Expanding Feeding Programs for Children with Autism

A recent pilot (38 children) study (WG Sharp et al. J Pediatr 2019; 211: 185-92) examined the effectiveness of a less intensive feeding program to help children with autism and food selectivity.

Background:  Many children with autism are extremely picky eaters.

  • They may limit their diet to a ‘beige diet’ consisting of foods like chicken nuggets and fries.
  • They may insist on only pureed textures
  • They may demand only specific foods and limit to specific brands

To normalize these diets, typically intensive structured feeding programs are needed.  However, these types of programs are costly, and not available in all communities. Parental training though the MEAL (Managing Eating Aversions and Limited variety) Plan was studied by the authors.  This program consisted of 10 core and 3 booster sessions.

Key finding:

  • At week 16, positive response rates on the Clinical Global Impression Improvement scale was 47.4%for the MEAL plan compared to 5.3% in a control parent education plan.

My take: This pilot study shows that less intensive programs may be helpful in children with autism and feeding problems.  However, even with this more limited MEAL plan, a multidisciplinary team with a dietitian plan for each child along with behavior management strategies was needed.

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Artwork near Krog Street Market

What Happens to Picky Eaters

“Little belly-achers grow up to be big belly-achers and big belly-achers beget little belly-achers” –John Apley

John Apley’s monographThe Child with Abdominal Pains indicates that children with recurrent abdominal pain often grow up to be adults with abdominal pains.  A recent study indicates the same type of phenomenon with picky eaters.

A summary of this study in Research Digest: The first study to see if fussy-eating children grow into fussy-eating adults (Thanks to Bonney Reed-Knight for this link.)

An excerpt:

60 per cent of fussy eating children in the study were also fussy eaters at age 23, but fussy eating young adults were no more likely to report signs of eating disorder than their non-fussy peers.

The researchers led by Meredith Van Tine at Stanford University School of Medicine managed to catch up with 61 individuals, now aged 23, who’d participated as children in a long-running study in which their eating habits had been scored by their parents at ages 2, 7, 9.5 and 11, including any signs of fussy eating (being a “selective eater”, having strong likes and dislikes, and only eating a limited variety of foods etc). The participants were now asked to rate themselves on whether they were selective or fussy eaters, and they answered questions about whether they engaged in behaviours related to eating disorders.

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Preventing Picky Eating Habits

According to several studies in Pediatrics and summarized in NY Times, preventing picky eating habits and developing good diet habits relies on #1) introduction of fruits and vegetables in the first year of life and #2) avoid sugar-sweetened beverages in infancy.

NY Times Food Introduction Article

Here is an excerpt of the summary:

The package of 11 studies was published in the journal Pediatrics and was funded by the Centers for Disease Control and Prevention and the Food and Drug Administration, among others. Investigators tracked the diets of roughly 1,500 6-year-olds, comparing their eating patterns to those observed in a study that followed them until age 1…

As it turns out, “when infants had infrequent consumption of fruits and vegetables, they also had infrequent consumption at 6,” said Kelley Scanlon, an epidemiologist at the C.D.C. and the senior author of a few of the new studies.

Dr. Scanlon and her colleagues suggested that it is best to interest children in fruits and vegetables by late infancy — roughly between 10 and 12 months old.

Another study in the new series found that babies who consumed any amount of sugar-sweetened beverages were two times more likely to drink them at least once daily at age 6. A third study found that infants ages 10 to 12 months who were given sugar-sweetened beverages more than three times a week were twice as likely to be obese at age 6 than those who consumed none as infants.

Their analysis took into account factors that could skew results, like race, family income and breast-feeding. ..Breast-fed infants are more accepting of new foods than babies who drank the same-tasting formula day after day, research has shown. A C.D.C. study in the new series found that children who were breast-fed were more likely to consume water (versus sugar-sweetened beverages), fruits and vegetables at age 6.

Related blog post:

Sweetened Beverages -A Big Problem for Little Kids …