By Charlene N. Rivera-Bonet | Waisman Science Writer
Karla Ausderau’s lab uses identity-first language in alignment with the majority preference of the autistic community. This story reflects that preference.
Feeding challenges seen in an autistic child’s first few years can help predict the type and severity of feeding challenges the child may experience later on. This finding, from the lab of Karla Ausderau, PhD, associate professor of kinesiology and Waisman investigator, shows the importance of attending to feeding challenges early in childhood to identify children that are at risk for more severe feeding challenges and offer early intervention to help prevent health issues later as older children.
Feeding challenges are a common concern for autistic children and their families, presenting in around 84% of autistic kids. These challenges can include a selective intake of foods, limited food variety, responses to food such as refusal, or other difficulties that interfere with the acceptance of food or mealtime preparation. They present in different ways but can be classified as sensory, behavioral, oral motor or gastrointestinal.
Children with feeding challenges have a higher risk of negative health, nutritional, developmental, social, and family outcomes. “Feeding challenges impact a child’s entire life. They’re such a large part of your daily routine. You eat three meals a day and multiple snacks a day. So, eating is a large percentage of your time,” says Brittany St. John, PhD, former graduate student in Ausderau’s lab, current Fulbright Postdoctoral Scholar at the Olga Tennison Autism Research Center and first author of the study. Eating also happens in many contexts and settings such as at home, school, the community, and birthday parties. “So, if eating is hard, all of those settings become hard,” she adds. It can also be a challenge for parents as they are constantly switching strategies on how to get their kids to eat more.
The aim of the study was to better understand how feeding challenges present in autistic children and identify factors in early feeding that can predict how feeding challenges will present later on in terms of type and severity.
Some autistic children eventually grow out of their feeding challenges, but some have more chronic difficulties. “If we can predict which kids are going to have more of these lifelong challenges we can then intervene early to support them,” Ausderau says.
Feeding challenges, the study found, can emerge early on for autistic children. Caregivers reported that feeding challenges started before their child received an autism diagnosis, suggesting that these feeding challenges, especially for kids who are showing signs of autism, need to be attended to early on.
Difficulty with breast or bottle feeding, difficulty transitioning to baby foods and difficulty transitioning to table or family foods are examples of early feeding challenges, and used to predict feeding challenges later on.
Their results showed that these early feeding challenges were predictors of whether the children would develop a gastrointestinal, sensory, oral motor, or behavioral challenge later on and how severe.
They found that children who early on had difficulty transitioning to table foods and continued to restrict their diet over time were more likely to have feeding challenges that were sensory-based. Previous studies have shown that food selectivity based on the sensory properties of food, texture in particular, is the most common reported feeding challenge.
Oral motor challenges were predicted by all early feeding transitions – breast or bottle feeding, baby foods, and table or family foods. Two of these, breast or bottle and transitioning to baby foods, predicted gastrointestinal challenges.
“[This study] helps remind us that we need to pay attention to some of these early feeding behaviors including transition feeding behaviors that might be important for us to understand to determine what intervention could be helpful now as well as in the future,” Ausderau says.
Sensory feeding challenges, or food selectivity based on the sensory properties of the food such as texture, were the most commonly identified. They were strongly predicted by a difficulty transitioning to table or family foods.
Current models of treatment focus on exposing kids to specific foods in order to desensitize them – known as exposure therapy. The results from this study emphasize the need for a more individualized approach due to the big range of how feeding challenges present in autistic children.
Many providers, St. John points out, take a “let’s wait and see” approach to feeding challenges. This research, however, suggest these need to be addressed early on. “We don’t want to wait until it’s a crisis,” St. John says. They want to start intervention before the child starts having nutritional impacts.
“My biggest takeaway is that feeding challenges that are significant for children are showing up in really early development,” St. John says. “And that we need to start paying attention to those early developing challenges, because there are so many more opportunities for intervention in those first five years than there are down the road for those kids.”
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