Picky Eating Versus Feeding Disorders Blog Author: Laura Rosales

laura-pic-1Introduction

Do you have problems feeding your child? Will they not eat certain foods? Many children with Autism have problems with eating certain foods or even trying certain foods. Nutrition is an imperative part of your child’s growth and is an important topic of concern during the developmental stages.  Research shows that 40% of toddlers and young children present symptoms of feeding issues such as “picky” eating, limited food preferences, poor appetite, and behaviors that may affect the time during mealtimes.  However, many autistic children are labeled only as picky eaters instead having feeding disorders:

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Working as a Pediatric Dietitian for many years, I have had numerous opportunities to
work with children that are diagnosed as picky eaters or as having a feeding disorder. However, many children with Autism that have feeding disorders, services are delayed or denied due to only being diagnosed with picky eating.

This is devastating for these children because a delay or denial of such treatments could impair cognitive and developmental growth.  Therefore, it is imperative that we educate providers assess for symptoms of feeding disorders earlier rather than labeling children with Autism only with picky eating.

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CHALLENGES                                       CHALLENGES                                       CHALLENGES                          

One of the challenges in treating Autistic children is ensuring their nutritional needs for growth. Many present with feeding problems since child birth. While working with mothers that have children with autism I have observed the overwhelming feelings of stress that overcomes them when

  1. they work with their children that may refuse foods,01 Sep 2000 --- Mean teacher --- Image by ©LWA-Dann Tardif/CORBIS
  2. have extreme temper tantrums,
  3. have reduced food choices
  4. present the inability to communicate their needs.

 

If you have these problems you may feel being watched and labeled as an unfit mother by Medical Providers. You may afraid of being referred to Child Protective Services.  Mothers have mentioned that their providers often excuse the child’s behavior by stating that their children are just being picky eaters and may outgrow this stage.

 

Moreover, some providers may request that mothers try to introducing children to different foods. Mothers often ask what they can feed their children when they refuse.

Research

The following study researched how mothers worked through challenges. The results of the study noted that the challenges go much further than the diagnosis of “picky eating” and that proper evaluation and further treatment options are necessary for these children. The study obtaining four main processes which included

  1. The ability to recognize the problems in feeding
  2. The ability to define the reason of challenges which included sensory differences, needed for sameness, food jags, behavioral challenges, and other co-morbidities.
  3. The ability for the mothers to find support and confirmation of feeding difficulties. The study found that the mothers had support but the problems were often dismissed and were not treated; thus, leaving the mothers to deal with the problems on their own.
  4. The last process obtained was that mothers ended up having to determine their own treatment towards their children’s behavior instead of being treated by a professional. The mothers also stated they were guided by what their child did and used options that worked eventually increasing their child’s nutrition and their food option intake.

Mom is Overwhelmed!!!

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Many of the mothers that I have seen would give into the child’s tantrums; therefore many children would end up eating less than 10 food items as adults. One case in particular was of a young man in his 30’s that would only drink Coke and eat steak. This manner of eating had affected his health and was being treated not for feeding problems but for Diabetes, elevated Cholesterol and Vitamin Deficiencies.

Do you have problems like this? Working with your children through the tantrums is very important in helping them increase their food variety as they grow into adults.

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One of the main goals is to increase their food choices to help them learn to eat healthy meals as children and as adults. However in the case of the 30 year old man, due to the lack of proper diagnosis of having a feeding disorder, the family had to address a much bigger disease process later in their son’s life.

A guideline created by Baird, Hannah and Murphy in 2011, summarized the recommendations from the National Institute of Health and Clinical Excellence (NICE). The Institute provided guidelines for individuals to help assess Autism in children but they failed to distinguish between picky eating and feeding disorders. This is a setback for these children because many may have underlying causes that are not being addressed such as hypersensitivity to foods, issues of the mouth, allergies, problems swallowing, and problems with gastric reflux just to name a few (4).laura-pic-7

Another study written by Sharp G. William, Jaquess L. David, Morton F. Jane, and Herzinger V. Caitlin in 2010 reviewed literature concerning pediatric feeding disorder treatments from 1970 to 2010, especially those studies that looked at severe denial of food or choosiness.  “I do not want it!!!!”

