Healthy eating supports growth, development and social interaction during meals, yet a comprehensive review shows that children with autism spectrum disorders (ASD) face much higher rates of feeding problems than their peers.
In a wide-ranging meta-analysis of peer-reviewed studies on feeding behavior in children with autism, researchers from Marcus Autism Center and the Department of Pediatrics at Emory University School of Medicine found that children with ASD are about five times more likely to experience feeding problems. These problems range from severe food selectivity and rigid mealtime rituals to extreme tantrums during meals. The review also found that dietary analyses revealed lower intake of key nutrients—most notably calcium and protein—and a greater overall number of nutritional deficits in children with autism compared with typically developing peers.
The findings are reported in the Journal of Autism and Developmental Disorders.
“The results of this study have broad implications for children with autism,” says William Sharp, PhD, a behavioral pediatric psychologist in the Pediatric Feeding Disorders Program at Marcus Autism Center and an assistant professor at Emory University School of Medicine. “Our analysis highlights the importance of assessing mealtime concerns as part of routine health screenings and points to the need for greater attention to diet and nutrition within the autism community.”
Chronic feeding problems can lead to serious medical and developmental consequences. Children who struggle with persistent feeding difficulties are at greater risk for malnutrition, slowed growth, social challenges around eating and poorer academic performance. The review raises concern that the distinctive feeding behaviors and dietary patterns common in some children with ASD could increase the risk of long-term health problems, such as reduced bone growth or metabolic conditions, and may contribute to obesity or other diet-related diseases later in life.
Parents of children with autism commonly report worries about how limited their child’s diet can be. This systematic review and meta-analysis, led by Dr. Sharp and colleagues, represents the first effort to combine data across studies and quantify both the prevalence of feeding problems and differences in nutrient intake between children with ASD and their peers. By compiling results from multiple empirical studies, the authors provide stronger evidence about the scope and nutritional impact of feeding disorders in the autism population.
Despite frequent caregiver concerns and the potential for long-term medical consequences, feeding problems are often overlooked in clinical practice and autism research. “Feeding issues receive less attention than other clinical or research priorities in autism,” Dr. Sharp notes. “That gap can leave clinicians unprepared to respond to parents’ concerns or, worse, allow unproven or potentially harmful alternative treatments to fill the void.”
One common example is the widespread adoption of elimination diets by some families. The meta-analysis suggests that restrictive diets may increase nutritional risk for already vulnerable children with ASD unless they are carefully supervised by qualified healthcare professionals. In response to their findings, the researchers developed autism-specific recommendations to guide clinical care and future research.
Key recommendations include routine screening for feeding concerns and nutritional imbalances during medical visits for children with ASD and regular measurement of growth parameters such as weight, height and body mass index. The authors also advise healthcare providers to carefully weigh the potential benefits and risks before recommending an elimination diet, taking into account each child’s unique feeding profile and nutritional status.
“This is the first study to quantify the impact of feeding disorders in the autism population,” Dr. Sharp says. “We hope these results will inform clinical practice and shape future research priorities.”
Marcus Autism Center is using these findings to expand research within its Pediatric Feeding Disorders Program. Future research priorities identified by the team include detailed studies of the health burden associated with atypical dietary patterns—such as the prevalence of obesity and related conditions—and investigations into the social and family-level stresses that chronic feeding problems create for children with ASD and their caregivers.
Notes about this autism research article
Contacts: Holly Korschun and Carrie Edwards – Emory University
Source: Emory University press release
Image Source: Image adapted from an Emory University press release.
Original Research: “Feeding Problems and Nutrient Intake in Children with Autism Spectrum Disorders: A Meta-analysis and Comprehensive Review of the Literature” by William G. Sharp, Rashelle C. Berry, Courtney McCracken, Nadrat N. Nuhu, Elizabeth Marvel, Celine A. Saulnier, Ami Klin, Warren Jones and David L. Jaquess. Published in Journal of Autism and Developmental Disorders, published online February 4, 2013. DOI: 10.1007/s10803-013-1771-5.