Coffee Break with Card: Interview with John's Hopkins Hospital Nutritionist

What are the most common struggles with nutrition that you see with your patients with autism?

The research suggests that children and adults with autism are at a higher risk for being at an unhealthy weight. Children with ASD are at increased risk for feeding problems, including:

• food selectivity

• rituals

• compulsive eating of specific foods

• gagging

• emesis

• pica 

• rumination

Some of the common nutrition struggles that parents have reported include “selective eating” related to food texture, taste, smell, and temperature, which can limit the foods that children will eat. There may also be disruptive meal time behaviors present. Additionally, parents have reported a primary reliance on “safe foods,” which tend to be foods such as French fries, chicken nuggets, pizza, and other processed foods. The reason why these foods tend to be considered “safe” to many children with autism is because they will most likely be consistent anytime you prepare or eat these foods. For example, chicken nuggets from a fast food restaurant will always taste the same, look the same, and smell the same, which some children with autism prefer rather than taking a “risk” of eating a blueberry, which could be sour, bland, sweet, mushy, or firm. Our fresh fruits and vegetables tend to be more variable in flavor and texture, which can lead to a general distrust of these foods if the experience differs significantly from time to time.

When would you recommend a family work with a Registered Dietitian?

A family should consider working with a Registered Dietitian if the foods your child will eat becomes more and more limited, such as excluding entire food groups (fruits, vegetables, meats, etc.) I recommend seeing a Dietitian if you observe large shifts in weight, such as losing weight or gaining weight. Additionally, if you have any questions about nutrition or healthy eating, as sometimes it can be challenging to find evidence-based answers online on many nutrition topics, a Registered Dietitian can help!

What does a Registered Dietitian do? How can caregivers or adults with autism find a qualified provider who is familiar with the needs of children and adults with autism?

A Registered Dietitian is a provider who can assess your child’s diet and meal patterns to evaluate areas where certain types of foods or beverages can be adjusted. Registered Dietitians also provide nutrition education to help you and your child learn more about healthy eating to support you and your child’s health. Many times, Registered Dietitians will work with you to set goals that you can work on between appointments, and evaluate progress in meeting those goals at a follow-up visit.
 
When looking for a qualified provider, look for a Registered Dietitian. A Registered Dietitian will have the credentials “RD” or “RDN” after their name. A dietitian who specializes in pediatrics for those under 21 years of age, or an adult Registered Dietitian for those >21 years of age would also be the best choice. RDs who provide outpatient services are most often at hospitals and sometimes can even have private practices as well. Dietitians go through many years in school and receive over 1,200 supervised practice hours of training in nutrition and are licensed health care providers. 

How does the work of a Registered Dietitian differ from the work of a feeding therapist?

A Registered Dietitian can help assess the quantity and quality of the foods and drinks that are consumed by your child. A feeding therapist will work with your child to initiate an “intervention”, where typically you would go into the appointment with hands-on time with the feeding therapist to aid in looking at, touching, and tasting new foods. A Registered Dietitian does not perform the intervention during appointments, rather, they can provide tips and tricks on nutrition topics, such as monitoring portion sizes, choosing the healthiest beverage, or providing recipes that incorporate new vegetables and fruits. 

What are things that caregivers can do at home to support the work being done by their Registered Dietitian?

An important point that I would recommend is to neutralize language around food and eating. For example, you may be someone who hates peas and the thought of eating a pea really grosses you out, your child may pick up on your body language or how you describe these foods, which can hinder progress in trying foods. Of course, parents, you are allowed to not like some foods, but simplifying language to “I do not like this” or “I’d prefer not to eat this” versus “Wow this food is so disgusting! I would NEVER eat that! This is horrible! Yuck! Nasty!” can help with limiting bias in language. Another point is that at times, it can be challenging for these children to try new foods. Empathizing with their struggles can help support their care. Try to refrain from the mindset of "They'll eat if they're hungry." Oftentimes, that mindset can set back their care.