic people in the
try and ‘hide and
UK and have 37 specialist autism services
that are either accredited or working towards disguise’ healthy foods
accreditation with the National Autistic in their safe foods”
Society.
l The child is likely to feel very
anxious about situations involving
We can support you in many ways, such as
food. They often have general
at home, going out, finding education or anxiety and are fearful of change.
employment. l The restricted diet may lead to
problems with the child’s ability to
cope with school mealtimes.
l The child will often eat specific
to context – in other words, only
eating certain foods in certain
places. They might eat sausages
Enquire today REFERENCE
at school, but will not eat the
same sausages at home.
1
American Psychiatric Association (2013): Diagnostic l The child might not seem
0800 0353 776 referrals@voyagecare.com www.voyagecare.com and Statistical Manual on Mental Disorders (5th Edition, interested in eating. Parents often
Arlington, VA: America Psychiatric Publishing. report that a child never seems
Diet & nutrition
hungry, doesn’t seek out food, and
goes for long periods without
eating. The child might fail to gain
weight as expected. This is more
likely if the child does not have
access to preferred or ‘safe’ foods.
A limited diet can, in some
children, lead to nutritional
deficiencies. Surprisingly,
though, this isn’t often the case.
Where there is a deficiency, iron-
deficient anaemia is one of the
most likely consequences.
This disorder is seen more often
in boys than girls because it is
linked to the extreme sensory
problems that are often associated
with ASD.
Adapted from Food Refusal and
Avoidant Eating in Children,
including those with Autism
Spectrum Conditions by Gillian
Harris and Elizabeth Shea.
Jessica Kingsley Publishers,
£16.99/$24.95 paperback

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