Nurturing Growth: A Holistic Approach to Feeding Challenges in Children with Autism

Part 1: Understanding the Foundation Welcome to the first part of our in-depth series on supporting children with autism through feeding challenges. We sat down with two incredible experts: Casandra Ang, a Registered Dietitian and Managing Director of MyDietitianEats (MDE), and Belinda Phang, a Program Supervisor at Seed Autism Services (SEED). Together, they bring a wealth of knowledge on how to approach mealtime struggles with compassion and effective strategies.

Casandra (left) with Belinda (right) during the interview.

Meet our Experts

Casandra Ang, the Managing Director at MyDietitianEats, has over seven years of experience as a dietitian, focusing on practical nutrition for families. She's passionate about helping children with feeding challenges, especially those with autism, by improving their nutrition and mealtime experiences.

Belinda Phang brings nearly nine years of expertise as a Program Supervisor at Seed Autism Services. She works with neurodivergent children and their families, providing early intervention through behavioural and skill assessments, creating Individualized Education Plans, and training caregivers. She's a strong advocate for collaborative, person-centred care.

The Power of Collaboration: Why It Matters

Both Casandra and Belinda were inspired to collaborate because they share a core belief: supporting children with autism needs a holistic approach. Many children face significant nutrition challenges, which aren't always addressed alongside their behavioural needs.

"When dietitians work closely with ABA therapists, we can better understand the child’s relationship with food and create more effective, family-friendly strategies," Casandra explains. Belinda adds that this combined expertise provides more holistic care, ensuring consistency and continuity across different settings – crucial for a child's development. This interdisciplinary effort truly bridges a gap, offering stronger, more comprehensive support to families.

How Behavioural Challenges Influence Mealtimes

It's common for behavioural challenges to impact a child’s daily routines, and mealtimes are no exception. Belinda elaborates on some key challenges:

• Difficulty with transitions: Moving from one activity to another, like playtime to the dining room, can be tough.

• Communication barriers: An inability to communicate wants, needs, or feelings can lead to frustration, resulting in tantrums or meltdowns.

• Sensory sensitivities: Children can be hyper- (overly responsive) or hypo-sensitive (under-responsive) to tastes, textures, smells, or even the sounds of eating.

• Insistence on sameness: A strong need for predictability can cause stress when unexpected changes occur.

As Belinda puts it, "All these combined together leads to cumulative build-up of anxiety and frustration affecting the child being able to tolerate multiple different routines in a day, and often lead to accumulation of things to tolerate even before mealtimes." This means a child might already be overwhelmed before even sitting down to eat.

Casandra notes that these behaviours can lead to rigid food preferences, refusal to try new foods, or only eating in very specific ways, impacting nutrition and creating tension at the table. Addressing both the behavioural and nutritional aspects together is vital for making mealtimes more positive and manageable for everyone involved.

Common Nutritional Concerns We See

When it comes to nutrition, both experts frequently encounter specific issues.

• Limited Food Variety: Casandra often sees children with highly restricted diets, preferring only certain textures or colours. This can lead to significant gaps in essential nutrients like fibre, iron, or calcium.

• Constipation and Weight Issues: These dietary restrictions can contribute to constipation, poor weight gain, or an over-reliance on low-nutrient foods.

• Avoidance of Food Groups: Belinda highlights that some children completely avoid entire food groups, like proteins or vegetables.

• Over or Under-eating: She also points out issues with portion control. For example, a child who only likes crunchy snacks might eat a lot of them, as they are often high in calories but not very filling, risking overeating without feeling truly satisfied.

Both experts stress that every child is unique, making individualized assessment and small, realistic steps crucial for progress.

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Stay tuned for Part 2, where we'll explore specific strategies for approaching selective eating, effective behavioural techniques, and how to assess the underlying reasons behind picky eating!

Edited by: Raja Nishah