Autism and Picky Eating

What Distinguishes Developmentally Appropriate Picky Eating from Pediatric Feeding Disorders?

Every parent knows that mealtimes with young children can present challenges. Refusals to eat certain foods, complaints about textures, and demands for favorite meals are often chalked up to “picky eating.” However, there’s an important difference between what’s considered typical picky eating in childhood and what constitutes a pediatric feeding disorder—especially in the context of children with autism.

Developmentally Appropriate Picky Eating

Typical picky eating usually emerges during the toddler and preschool years as a developmentally appropriate phase. These children may temporarily restrict their choices, refuse new foods, or favor one meal repeatedly. However, they generally maintain a repertoire of at least 30 different foods and are willing to try new options over time with repeated, pressure-free exposures. This stage, while sometimes frustrating, doesn’t have a significant impact on the child’s overall nutrition or the family’s quality of life. Growth, weight, and hydration generally remain unaffected as well.

Pediatric Feeding Disorders

By contrast, Pediatric Feeding Disorders (PFD) is “defined as impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction”.

Signs that your child may qualify for a diagnosis of PFD (these are not exhaustive):

• Eating fewer than 20 foods, with a consistently restricted diet.
• Ongoing feeding challenges since infancy or persistent issues beyond the preschool years.
• Refusal of entire food textures or nutritional groups.
• Significant distress at mealtimes, sometimes including not wanting to eat with the family due to sensory sensitivities (sight, smell, sound).
• Physical impacts such as failure to thrive, slow growth, or dehydration.
• Mealtimes being a source of stress, anxiety, and even family conflict.

For children with autism, these feeding difficulties are further complicated by unique sensory, motor, and medical factors, requiring a differentiated and more nuanced approach to care.

Why Children with Autism Are More Likely to Struggle with Picky Eating

Feeding challenges are exponentially higher among children with autism. Research suggests that up to approximately 80% of children with autism experience feeding difficulties qualifying for a Pediatric Feeding Disorder diagnosis, compared to only 25% in the general pediatric population.

Underlying Causes: What Makes Mealtimes So Hard?

The sum of these factors means that standard picky eating strategies often fall short for children with autism, requiring more personalized, holistic approaches. Please note, the following are not all encompassing, nor are they mutually exclusive examples. There is a lot of overlap between these underlying causes of complex picky eating (sometimes qualifying for a diagnosis of PFD). It’s important to view and understand your own child’s feeding and mealtime challenges from a whole-child, holistic perspective.

Sensory Processing Differences

Children with autism often experience the world with heightened or distorted sensory perceptions. This can make mealtimes overwhelming. Factors such as bright lights, strong environmental smells (from foods, cleaning products, scented candles, etc.), background noise, and the visual appearance of food can trigger discomfort, aversion, or even distress. The sensation and texture of certain foods in the mouth may cause gagging or refusal, while the presence of non-preferred foods on the same plate as preferred foods can also be upsetting.

Structural-Functional Challenges

Chewing, swallowing, and overall mouth coordination might be more difficult for children with autism, whether due to low muscle tone, impaired oral motor planning, or structural concerns such as a tongue tie and/or high-vaulted palate. These difficulties can cause children to avoid foods that are hard for them to manage, narrowing their accepted foods even further.

Medical and Gastrointestinal Issues

Many children with autism have associated gut-health challenges, such as chronic constipation, reflux, dysbiosis, or “leaky gut”. These can contribute to changes in appetite, food intolerances, and strong cravings.

Biochemical-Nutritional Factors

Nutritional deficiencies, such as zinc, are also common and can further impact the sensory perception of taste and smell, thus impacting the child’s willingness to eat a diverse diet. Certain foods can create an addictive-like craving, especially if a child’s gut is imbalanced or their immune system is reacting to specific food proteins (for instance, casein in dairy or gluten in wheat). This is linked to the “exorphin” effect, where these foods trigger opioid-like responses in the brain, further driving intensive cravings and selective eating.

Early Feeding Histories and Trauma

Feeding difficulties may trace back to infancy: trouble breastfeeding, transitioning to solids, or negative experiences with feeding and mealtimes early in life can be related to self-restricted eating as a child grows.

Behavioral and Emotional Regulation

It is not uncommon that a child with autism struggles with overall regulation, generally speaking. Children with autism may also find transitions difficult, such as coming to the table or trying something new or unpreferred, heightening anxiety around mealtimes.

