The Difference Between Picky Eating & Problem Feeding for Kids on the Autism Spectrum
Up to 90% of parents who have a child on the spectrum have experienced their child to be a selective eater [1]. On average, children with ASD consume fewer foods than the typically developing child (33.5 vs 54.5 foods, respectively) [2]. Unfortunately, many healthcare providers fail to recognize the differences between “picky eating”, a developmentally appropriate phase, and selective eating, which can cause nutrient deficiencies, gut issues, and other nutritional problems over time.
The odds of a child on the spectrum having a feeding problem are 5 times greater than a neurotypical child, so it’s important that both parents and practitioners understand the difference between picky eating and problem feeding so that a child can get the kind of feeding support and appropriate referrals to help them thrive.
Picky Eaters vs Problem Feeders
The SOS Approach to Feeding defines a picky eater as a child who:
Has a decreased range or variety of foods, but typically eats 30 food items or more
Re-gains a food due to “burn out” after a 2 week break
Can tolerate new foods on their plate and will usually can touch or taste a new food, even reluctantly
Eats at least one food from most all food texture groups and food groups
Frequently eats a different set of foods than the rest of the family, but usually eats with the family
Will typically make progress with new foods after ~15-20 exposures
Sometimes reported by parent as a “picky eater” at well-child check-ups
And a problem feeder as a child who:
Has a limited variety of foods, typically fewer than 20 different food items
Does not re-gain a food (easily) due to “burn out”
Cries and “falls apart” when presented with new foods
Refuses entire categories of food groups and textures
Almost always eats different foods than the family, and often times eats separately than the family
May make progress with new foods after more than 25 exposures
Persistently reported by parent as a “picky eater” across multiple well-child check-ups
Nutritional issues Caused By problem feeding
While problem feeding is an issue in itself, problem feeding can cause many other issues down the road. Eating fewer foods can lead to consuming fewer nutrients, which can cause other issues such as:
Nutrient Deficiencies
Over time, eating a limited variety of foods puts kids at higher risk for nutrient deficiencies. Nutrient deficiencies can manifest as fatigue, brain fog, thinning hair, brittle nails, mouth sores & cracks, eczema, low muscle tone, fragile bones, poor sleep, vision loss, and many other symptoms. It’s not uncommon for deficiency symptoms to be passed off as “autism symptoms” without further investigation. Routine blood work can help stay ahead of deficiencies and catch them sooner than later.
Chronic Constipation
For kids with limited diets consisting of packaged foods, fast foods, and other processed items, they typically consume lower levels of fiber. Fiber is important for healthy and regular bowel movements and for feeding the beneficial bacteria in the intestines that help with digestion of food and extracting important nutrients. A large percentage of kids on the spectrum rely on over-the-counter laxatives to remain regular, though this may be possible if diet, lifestyle, and nutrition supplements are utilized correctly. Note that Miralax is not approved for use for children under 17, or for more than 7 days at a time (it even says so on the bottle).
Weight Imbalances
Being a selective eater does not necessarily mean that a child will be underweight. In fact, most processed and packaged foods are high in calories, making overweight and obesity a possibility. Kids on the spectrum often do not eat enough daily protein and fiber, which can cause them to be persistently hungry throughout the day and graze on snacks all day long. This may results in weight gain or weight loss depending on the child.
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References
[1] Mulle, J.G., W.G. Sharp, and J.F. Cubells, The gut microbiome: a new frontier in autism research. Curr Psychiatry Rep, 2013. 15(2): p. 337.
[2] Zimmer, M.H., et al., Food variety as a predictor of nutritional status among children with autism. Journal of Autism & Developmental Disorders, 2012. 42(4): p. 549-56.
[4] Sharp, W.G., 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, 2013. 43(9): p. 2159-73.
[5] Ma NS, Thompson C, Weston S. Brief Report: Scurvy as a Manifestation of Food Selectivity in Children with Autism. J Autism Dev Disord. 2016;46(4):1464-70.
Updated July 2025
