Reposting Lindsey Biel's Autism Digest article

Autism Asperger’s Digest March-April 2011 issue
Column: Sensory Smarts www.autismdigest.com
Happy Mouths, Happy Meals


Sensory Problems Usually Are the Problem with Difficult Eaters
Dear Sensory Smarts,
My five-year-old is such a picky eater! There are only a few foods she’ll eat: pasta, pizza, and ice cream. She wants to eat macaroni n’ cheese almost every meal, but it has to be one particular brand. If the store is out, she will not eat another brand. My parents and in-laws think it’s because I spoil her. They all say I should serve her what everyone else is having and if she doesn’t eat, then tough. I did try it once and she simply did not eat. Help!
From,
Mac n’ Cheese Maven’s Mom

Dear Maven’s Mom,
Kids with oral sensory issues and food aversions will not eat foods they find repulsive and may wind up with nutritional deficiencies. Your child did not become an extremely selective eater because of something you did. It may help to consider the underlying factors that may be impacting your child’s inability to tolerate a wider variety of foods.

Oral Sensory Problems
Kids with sensory challenges, especially those on the autism spectrum, often have sensory issues in and around the mouth. Remember that the lips, tongue, inside cheeks, and throat are lined with skin. A child may be exquisitely sensitive to textures, and unable to tolerate foods that are lumpy, slippery, chewy, crunchy, or a combination of textures, like yogurt with granola. Some kids are particular about flavors, and may only eat foods that are bland, sweet, or even highly spiced. Some kids are particular about temperatures and insist on or refuse foods that are cold, hot, or lukewarm. Some kids stuff their mouths to feel there’s something in there. Other kids object to the way food looks or when items touch each other on a plate.

Some problem feeders have oral-motor weakness, and lack strength and stability in the lips, tongue, and jaw for nursing and later for eating solid foods. Jaw weakness makes chewing difficult while tongue weakness makes it hard to form a bolus (round food mass) to swallow. High or low muscle tone in the mouth can also be an issue. A child may have a hyperactive gag reflex and avoids eating and gagging. At its most extreme, a child may throw up when an offending food is tasted, smelled, or simply mentioned.

Most kids on the spectrum crave predictability. Your daughter may insist on exactly the same brand of mac n’ cheese cooked exactly the same way as a form of control in a world that sometimes feels out of control. If she has successfully eaten that one type of mac n’ cheese in the past, it’s got to be the very same kind in the future.

It sounds like your daughter sticks to “the white diet,” consisting of carbs and cheese, a common diet among kids with sensory issues. These foods are relatively soft and have an easy “mouth feel.” Unfortunately, these foods consist of gluten and dairy, which many kids with autism do
not tolerate well. Gluten is the main protein in wheat and other grains and casein is a protein in cheese and other dairy products. The theory is that these proteins trigger immune responses in some kids, resulting in a pleasurable, druglike response. Gluten and casein sensitivities are worth exploring with a nutritionist or allergist.

When a child has a significantly limited food repertoire, do not withhold the few foods that are acceptable. If you take away that one brand of mac n’ cheese, you’re taking away one of the few sources of nutrition for your child, even if it is a poor one. Pizza can be healthy if you buy or make it with high-quality ingredients.

I start by identifying one food the parent would like to add to a child’s diet, typically a fruit or vegetable. If possible, the child selects the particular fruit or vegetable.
Find more on eating difficulties and other sensory challenges in Raising a Sensory Smart Child and at sensorysmarts.com. You may also want to check out these books: Just Take a Bite (by Lori Ernsperger, available in bookstores and online) and Happy Mealtimes with Happy Kids (by Melanie Potock, available at MyMunchBug.com).

Got a question? I’d love to hear from you. Please email questions to Lindsey@sensorysmarts.com.