Strategies to Support Feeding Challenges with Behavioral and Nutritional Strategies

Managing complex picky eating, particularly with children on the autism spectrum, demands compassion, patience, and tailored strategies to “meet them where they are”. Here’s how to support your child holistically:

Adopt a No-Pressure, Positive Mealtime Approach

Focus on Positive Experiences, Not Consumption

The primary goal is positive interactions and experiences with foods, not forcing or pressuring your child to eat through force feeding, ultimatums, or bribes. Offer new foods in very small amounts alongside familiar, preferred foods. The new or unpreferred food should also be something that the rest of the family is eating as well. For example: If the family is having a side of green beans or mashed potatoes, and these are new or unpreferred to the child, even a single green bean, or a teaspoon of mashed potatoes, is enough for positive exposure.

Keep Mealtimes Relaxed

Maintain a calm and neutral demeanor. Avoid showing frustration or pressuring your child to eat. Often times this only adds to their mealtime anxiety. Acknowledge the small steps of your child’s progress along the way, like interacting with, touching, or smelling a new food rather than just the act of eating it.

Create Clear Routines

Predictability reduces anxiety. Use countdowns (“Five minutes until lunch… When the timer goes off, that means it’s time to get ready to eat”), visual schedules, or simple routines to ease transitions into mealtimes. Consider a pre-meal and post-meal routine to signal the start and end of meals. For example, a pre-meal routine might be washing their hands before the meal and/or pulling out everyone’s chair, which provides some heavy work for regulation before being seated. A post-meal routine might include helping take care of their leftovers and/or asking them to gather the silverware to put in the sink.

Make it Fun, Novel, and Sensory-Friendly

Considering using food picks, cookie or fruit/veggie cutters, and/or create simple shapes such as a smiley face, a heart, or the first letter of their name with food on their plate to foster curiosity and engagement. For children who are sensitive to touch, utensils like food picks can help reduce direct hand contact with foods they’re learning about, as they work towards becoming more comfortable to touch them over time.

Address the Environment and Sensory Input

Simplify the Setting

Dimming the lights or using natural lighting from windows if possible, minimizing table clutter to only what’s required for the meal, and reducing background noise in the mealtime environment can help children focus and feel more regulated (and safer) during meals.

Offer Deconstructed Meals

Serve components of dishes separately (such as separating ingredients in pasta salad) to avoid overwhelming your child with mixed consistency or foods that are touching one another.

Ensure Optimal Mealtime Positioning

Children should be seated with the ability to ground their feet, with the angle at their knees and hips at about 90 degrees, to optimize comfort and support motor control, as well as digestion.

Nutrition Strategies for Feeding Success

Clean Up the Diet Gradually

Move towards whole, minimally processed, and organic foods where possible and feasible. Start by upgrading the quality of animal-based products such as dairy (if tolerated), eggs, and meats where your budget allows. Swap out highly processed favorites with “cleaner” versions. For example, get organic, food-dye free and additive-free waffles instead of the common brands. Use the Environmental Working Group’s “Clean 15” and “Dirty Dozen” lists to prioritize organic produce.

Avoid Additives and Hidden Triggers

Some food dyes, synthetic additives, and “natural flavors” contain hidden forms of glutamate (producing a similar effect to MSG), which can exacerbate cravings, behavioral issues, and physical symptoms. When it comes to processed foods, especially ultra-processed foods, aim to opt for choices with short, recognizable ingredient lists.

Balance Blood Sugar

Structure meals and snacks to include proteins, healthy fats, and fiber alongside carbohydrates, especially at breakfast. This helps stabilize mood, promote satiety, and avoid spikes and crashes in energy. This can really support the child’s overall mood, regulation, and appetite throughout the day.

Address Nutritional Deficiencies

Consulting with a trusted practitioner about common deficiencies, especially zinc and iron, can be really supportive. Deficiencies can distort taste and decrease willingness to try new foods, among many other issues related to their overall health and well-being.

Support Gut Health

Introduce (as tolerated) probiotic-rich foods such as sauerkraut or other fermented vegetables, as well as ample fiber to support a healthy gut microbiome. In some cases, eliminating common offenders, such as gluten and dairy, may help, but should be done gradually and in consultation with a professional if your child is significantly limited. It’s best not to cut foods “cold turkey” all at once for children with an already self-restricted diet.

Gradually Expand the Food Repertoire

Implement Slow, Gentle Changes

For complex picky eaters, blended or phased “clean swaps” work best. For instance, mix one-quarter of a new yogurt with three-quarters of their usual yogurt, and slowly increase the ratio over time. Animal-based products are best with this approach. However, when it comes to processed foods, you may need to be more strategic so that you aren’t caught “sneaking” in the new food. Never sneak a new food if there’s a chance your child will notice; you want to maintain their trust at mealtimes. With processed food swaps, be more transparent about it. For example, give your child their usual crackers on a plate (a little less than usual) and put a couple of the new cracker option beside those.

