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

Part 2: Strategies and Techniques Welcome back to our series! In Part 1, we introduced Casandra Ang, a registered dietitian and the Managing Director of MyDietitianEats (MDE), and Belinda, a Program Supervisor at SEED Autism Services (SEED), and discussed how behavioural challenges impact mealtimes and common nutritional concerns. In this second part, we'll explore the gentle but effective strategies they use to approach selective eating and picky eating behaviours.

Approaching Selective Eating & Food Aversions

When a child is a selective eater or has strong food aversions, both experts emphasize a gentle, step-by-step approach focused on understanding the underlying reasons and building trust.

Casandra explains her process. First, she works to understand why a child avoids certain foods – whether it's due to sensory issues, established routines, or past negative experiences. The goal is to expand food variety in a way that feels safe for the child. This means starting with tiny modifications, like changing a food's shape, colour, or how it's served, to build flexibility while keeping the child comfortable. "We never force children to eat," Casandra states. Instead, the focus is on creating a positive mealtime environment through strategies like food play, repeated exposure, and letting the child observe others enjoying the food. "It takes time, but every small step matters," she affirms.

Belinda adds to this, highlighting the importance of investigating the root cause—be it biological, physiological, or behavioural—before developing individualized strategies. Building trust and a positive mealtime experience by keeping mealtimes predictable and low-stress is crucial.

Belinda suggests:

• Identifying safe foods: Foods the child consistently accepts.

• Presenting safe foods differently: For example, melting cheese or cutting it into different shapes.

• Selecting new foods similar to safe ones: For example, transitioning from French fries to baked sweet potato fries can offer the same crispy texture and familiar shape, while also providing more fibre and nutrients. These can still be lightly seasoned to the child’s preference, making the change feel less overwhelming but still nutritionally beneficial. Another gentle step might be moving from apple slices to pear slices — similar in crunch and sweetness, but just different enough to build flexibility.

• Allowing exploration through food play: Encouraging children to look, touch, smell, taste, and then finally try new foods without pressure.

• Involving children in food preparation: From grocery shopping to washing, cutting, and cooking—this helps build familiarity and comfort.

• For children with oral motor challenges, collaboration with dietitians and speech language pathologists is also essential.

Assessing Picky Eating: Is It Medical, Sensory, or Behavioural?

When a child is a picky eater, Casandra explains that understanding the underlying cause is key, as it's often a mix of factors - medical, sensory and/or behavioral.

Factors that may contribute to picky eating behaviors in children with autism.

Medical Causes: Sometimes, a child avoids food due to discomfort from conditions like constipation, reflux, or food sensitivities, even if they can't verbalize it.

Sensory Issues: Children might be highly sensitive to specific textures, smells, or colours. They might prefer only crunchy foods or avoid anything mixed or mushy, not out of stubbornness, but because of how their brain processes those sensations.

Behavioural Factors: Strong routines around food, difficulty with changes, or feeling pressured during mealtimes can contribute to resistance. Stress or negative past experiences with food also play a significant role.

"Understanding where the challenges come from helps us support the child in a way that’s realistic and respectful," Casandra explains.

Effective Behavioural Techniques for Restricted Diets

For children who refuse to eat or have highly restricted diets, both experts employ gentle yet powerful behavioural techniques designed to build trust and reduce pressure.

Positive reinforcement is all about making new foods a good experience for kids. This means praising them for even tiny steps, like just looking at, smelling, or touching a new food. These positive moments are unique for every child and can be anything from a simple "Good job!" to a quick play with their favorite toy.

Food chaining, or shaping, helps kids try new foods through tiny, gradual changes. You start with foods they like, then slowly introduce similar ones—maybe just a new shape or texture. This breaks down eating into small steps (look, touch, smell, bite), making new foods less scary and more approachable.

Repeated exposure - offering the same food multiple times without pressure to build familiarity.

Using visual aids like picture routines, "first-then" boards, or social stories also help provide clear expectations at mealtime and explain the benefits of eating different food groups. This consistency reduces anxiety and increases predictability.

Other important strategies include providing choices (e.g., "Do you want to try the carrot sticks or the apple slices?"), ensuring consistency and structure at mealtimes, modelling by therapists and family members, careful planning and keeping mealtimes calm, predictable, and low-pressure helps the child feel safe enough to explore at their own pace.

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Join us for Part 3 of our series, where we’ll discuss how to overcome challenges in changing eating behaviours, essential red flags to watch for, practical tips for parents, and the inspiring future of collaborative care.

Edited by: Raja Nishah