The Difference Between Picky Eating & Problem Feeding

It’s common for children with autism spectrum disorder (ASD) to be selective eaters. In fact, one study showed that 70-90% of parents who have a child on the spectrum reported their child to be a selective eater [1]. Children with ASD are more likely to avoid foods and exhibit neophobia (fear of trying new foods) than their typically developing siblings and other children without ASD [2]. On average, children with ASD consume fewer foods (33.5 vs 54.5 foods) than the typically developing child [3]. The odds of a child having a feeding problem are five times greater in a child with ASD [4].

picky eating autism

Children with autism are commonly referred to as a “picky eaters” when, in fact, they are “problem feeders”.

Is there a difference? Glad you ask.

Picky Eaters vs Problem Feeders

The SOS Approach to Feeding defines a picky eater as a child with:

  • Decreased range or variety of foods that will eat = 30 foods or more

  • Foods lost due to “burn out” because of a food jag are usually re-gained after a 2 week break

  • Able to tolerate new foods on plate and usually can touch or taste a new food (even if reluctantly)

  • Eats at least one food from most all food texture groups

  • Frequently eats a different set of foods than the rest of the family, but usually eats with the family

  • Will add new foods to repertoire in 15-25 steps on Steps to Eating Hierarchy

  • Sometimes reported by parent as a “picky eater” at well-child check-ups

They also define a problem feeder as a child with:

  • Restricted range or variety of foods, usually less than 20 different foods

  • Foods lost due to food jags are NOT re-acquired

  • Cries and “falls apart” when presented with new foods

  • Refuses entire categories of food textures

  • Almost always eats different foods than the family

  • Adds new foods in more than 25 steps

  • Persistently reported by parent as a “picky eater” across multiple well-child check-ups

 
 Credit:  SOS Approach to Feeding  by Dr. Kay Toomey

Credit: SOS Approach to Feeding by Dr. Kay Toomey

 

Common issues with 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 Deficiency

When consuming a diet low or lacking in nutrients over time, it’s easy to develop nutrient deficiencies. Vitamins and minerals play a vital role in our diet and are necessary for total body function. When we do not consume adequate amounts, cellular function and vital processes suffer. There have even been recent studies on scurvy (vitamin C deficiency) in seven children with autism with food selectivity [5] at Boston Children’s Hospital. If you suspect your child has nutrient deficiency, you can get them tested! I do this with my clients regularly - you can take a look at micronutrient testing here. Nutrient deficiency 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 serious symptoms.

Chronic Constipation

Diets of selective eaters tend to consist of foods that are extremely low in fiber, such as processed and refined grains, microwavable meals, packaged snacks, and fried foods. Without fiber, the GI system is not able to function properly, and can become backed up and “stuck”. Constipation is a very common issue in autism - in fact, a large majority of my case load was on Miralax before starting therapy with me (note: Miralax is not intended to be used for more than 7 days - it even says so on the label!).

Underweight/Malnutrition AND Overweight/Obesity

I commonly see both sides of weight management with selective eaters. They can be so selective that they only will eat a few foods, causing them to only be able to consume a few hundred calories, and therefore become underweight/malnourished. Then I also see kids who are very selective and will binge on chicken nuggets, french fries, coca cola, etc. While their diet is selective, it is a calorie OVERLOAD and causes these children to be overweight or obese.


My Child is a problem feeder… what next?

Identifying a child as a problem feeder and not just a “picky eater” is the first step to the puzzle! From here, we can decide which approach to take. FIRST, the child needs a full nutrition evaluation! During an evaluation we can evaluate diet, lifestyle, physical activity, nutrient deficiencies, gastrointestinal issues, and nutrition supplements. SECOND, the child should be enrolled in SOS Feeding Therapy (click here to find a therapist in your area). Note: there are other types of feeding therapy, but SOS has personally proven to be the most successful and the most gentle on children and developing positive feelings toward food.

It’s important that we start nutrition therapy/SOS Therapy as soon as possible to have the greatest impact. If you believe your child is a problem feeder and would like guidance, feel free to contact me and I’d love to help guide you and your child to a healthful and nutritious diet.


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] Schreck, K.A., K. Williams, and A.F. Smith, A comparison of eating behaviors between children with and without autism. Journal of Autism & Developmental Disorders, 2004. 34(4): p. 433-8.

[3] 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.