Encourage Food Play and Exploration Outside Mealtimes

Activities like food-based crafts such as smashing berries for a paint or using potatoes, carrots, celery as stamps, playing “restaurant” or pretending to have a grocery store with fake or real foods can foster positive associations without the pressure to eat. Consider letting your kid tag along for grocery store trips and browse the produce section with them, teaching them how to know which produce to pick by using senses such as smell, look, and feel. There’s zero pressure to eat it, and they’re getting a rich sensory experience outside of the mealtime environment.

Model and Involve Your Child

Eat Together

Shared mealtimes model healthy eating and reinforce positive social interactions.

Involve Them in the Meal Prep

Ask for their help and get them involved in prepping the meal or setting up the table. Depending on your child’s age and ability, it could be anything from pushing a button on a blender or mixer using hand-over-hand support, to mixing, stirring, pouring, chopping, serving, or carrying a dish to the table. Think about the small ways and “asks” that you can enlist your child’s “help” and make them feel like they’ve had a supportive role in the mealtime experience for the whole family.

When to Seek a Feeding Therapist and How to Find One for Your Child

After implementing the strategies included here, if your child continues to have significant feeding challenges, it’s likely time to consider seeking professional guidance.

When to Seek Help

• Your child eats fewer than 20 foods or has a persistently restricted diet.
• There has been little or no improvement despite consistent, pressure-free strategies.
• Mealtimes remain a major source of stress for your child and/or family.
• There are concerns about weight gain, hydration, chewing, and/or swallowing.
• Feeding difficulties have significantly impacted your child’s (and family’s) quality of life for more than a couple of months.

Whom to See

• Pediatric Speech-Language Pathologists (SLP) or Occupational Therapists (OT) specializing in pediatric feeding disorders have the expertise to address sensory, motor, and behavioral aspects of picky eating.
• Nutritional professionals with experience in autism and pediatric feeding issues can help tailor dietary strategies and identify potential nutritional gaps.
• If your child is experiencing medical related issues related to their restricted eating, speak with your child’s pediatrician, a Medical Academy of Pediatric Special Needs (MAPS) MD, functional-medicine doctor, naturopathic doctor, or other trusted healthcare practitioner who can support you.

How to Find the Right Support

Start Local

Look for private therapists or clinics in your area who have SLPs and/or OTs who offer pediatric feeding therapy. Ideally, a licensed therapist who can provide sessions in your home is preferred, as this case best reflects your child’s natural eating environment. It is strongly recommended that parents are involved in the feeding therapy process to help generalize the strategies and therapeutic progress outside of the therapy session.

Ask the Right Questions

Not all feeding therapists approach feeding the same way. Look for professionals who use no-pressure, sensory-friendly, and motor-based approaches, and who provide robust parent coaching. In addition to private practices, hospitals and university clinics may also offer feeding programs. Always verify the therapist’s credentials and trainings in pediatric feeding and confirm that their approach aligns with what you’re looking for.

School Therapists vs. Private Therapists

While not common, school-based SLPs or OTs with the additional training and knowledge will sometimes address feeding, but focus primarily on safety (e.g., swallowing), rather than expanding diet or treating complex picky eating.

Parent Involvement is Key

No matter the setting, parental participation is key. Therapists should provide hands-on strategies to help parents carry over feeding and mealtime skills into the family’s daily lives. Assembling a holistic team including, but not limited to; a pediatric feeding specialist, a holistic nutritionist, and perhaps a medical doctor often yields the best results.

Key Takeaways

Feeding challenges in children with autism are complex, multi-layered, and sometimes overwhelming. Yet, with individualized, compassionate strategies, progress — however slow — is possible. Begin with small, practical changes in the environment and routines, focus on positive food experiences and exposures, and don’t hesitate to involve specialized professionals when needed.

Remember to celebrate every small victory as a step forward. Over time, small victories lay the foundation for lifelong healthy eating habits and greater family harmony at the table. We hope you found this information supportive and wish your child and family all the very best as you move forward!

About Shandy Laskey MA CCC-SLP FNTP

She provides virtual parent coaching to guide families on identifying ways to address the underlying causes of their child’s condition and/or related symptoms, while also teaching integrative strategies for learning, behavior, communication and mealtimes.

Shandy is the Director of Community Development at Documenting Hope. Read more about Shandy’s story and work at: SpeakingOfHealthAndWellness.com

Still Looking for Answers?

Visit the Documenting Hope Practitioner Directory to find a practitioner near you.

Join us inside our online membership community for parents, Healing Together, where you’ll find even more healing resources, expert guidance, and a community to support you every step of your child’s healing journey.

More To Explore