Feeding therapy for autism: What parents should know

Feeding therapy is designed to help your child develop a positive relationship with food. Parents who have an autistic child with picky-eating habits report significantly more stress at home.¹ With over 70% of parents describing their autistic child as a picky-eater, that is a lot of stressed parents at mealtime.²

 

What exactly is feeding therapy?

Feeding therapy refers to programs that are designed to help your child develop a positive relationship with food. Because feeding issues often have more than one cause, feeding programs are a combination of different treatment strategies. With the support of your child’s doctor, feeding interventions include behavioral, speech & swallow, nutritional, and occupational therapies.

 

If you already have speech, occupational, and/or behavioral therapy for your child, you are on the right track to integrate feeding therapy into their routine. Your child’s feeding intervention team can include your pediatrician, a gastroenterologist (a GI and liver doctor), a speech-language pathologist (also known as speech therapist), an occupational therapist, a registered dietitian, and behavioral therapist.

 

 

Feeding therapy sounds great! But where do I start?

The best place to start is with your pediatrician. Before attempting any feeding intervention, children should have some form of a feeding assessment to better understand the underlying causes of the feeding problem. This assessment is likely to be done by a variety of feeding team members.

 

What happens during a feeding assessment?

The first step of a feeding assessment is to screen your child for any underlying medical issues that could be contributing to their problems with eating. Your pediatrician will speak with you about your child’s feeding habits and any other symptoms they have experienced. If your pediatrician feels no further medical evaluation or treatment is needed, they can provide you with information about how to start feeding therapy.

 

Try not to stress if your pediatrician recommends more medical evaluation. Because nutrition is so vital for children’s growing bodies, they will want a comprehensive understanding of your child’s health in order to provide the best therapy for their body’s specific needs. If they feel more investigation is needed they may take one or more of the following steps:

• Perform lab work (blood draw, stool sample, etc.) and/or imaging (X-rays, ultrasounds, etc.)
• Refer to a pediatric gastroenterologist, speech-language pathologist, nutritionist, pediatric allergist or other specialist if needed

 

While not all children will need to be further assessed by a feeding specialist, it may be necessary for some children to be evaluated by professionals who have different domains of feeding expertise.

 

Pediatric gastroenterologists are medical doctors that have received the same training as your pediatrician plus extra training in children’s liver, digestional, and nutritional issues. Your pediatrician may refer you to a pediatric gastroenterologist if they feel a more specialized look at your child’s digestive system is needed. At this doctor visit, they’ll dive deeper into your child’s eating habits and any other symptoms they have been having. The gastroenterologist may decide to do further lab work and/or imaging if they feel it is necessary.

 

Speech-language pathologists (SLPs) are experts who have received specialized training in feeding and swallowing disorders (also called dysphagia). All children have difficulties with eating at first. Children have to learn to put (and keep) food in their mouths, close their lips, and coordinate chewing and swallowing. While it’s normal to have a laundry hamper full of food-stained clothing as children first learn these skills as infants, some children will continue to have difficulties eating and drinking over time.

 

Some of the signs your child may have a swallowing disorder include refusing liquids and coughing/choking or a gurgly sounding voice after eating or drinking. The American Speech-Language-Hearing Association (ASHA) is a great resource to learn more about feeding and swallowing disorders in children.

 

SLPs will watch your child eat and drink to see if they show signs of difficulties with moving food or liquid from the mouth, throat, or esophagus to the stomach. After watching how your child chews and swallow, if they feel further investigation is needed, there are two tests they may choose to perform:

1. A barium swallow study, also called esophagram or video fluoroscopy swallow study, uses a special type of X-ray imaging (called fluoroscopy) that looks at the back of your child’s mouth to their esophagus (the tube that connects the mouth to the stomach). Fluoroscopy is a kind of X-ray “movie” that shows real-time movements inside the body. Your child will drink a liquid with barium in it. The liquid is usually flavored strawberry (Quick tip! If your child is extra picky, ask if the liquid can also be mixed with chocolate syrup!). Barium shows up on X-ray and shows where the liquid goes when your child swallows. Check out the Children’s Hospital of Philadelphia’s website to learn more about what to expect during your child’s barium swallow study.

 

 

2. Endoscopic examination: a small tube with a camera is placed in your child’s nose, allowing the SLP or doctor to watch your child swallow on a screen. Check out this video made by the Children’s Wisconsin to help you and your child prepare for endoscopic evaluation: Upper endoscopy: Guide for children.

 

Nutritionists or registered dietitians are experts in food and nutrition. Your child may require a nutritional workup to determine if they have any nutritional deficiencies (this can vary from completing a food diary to performing blood work).

 

Behavioral therapists or psychologists who work with autistic children are typically experts in applied behavioral analysis (ABA). A behavioral assessment will help figure out which behaviors are contributing to your child’s feeding difficulties. Some examples of unhelpful behaviors include avoidance, refusal, tantrums, etc. They can also assess environmental factors that may also be contributing, like distractions, seating, schedules, etc.

 

Now that we have discussed who your feeding therapy team is and the different feeding assessments that may be needed, let’s talk about feeding therapy program.

 

Autistic children’s relationship and difficulties with food are complicated. If you’d like to read more about how autism affects eating, check out our guide for picky and selective eaters. The goal of feeding therapy is to help your child improve their relationship with food and eat a more nutritious diet. By helping your child learn new skills, feeding therapy will hopefully reduce stress at mealtime for the whole family. 

 

 

Similar to the feeding assessment, different parts of feeding therapy will be provided by different specialists. Depending on the results of your child’s feeding assessment they may require one or more of the following feeding therapies:

 

Nutritional therapy and guidance can be provided by your pediatrician, gastroenterologist, and registered dietitian. A registered dietitian will help determine your child’s nutrition goals and monitor their progress to make sure their growth and nutritional goals are met. Depending on what information was discovered in your child’s nutritional assessment, your RD will decide if nutritional supplements are needed. They are also extremely valuable in educating the whole family about age-appropriate nutrition and how to plan nutrition meals at home.

 

Occupational therapists will teach your child the skills and habits to increase their ability to have a positive participation in mealtime. Some of the skills your child may learn in occupational therapy include:

• Developing strategies to increase the acceptance of food textures
• Advance your child’s feeding skills by improving their posture, hand-to-mouth coordination, fine motor skills needed for using utensils, etc.

 

A number of studies have shown the effectiveness of behavioral therapies for increasing autistic children’s acceptance of new foods. Therapy will focus on gaining new skills overtime to decrease unwanted mealtime behaviors (avoidance, attention seeking, pleasure seeking, obtaining a reward).

 

If your child has other health conditions, be sure to speak with your pediatrician about special dietary needs. If you're looking for a neurodiversity-friendly nutrition expert, check out our directory.

 

Don’t most kids go through a picky-eating stage? Will my autistic child outgrow it too?

In short, it’s unlikely. Unfortunately autistic children are more likely to have difficulties at mealtime, and research shows they often struggle to improve their eating patterns without intervention or therapy.³

 

So we know most autistic children have eating difficulties and most will need feeding therapy to improve their eating habits…. Why is this so common?

Eating is a complex behavior that can cause a lot of anxiety for your child (read more about it in our article “How does autism affect eating?”). In addition to the complicated behavioral piece of picky-eating, some autistic children have other underlying causes that contribute to their feeding difficulties. Some of these causes include:

• Gastrointestinal issues (constipation, reflux, etc.)
• Food allergies
• Oral motor (or chewing issues)
• Swallowing disorders (difficulties with moving food or liquid from the mouth, throat, or esophagus to the stomach)