Mealtimes can be tough when your child is autistic or has ADHD. Here are 5 tips to try

PTI, Jun 18, 2024, 11:33 AM IST

Representative image (Source: Shutterstock)

Gathering as a family for a meal can serve several purposes: from social connection to nutrition. But this can also make eating and mealtimes tricky to manage when someone in the family is neurodivergent.

Many autistic children and children with attention-deficit hyperactivity disorder (ADHD) display what has been called “abnormal feeding behaviours”. Children may develop these behaviours as a way to cope with the complex task of mealtimes.

The skills involved in mealtimes such as recognising feelings of hunger and thirst, completing tasks in a set order, processing all kinds of sensory input, using fine motor skills, and interacting socially can be challenging. With meals occurring up to six times a day, the whole activity can become daunting. But not getting enough to eat can have a negative effect on behaviour, learning and health.

So, what can you do to help your child get what they need at mealtimes?

Common behaviours

Common abnormal feeding behaviours in autistic children and children with ADHD include:

• food selectivity, where a child has a small range of preferred foods and limited variety. For example, children choosing only grain-based or dairy foods, such as noodles and yoghurt, or toast and cheese.
• strong preferences in how food is prepared and presented, including brands or tableware used – such as only accepting hot chips from one source, or only being able to use one bowl or fork
• hypersensitivity to textures, such as needing foods to be very crunchy or preferring foods that are smooth like puree
• overeating or undereating due to differences in how children understand and respond to body signals, a sense known as “interoception”. This can mean they go long periods without eating, or graze throughout the day
• avoiding eating with others, choosing instead to eat in the lounge room or their bedroom
• inflexibility around mealtime routines due to a drive for consistency and sameness to feel safe. This means eating in different places, at different times, or having unfamiliar foods becomes challenging
• difficulty transitioning to mealtimes due to hyperfocus on a preferred task.

Getting enough fuel

While some children can meet their nutrition requirements despite these challenges, others face more serious consequences. Sometimes these difficulties can impact their growth, lead to vitamin or mineral deficiencies, cause stomach or gut issues, and even increase the risk of developing chronic diseases later in life.

It also has a significant impact on the daily lives of parents and caregivers navigating these challenges while trying to provide food for their children.

Parents struggle to know how best to approach mealtimes and worry about the potential health impacts of their child’s diet.

Instead of panicking, punishing or trying to “fix” these behaviours, a more supportive mealtime approach that acknowledges and accommodates the child’s needs can be a better strategy.

5 ways to support children with different mealtime needs

There are ways you can make mealtimes more manageable and nutritious, while acknowledging challenges and preferences. Here are six things to try:

1. Identify safe foods – if your child prefers a particular food or type of food (such as salty, crunchy, sour), try to find “safe foods” within each core food group (grains, meats and fish, fruit, vegetables, and dairy). Offering these foods may help increase your child’s intake of key nutrients from each food group in a way that suits their sensory preferences.

2. A special plate, spoon or set – if your child prefers specific tableware, allow them to use it in and out of the home. This will mean taking items with you when dining out. Introduce new types of tableware outside of mealtimes and use them in play (such as a pretend cafe or shop) or other activities to build familiarity before using them at mealtimes

3. Offer regular meals and snacks – differences in interoception, or how we feel bodily sensations, can mean neurodivergent children do not interpret feelings of hunger and thirst as neurotypical people do. So your child might not be able to tell if they are hungry or full easily. Offer food on a predicable schedule (roughly every two to three hours). Some children will also get a sense of safety from regular routines

4. Keep offering a mix of foods – children may go through phases of wanting only one type of food. This can be due to sensory-seeking behaviours, a need for sameness, or fixations on topics or items. A supportive approach is to offer familiar, safe foods with other foods from the core food groups or the family meal. It is important to continue provide opportunities everyday for your child to try a range of foods. This might look like offering them some of your dinner on a side plate, or allowing them to serve themselves from a selection of preferred and non-preferred foods

5. Manage sensory input – some children find mealtimes overwhelming due to the sensory input from smells, tastes, textures, sounds and even the sight of food and eating. To help your child manage sensory input, consider using headphones to reduce noise, using a fan to divert strong smells, or offering cold foods. Your child might need distractions like watching TV, using fidget toys or listening to music. Always set them a place at the family table and encourage them to eat with the family, but allow them to move to a separate quiet space if they feel overwhelmed.

Worth the effort

Taking a neuroaffirming approach to eating can significantly reduce the stress experienced by children at mealtimes. Making them feel better understood and more accepted can even lead to a healthier diet over time.

By Stella Boyd-Ford, Research Fellow with the Grow&Go Toolbox, The University of Queensland, and Clare Dix, Research Fellow in Nutrition & Dietetics, The University of Queensland (The Conversation)