The article states that the process of assessing and treating such problems is extensive and may be affected by several factors. The researchers obtained 48 single case studies. Sharp and colleagues obtained a large amount of information which included treatment, medical, and nutritional outcomes. Moreover, the discontinuation of bottle feeding promoted an increased intake of food consumption and increased in dietary variety and negative reinforcement, did not seem appropriate in the treatment of feeding disorders.

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Say “NO” to the

Baby Bottle eat more

food as child gets older.

 

 

Many of the cases that are referred to me are for:

  1. children that already display a health concern,
  2. very low weight or obesity,
  3. high insulin,
  4. elevated lipid levels,
  5. problems with diarrhea or constipation,
  6. Feeding disorders.

One case in particular, is of a child that would have extensive tantrums at the table to the point that the mother feared feeding times and would begin to cry.

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This child was below the 5th percentile on the growth charts. The child was referred for allergies to food and resulted being allergic to milk and wheat. In addition, every time the child ate these foods, his stomach would begin to hurt. Due to his low communication skills, he expressed his pain was through tantrums. After removing the foods he was allergic to, the child began to speak and make phrases. Moreover, he was able to sit at the table, read, and learned to say words like:

“Please” and “no thank you”.

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Children with autism face many challenges. Some families may not be able to take care of their adult children due to the high level of care they may need and due to the parent’s older age.

One case in particular, was of a 24 year old man that had been transfer from jail because he had an aggressive reaction towards the parent which sent the parent to the hospital. The young man was Autistic and was weighing 320 pounds.

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He would drink 2 gallons of soda per day and loved to binge on everything in the refrigerator at night. He was aggressive when food was controlled or refused.  The client was referred for weight management and Pre-diabetes but not for feeding disorders.

Cases such as the ones mentioned are much more difficult to treat as adults because many habits and behavioral patterns have already been established. Therefore, it is imperative that you ask your providers to begin assessing for symptoms of feeding disorders earlier rather than labeling your children with Autism as a picky eater, in order to reduce health consequences that may arise into their adulthood.

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References

  1. Assa’ad Aal MD. Eosinophilic Esophagitis: Association with Allergic Disorders. Gastrointestinal Endoscopy Clinics of North America (2008) 181):119-132.
  2. Baird Gillian, Douglas Hannah Rose, Murphy M Stephen. Recognizing and Diagnosing Autism in Children and Young People: Summary of NICE Guidance. BMJ (2011) 343:900-343. Down loaded from 132.174.255.223 on Sunday 11 September 2016. 21:13:25 UTC
  3. Patel Bhavisha, MD, and Volcheck W. Gerald MD. Food Allergy: Common Causes, Diagnosis and Treatment. Mayo Clin. Proc.(2015) 90(10):1411-1419. http://dx.doi.org/10.1016/j.ayoc.2015.0.12
  4. Rogers G. Laura, Magill-Evans Joyce, Rempel R. Gwen. Mothers’ Challenges in Feeding their Children with Autism Spectrum Disorder-Managing More Than Just Picky Eating. J Dev Phys Disabil (2012) 24:19-33.doi: 10.1007/s10882-011-9252-2
  5. Steward-Scott Ellena, RN, BSN. Autism Spectrum Disorders: Picky Eaters. Journal of Pediatric Nursing (2014) 29:107. doi: 10.1016/j.pedn.2013.12.009
  6. Sharp G. William, Jaquess L. David, Morton F. Jane, Herzinger V. Caitlin. Pediatric Feeding Disorders: A Quantitative Synthesis of Treatment Outcomes. In Child Fam Psychol Rev (2010) 13:348-365. doi: 10.1007/s10567-010-0079-7
  7. Shunquan Wu, Yingying Ding, Fuquan Wu, Ruieung Li, Going Xie, Jun Hou,Payon Mo. Family History of Autoimmune Disease s Associatedwith a Increased Risk o Autism I Children: A Systemic Review and Met-analysis. Neuroscience and Biobehavioral Reviews (015) 55:322-332 http://dx.doi.org/10.1016/j.neuiorev.2015.0.004
  8. Weikang Yang, Hui Xia, et al. Epidemiological investigation of suspected autism in children and implications for healthcare system; a mainstream kindergarten-based population study in Longhua District, Shenzhen. BMC Pediatrics, 2015 15:207.

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