Picky Eaters vs. Sensory Eaters in Neurodiverse Children

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Most young children go through food jags — periods of picky eating where they will only eat one food or a small selection of foods for days or weeks at a time. This is a normal and usually short-lived behavior in children as they learn to exert their independence.

Picky eating is prevalent in children with neurodiverse conditions, but it can be longer-lasting. Moreover, some neurodiverse children have a more extreme form of restricted eating, known as sensory eating. It’s helpful to educate parents about the differences between picky and sensory eaters and how to support each situation.

 

Neurodiversity and Picky Eating

Most young children will outgrow their tendency toward picky eating by the end of their elementary years. They gradually accept a broader range of foods and the meals that their parents or caregivers serve. Still, some children are longer-term picky eaters. Research shows that these children often have parents or caregivers who are picky eaters, suggesting both genetic and environmental contributors. A lack of experience early on with various tastes, textures, and smells can lead to picky eating later in life.1

Picky eating in children with attention-deficit hyperactivity disorder may also be related to low levels of dopamine activity in their brains.2 Dopamine is the brain chemical responsible for feelings of pleasure and reward, and these children may be chemically wired to seek more dopamine from certain foods, such as sugar.2 Low dopamine levels may lead a child to push away nutritious foods like vegetables or protein because these do not deliver the sugar and dopamine rush that the ADHD brain craves.

 

The Difference Between Picky and Sensory Eating

Children with neurodiverse conditions may also exhibit sensory defensiveness, which is more than “picky eating.” A particular taste, smell, texture, temperature, or food color provides a sensory overload which can make the children feel like the sensory experience is “hurting” them. The experience can be so overwhelming that exposure to it can repulse, panic, or sicken a child.3

Sensory overload can come in different forms. Two commons are:

  • Texture sensitivities. Here, children can handle certain textures, such as smooth, pureed foods like yogurt or pudding, but foods like chips or a slice of turkey make them gag.
  • Flavor or smell sensitivities. Children sensitive to flavor can experience a meltdown or have a physical reaction because they view certain foods as too sweet, spicy, salty, etc. Children with flavor or smell sensitivities might choose to avoid eating to prevent physical or mental pain they associate with the food.

Over time, more negative behaviors around eating may develop. A neurodiverse child with eating challenges might begin to fear more foods or mealtimes in general. As they associate eating a wider range of foods with a negative experience, they might often refuse to eat.1

Parents or caregivers who worry about whether their child is a picky or sensory eater should consider these factors.

Is their “acceptable foods” list getting longer or shorter?

All children experience eating jags, where they always ask for one food, and suddenly they don’t want it. Picky eaters will return to that food again after a while, so their food repertoire expands over time. However, sensory eaters may never eat the food again. They slowly whittle away at acceptable foods until the list includes less than 10 or 20 foods.

Can they watch others eat food they don’t like?

Picky eaters don’t mind — if they don’t have to eat the offensive food. But sensory eaters will gag or even vomit just watching others eat food they don’t like. Sometimes this behavior comes from forcing a child to eat food they don’t want.

How are mealtimes?

A picky eater can tolerate new foods on a plate—even if reluctantly. A sensory eater “falls apart” when presented with new foods and refuses to eat.

Strategies For Supporting Sensory and Picky Eaters

For children who are sensory eaters, mealtimes often become a struggle between the child, family, and food. But enforcing strict food rules is never the solution because the child’s fears about eating may worsen. If they believe a food causes pain, it will not matter how hungry they are. They’ll refuse the food to avoid the pain. Instead, parents or caregivers should avoid pressure and introduce new foods in a supportive way.

Pediatric dietitians, speech pathologists, and clinicians who specialize in working with neurodiverse children recommend a stepwise approach to encourage children to expand their food choices. Healthcare providers can work with parents on implementing these strategies to support a child with sensory eating issues:4

  • First, encourage parents and caregivers not to pressure the child. As scary as it is to hear a diagnosis of “failure to thrive,” placing added pressure will not help. Forcing a child to eat only serves to increase the fears around food.
  • Address the sensory eater’s fears, discuss them openly, and validate them by letting the child know you understand how hard it is for them to eat certain things, and that’s OK.
  • As children get older, their sensory system naturally matures. Introduce new foods in small amounts as they seem ready. But be aware the fear and behaviors the child developed over the years might remain, so feeding must go slowly.
  • Try a chart system to break new food introduction into smaller steps. For example:
    • Monday: Smell the food
    • Tuesday: Kiss the food (or touch to lips)
    • Wednesday: Lick the food
    • Thursday: Hold a bite of food in their mouth
    • Friday: Chew a bite and swallow
    • Saturday: Provide a reward for their efforts

After their child has successfully chewed and swallowed that initial bite, parents can suggest they take one bite of the new food every day. Then the next week, two bites, and so on, until they eat an acceptable amount to incorporate into meals. The goal is to decrease the child’s discomfort and slowly lessen their fear.

  • The “trying plate” is another variation of this method. This plate is separate from regular mealtime plates. Place new foods on the “trying plate” and allow them to take bites when ready. The “trying plate” can be used at one meal per day unless the child is prepared to try it for two or even three meals per day.
  • Finally, make food fun. Presentation often impacts a child’s decision to eat food. Cut food into funny shapes using cookie cutters or take a few seconds to make a fruit happy face on top of their pancakes. Serve vegetables with an assortment of tasty dips, so the child can choose and feel in control of the meal.

Many children automatically respond to a new food by rejecting it. Parents should be aware that it often takes an average of 15 times before they will accept it. It’s helpful to go slowly and reinforce to the child that “it takes time to learn to like new foods.”

These additional tips can help support general picky eaters and help them feel more comfortable trying new foods.

  • Encourage parents and caregivers to involve the child in food preparation by allowing them to play a part in meal planning, taking them to the grocery store, and participating in meal prep. Children are often more interested in food when they have ownership and pride in the meal.
  • To make it easier for the child to make healthy choices, ensure a variety of colorful, healthy foods are in the house and limit sugary beverages and non-nutritious foods.
  • As much as possible, structure meals around certain times and turn off outside distractions from cell phones or the TV.
  • Don’t be concerned with convention. It’s OK to have chicken for breakfast and eggs and bacon for dinner. In fact, for many children, mixed-up meals are a special treat.
  • Help parents and caregivers to promote positive thoughts and energy using techniques like encouraging the child to practice deep breathing at mealtimes and throughout the day and visualizing a positive image associated with eating the feared food.
  • Finally, praise the child for any progress, even touching, smelling, or licking a new food.

 

Eating and trying new foods is something most adults take for granted and enjoy, but it’s often a difficult struggle for children on the neurodiverse spectrum. These strategies can help empower parents, caregivers, and children to persevere patiently.

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REFERENCES:

  1. Mascola AJ, Bryson SW, Agras WS. Eat Behav. 2010;11(4):253-257.
  2. Johnson RJ, Gold MS, Johnson DR, et al. Postgrad Med. 2011;123(5):39-49.
  3. Baraskewich J, von Ranson KM, McCrimmon A, McMorris CA. Autism. 2021;25(6):1505-1519.
  4. Russin, L 2017 It’s Not ‘Picky Eating’: 5 Strategies For Sensory Food Sensitivities OAR. Accessed September 21, 2022 https://researchautism.org/its-not-picky-eating-5-strategies-for-sensory-food-sensitivities/