Identifying a Pediatric Feeding Disorder in Patients with Autism
Parents have long known that trying to get kids to eat well can be an uphill battle. Among children with autism spectrum disorder (ASD), that battle can be intensified. In fact, paediatric feeding disorders may affect1 up to 25% of normally developing children and up to 35% of children with neurodevelopmental disabilities. Therefore, it can be crucial for physicians to identify feeding disorders in kids with ASD in order to ensure proper food consumption, nutrition and healthy growth.
Since children with ASD can display inappropriate mealtime behavior that interferes with food consumption and proper nutrition,2 it can be difficult to distinguish between behaviours that may prevent a child from consuming enough calories or nutrients for proper growth and a true feeding disorder. Is a patient on the autism spectrum a picky eater who limits food by choice due to behavioural issues with food texture or taste or other problems, or do they have a feeding disorder?
Symptoms of a paediatric feeding disorder can mimic those of a child with ASD, such as:
- A change in eating habits or ritualistic habits around food
- Delayed self-feeding skills
- Weight-loss or failure to gain
- Choking or coughing during eating
- Unexplained fatigue and lack of energy
- Disruptive behaviour during mealtimes
In fact, ASD can make diagnosing a feeding disorder or the evaluation for a possible feeding tube a tougher call and possibly lead to misdiagnosis, delayed diagnoses and inappropriate interventions.
"PAEDIATRIC FEEDING DISORDERS MAY AFFECT1 UP TO 25% OF NORMALLY DEVELOPING CHILDREN AND UP TO 35% OF CHILDREN WITH NEURODEVELOPMENTAL DISABILITIES."
What Factors Can Help Identify a Feeding Disorder?
Intervention for challenging feeding behavior in children with ASD typically begins with a screening for underlying GI problems and oral or motor issues. This can enable physicians and parents to confirm that the reasons for the childâs problems are behavioral3 rather than physical.
For instance, a child could have gluten or dairy allergies and associate eating certain foods with pain and constipation. A child could have a motor deficiency like a weak jaw that hurts when chewing crunchy foods, or a structural issue like an ulcer in the oesophagus that can cause burning and pain when eating spicy or acidic foods. Children with ASD also can have sensory issues to foods that make a loud noise when eaten, foods with textures that are unappealing, either soft or hard, or unfamiliar foods.3
A complete medical assessment with feeding and swallowing evaluation can be crucial to identifying a feeding disorder or the need for a feeding tube in children with ASD, along with behavioural assessments surrounding food refusal or restrictions. Occupational or speech evaluations can assess oral motor abilities, neurological problems and oral motor function.
Physicians may be able to discern ASD behaviours from feeding disorders through a thorough review of medical records and conducting relevant clinical assessments, such as:
- Review medical and developmental history, growth and symptoms
- Review the childâs dietary intake from a registered dietitian
- Review evaluations by psychologists, occupation or physical therapists
- Perform barium swallow testing or endoscopy assessments as needed
- Review gastro disorders such as reflux, constipation and delayed emptying
- Run appropriate lab work to rule out medical conditions that could be responsible for feeding problems.4
Diagnosing feeding disorders or the need for a feeding tube in children with ASD is undoubtedly challenging. It may be feasible to identify disorder and the necessary intervention through a comprehensive evaluation and an understanding of the overlapping behaviours of children with ASD and those with a feeding disorder.
References
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851259/#b1-pch03021
- https://www.kennedykrieger.org/patient-care/patient-care-programs/continuums/pediatric-feeding-disorders-continuum
- https://iancommunity.org/ssc/feeding-problems-children-autism
- https://www.urmc.rochester.edu/childrens-hospital/developmental-disabilities/conditions/feeding-disorders.aspx