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From Autistic Toddlers to Teens: Is My Child Getting a Complete Diet?

Autism diet: Is my autistic child getting a complete diet?

Updated: August 29, 2023 · 6 Minute Read

Rashelle Berry, MPH, MS, RDN, LD

Reviewed by:

Rashelle Berry, MPH, MS, RDN, LD

Highlights

  • Children with autism are more likely to be picky eaters which can lead to nutritional deficiencies like low vitamin D and calcium even with taking a multivitamin
  • Drinking too much milk or having very selective diets can cause issues like iron deficiency
  • Tips for picky eaters: Keep to a schedule, minimize distractions, approach new foods together, and support choice and control

"Is my child getting a complete diet" is extremely common for parents of children with autism to ask, with over 60% of autism parents reporting food-selectivity or picky-eating patterns.1 Many parents have a lot of uncertainty about their child’s nutrition and growth. This article will help you understand your child’s nutritional needs, some common nutritional deficits, and learn easy tips for picky eaters. 

 

How many calories do kids need?

The first step to ensure your child is getting enough nutrients to keep them healthy is to understand how many calories they need each day. 

 

Figuring out many calories your child needs can be tricky!  Age, sex, and activity level are big factors. Children’s activity levels can be one of three levels: sedentary (less active), moderately active, and active:

  • Sedentary lifestyles include light physical activity associated with normal daily activities (i.e., chores around the house). 
  • Moderately active lifestyles are equivalent to walking about 1.5-3 miles a day. 
  • Active lifestyles are when kids are walking 3+ miles a day or participating in vigorous activities like basketball or swimming for 60 minutes or more. 

 

Use the chart below as a helpful guide to understanding your child's caloric needs. For example, if your child is a 10 year old female who walks a mile to and from school every day and plays soccer, she would be classified as having an “active” lifestyle and her approximate caloric intake is 2000 calories per day.2

 

 

What do kids need to eat exactly?

 

Now that we know how many total calories your child needs, the next step is to look at specific food groups and how much of each should be on their plates each day.

 

Using the number of calories your child needs (see the chart in the first step above!), use this chart below to figure out how many servings of each food group your child should be receiving each day. 

 

For example, if we take our 10 year old physically active child who requires 2000 calories per day, we can use the chart to see she requires 2.5 cups of vegetables each day, 2 cups of fruit, 3 cups of dairy, etc.2

 

 

What about drinks?

 

Water and milk are best! 

 

Can I give too much milk? 

 

Yes! Too much milk can cause issues like iron deficiency anemia and can affect your child’s development. Iron deficiency anemia is a common problem, a few signs and symptoms include pale skin, fatigue, and unusual cravings for non-food items such as ice and dirt. Good sources of iron include fish, red meat, beans, and spinach. Foods rich in vitamin C, such as citrus fruits, can also helps with the absorption of iron,  If your child is drinking more than 3 cups (24 ounces) of milk a day (especially if they are also a picky-eater who doesn’t eat many iron-rich foods!), consult your pediatrician as they may recommend a screening test done through blood work and adding iron supplements or multivitamin.3

 

What about juice? 

 

Try to steer clear of juice and soft drinks. These are a sneaky way to add a lot of sugar and calories to your child’s diet and also cause unwanted trips to the dentist as they can cause cavities. If your child is already crazy about their juice cup, offer 100% fruit juice with no added sugars and no more than 4 oz a day. If you want to gradually get rid of the juice routine, try diluting the juice with increasing amounts of water to eliminate over time.  

 

Extra special considerations for extra special kids 

Since children come in all shapes, sizes, activity levels, and health conditions, the chart above is general guidelines. Certain health conditions require special attention to diet and growth. Other conditions such as congenital heart disease and gastrointestinal issues require special diets and close monitoring by your healthcare team. 

 

A very important and common concern for children with autism is picky and selective eating. If you rolled your eyes looking at the steps above because your child with autism has never had a full day's serving of vegetables in their life, you are definitely not alone. As if getting kids to eat their veggies isn’t challenging enough, research shows children with autism have significantly more eating challenges than their peers who are not autistic. In addition to sensory difficulties that can lead to a lot of anxiety with food, autistic children are 4x more likely to have gastrointestinal issues such as stomach pain and discomfort.4 This creates the perfect storm for extra extra picky eaters - and a lot of added obstacles and concerns for parents. 

 

The difficulties associated with autistic children and food can cause a wide range of concerns from children being underweight to overweight (overweight children can still be at risk for nutritional deficiencies!).5  This can lead to slower than normal growth and nutritional deficiencies like low vitamin D and calcium levels. Even when given multivitamins, many children with autism are still found to have some of these nutritional deficiencies.5 Check out the image below for some quick tips on how to address picky eaters.6

 

 

To dive deeper into understanding and treating selective eating in autism and alternative diets, check out our learning center. If your child has other health conditions, be sure to speak with your pediatrician about special dietary needs. 

Dive Deeper

Article References

  1. Petitpierre G, Luisier A-C, Bensafi M. Eating behavior in autism: Senses as a window towards food acceptance. Current Opinion in Food Science. 2021;41:210-216. doi:10.1016/j.cofs.2021.04.015
  2. Dietary Guidelines for Americans, 2020-2015. Dietaryguidelines.gov. Accessed February 8, 2022. https://www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans-2020-2025.pdf
  3. Iron deficiency in children: Prevention tips for parents. Mayo Clinic. Published December 7, 2021. Accessed February 8, 2022. https://www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/iron-deficiency/art-20045634
  4. Tang M, Adolphe S, Rogers S, Frank D. Failure to Thrive or Growth Faltering: Medical, Developmental/Behavioral, Nutritional, and Social Dimensions. Pediatr Rev. 2021;42(11):590-603. doi:10.1542/pir.2020-001883
  5. Stewart PA, Hyman SL, Schmidt BL, et al. Dietary Supplementation in Children with Autism Spectrum Disorders: Common, Insufficient, and Excessive. J Acad Nutr Diet. 2015;115(8):1237-1248. doi:10.1016/j.jand.2015.03.026
  6. Tips for Picky Eaters with Autism : NCHPAD - Building Inclusive Communities. National Center on Health, Physical Activity and Disability (NCHPAD). https://www.nchpad.org/1467/6396/Tips~for~Picky~Eaters~with~Autism. Published 2022. Accessed January 26, 2022.
  7. Childhood Nutrition. HealthyChildren.org. https://www.healthychildren.org/English/healthy-living/nutrition/Pages/Childhood-Nutrition.aspx. Published 2022. Accessed January 26, 2022.
  8. McGuire S. U.S. Department of Agriculture and U.S. Department of Health and Human Services, Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, January 2011. Advances in Nutrition. 2011;2(3):293-294. doi:10.3945/an.111.000430
  9. Robea MA, Luca AC, Ciobica A. Relationship between Vitamin Deficiencies and Co-Occurring Symptoms in Autism Spectrum Disorder. Medicina (Kaunas). 2020;56(5):245. Published 2020 May 20. doi:10.3390/medicina56050245
  10. Sharp, W.G., Berry, R.C., McCracken, C. et al. Feeding Problems and Nutrient Intake in Children with Autism Spectrum Disorders: A Meta-analysis and Comprehensive Review of the Literature. J Autism Dev Disord 43, 2159–2173 (2013). https://doi.org/10.1007/s10803-013-1771-5