Navigating Food Aversions

This weekend, Becca's godparents celebrated their 25th wedding anniversary, and they had a beautiful second wedding. Becca got all dolled up and went to the wedding reception, sat at the table, and danced on the dance floor. We were so proud of her.

When it came time for the dinner and our table was served, I went into Becca's bag and pulled out her pasta and she started to munch. One of the guests, let's call her Mary, asked me, "do you have to carry food around for her everywhere you go?"

"I do." I continued by explaining that Becca has a very limited palate. Her tastes dictate which restaurants I go to for family outings - and even then, I have to bring her food in a thermos with me in case she doesn't eat at the restaurant. She loves macaroni and cheese, but may not eat it at every restaurant due to differences in texture, shape, or style. So I can never be sure.

Mary looked at me and then asked, "she won't eat anything on this plate?" There was potato salad, and pork, and vegetables, rice, bread. "No," I answered. I continued to feed her the pasta from her thermos, and she was happily chowing down. After her food, she grabbed a cup with ice (a must anytime we go out to eat) and started to feel the ice and eat it. I explained to Mary that not only do I bring food everywhere, but that at home, I make two dinners - one for my husband and me, and the other for Becca. Most families with Autistic children will say the same - and if there are multiple Autistic individuals in the home, there may be even more dinners depending on the sensory and feeding needs of each individual. It's nothing to be sorry about. I am just providing what my child needs as any other mother would do - Autistic child or not.

Becca's limited palate is not unusual for people on the Autism spectrum. Studies show that over 70% of Autistic individuals have some sort of food aversion, defined as a strong dislike or repulsion from a particular food or foods. It often goes hand in hand with selective eating: only eating a certain selection of foods.

The most commonly reported reason for food aversion among Autistic young people is sensory sensitivity – an aversion to the texture, taste, sight, or smell of the food. Of these, aversion to the texture of the food seems most common.

Young Autistic people are often more sensitive to sensory experiences or process senses in a different way from other young people. Research has found that around 90% of Autistic people experience sensory symptoms, particularly related to smell and taste. These differences may cause strong aversions to certain foods so it feels hard or impossible to eat them.

Some people with sensory sensitivities may only eat starchy, bland, ‘beige’ foods such as potatoes, bread, and pasta. Other young people may only eat foods with little texture, such as pureed foods. Becca prefers saucy pastas without pieces, unless it's ground meat. So her food has to be prepared in a very specific way in order for us to be sure she will actually eat it.

Food aversions make feeding very tricky. The common wisdom among feeding for children is that the child will eat when he or she is hungry. Not so with an Autistic child. The other day, Becca was hungry and I made her a grilled cheese sandwich. I forgot to slice it down the middle as is my custom. She stared at the sandwich, which was intact, as if it were defective and just continued to look at it and cried in protest. When I realized the mistake that I had made, I cut her sandwich in half, and then she smiled and ate it.

Autistic individuals tend to thrive on routines. They might only want their food prepared in a very specific way, or only a specific brand, or a specific sauce, or will eat some foods only in some places. Deviations from the routine can inflict a considerable amount of distress and can lead to an Autistic meltdown.

Furthermore, food aversions can create situations where the individual avoids entire food groups, which can cause issues with nutrition. Becca eats very few kinds of foods, and will not touch fruits or vegetables, which is not ideal. So we have to find ways of getting her the nutrition she needs.

First, we make sure she has her multivitamin every day. The multivitamin is going to help ensure that she has the vitamins and minerals that she may not be getting from her food.

Secondly, we make small substitutions whenever we can. We swap ground beef for ground turkey or chicken. We puree vegetables and hide it in the pasta sauce. We boil chicken or vegetables to make broth which we then use to cook the pasta. We make fruit smoothies or popsicles. We do anything we can to fortify the food that we know she will eat. Of course, we continue to offer the fruit and the vegetables in the hopes that one day she will eat these, but in the meantime we do what we can to make her diet as healthy as possible given the challenges.

Third, we take her sensory sensitivities into consideration when we plate her food. She has issues with different textures mixed in the same bite. So if the pasta is mushy all of the elements on the plate have to also be mushy to increase the chances that she will eat it. If there is an element that is harder, I serve it separately.

Fourth, we allow Becca to eat in the way that she most feels comfortable. We encourage her to eat from the spoon, but if she is at home and free (as in, not in a restaurant or in public) and wants to eat with her hands, we allow her to do so. Her sensory needs sometimes make eating with utensils uncomfortable and she feels the need to feel her food in her fingers. Becca has sensory needs and if finger feeding helps give her the input she needs, then we feel it's okay to allow it once in a while. Of course, we encourage her to use the utensils (and she does most of the time), but we also don't want feeding to become such a structured activity that it becomes uncomfortable for her.

Fifth, we try to take opportunities to make meal times fun. This might include having Becca help with cooking the meal herself; she likes to be in the kitchen while I cook. So I might have her hold the pot, or add water, or stir the sauce, anything to help her feel included and to give her a sense of accomplishment. My favorite is that once the food is done, she will often scoop up the food and give it to Mommy or Papi to taste it right along with her!

Lastly, we do not force feed. We do not want to create a negative feeding experience. At every meal, we offer food we know she will eat so that she isn't hungry. As mentioned, we might hide the elements that we know she won't eat or try to offer new elements separately and leave them around in the hopes that one day she will be curious enough to try it.

We also keep Becca's therapists and medical team informed about her progress regarding feeding. In some cases, if food aversions are extreme, a child may need medical intervention to address it. In any case, food aversions are very common in Autistic individuals, and strategies that work for one person may not work for everyone. The important thing to understand is that this is not just a situation of a child being picky or wanting to eat snacks rather than food. This is not an issue that can be disciplined away by forcing a child to eat what the parent cooks. This is an issue that stems from the sensory needs of the child, and once we understand and accept this, we can work to make feeding a more pleasant experience for everyone.

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