DALLAS — Dysphagia is common in children with autistic spectrum disorder, presenting nutritional deficiencies that can affect growth and development and health in general, Dr. Rhonda S. Walter said at a conference sponsored by the American Society for Parenteral and Enteral Nutrition.
Dr. Walter, chief of developmental pediatrics at Alfred I. duPont Hospital for Children in Wilmington, Del., noted that improving nutrition in ASD children is challenging because dysphagia presents in various ways, including food selectivity or refusal and disruptive mealtime behavior. It commonly involves GI conditions like reflux, constipation, absorptive function or leaky gut, as well as biobehavior issues such as disordered attention regulation, rigidity, and sensory processing/integration disorder. Constipation is the most common GI complaint, with up to 37% of ASD children presenting with this problem.
“The main question is whether the eating disorder is attributable to autism or concomitant with associated medical disorders,” Dr. Walter said, stressing that improving nutrition in ASD children often requires a multidisciplinary team approach to evaluate the dysphagia and devise a treatment plan that emphasizes a whole child approach to managing GI problems, improving nutrition, and advancing food intake at feedings.
Assessment goals include documenting safety of swallow function, assessing the need for diet/food modification, identifying supplemental nutritional supports, diagnosing GI symptoms contributing to eating problems, and formulating objectives for achieving desired outcomes.
A treatment plan includes managing GI conditions and improving nutritional deficiencies with diet and supplements, as well as devising strategies to help parents overcome mealtime behavior issues.
She explained that autistic children may have an underlying sensory processing disorder that prevents normal organization, integration and use of stimuli from the environment, resulting in over- or underarousal of senses, learning problems, disruptive mealtime behavior, and inadequate food intake.
The inability to organize information may manifest as obsessive/compulsive food aversions, such as white things touching green things, Dr. Walter said. “Many kids are not organized enough to sit in a chair or sit and gaze at their food,” she added, noting that mealtime can take 40–60 minutes.
Treatment aimed at advancing feedings typically involves giving an appetite stimulant such as cyproheptadine or megestrol and desensitizing the child to food offered, noted Dr. Walter. “This is a field that begs to be standardized,” she added.
She stressed that behavioral strategies must correlate with developmental rather than chronologic age and recommended achieving food volume with lower texture form before upgrading to next—applesauce to apple pieces—and introducing new foods with familiar texture level or pairing them with familiar tastes.