Feeding Challenges In Children With Autism.

Every parent faces feeding challenges with their child, but when it comes to an autistic child challenges are manifold. Children who come under ASD face challenges in verbal and non-verbal communication. ETV Bharat Sukhibhava was in conversation with Arthi Gavatre, Occupational Therapist, Osmania Hospital, Hyderabad, and she helps us understand the feeding challenges in children with Autism.

Autism spectrum disorder is a developmental disorder. About 1 million children are diagnosed with autism every year in India. Children on the spectrum are characterized by challenges in verbal and nonverbal communication, social interaction, repetitive behaviors, and obsessive interest. Apart from this, they also have feeding and gastrointestinal issues. About 46-89% of children on the spectrum are found to have feeding problems. Studies have shown that children with autism are five times more likely to have feeding issues than typically growing children.

Ms. Arthi Gavatre, Occupation Therapist opined that "We commonly come across feeding problems like selective eating or refusal to eat based on texture. Most of the time their diet is far away from a balanced diet. They might just be eating junk food for most meals in a day. What does this lead to? Of course to gastrointestinal issues like bloating, constipation, leaky gut, allergies, diarrhea leads to irritability, sleep issues".

We all know that the brain has a direct impact on our stomachs. For example, just a thought of food secrets digestive juices or makes us hungry. But can the gut affect the brain or cognitive activity? Ayurveda, a very ancient science states, the digestive system is the source of energy and also diseases. A study conducted by Institut Pasteur has found evidence that the gut microbiome plays a role in brain function and mood regulation. Researchers are now studying this connection as a cause and reason for symptoms that are seen in children with autism.

What are the factors that affect gut microbiomes in infants?

As per Ms. Arthi Gawatre, a review of papers on evidence on early-life microbiota development and factors influencing its development before, at, and after birth was studied by Vyan Vandenplas and the team. They found the factors as follow:

1 Genetic background

2 Prenatal factors: maternal diet, obesity, smoking, use of antibiotics during pregnancy.

3.Mode of delivery Vaginal delivery exposes infants to the mother's diverse microbiota and helps diversify further. Infants born by a c-section lack that exposure.

4. Breastfeeding stimulates the most balanced microbiome development in infants.

How can we help develop a healthy microbiome?

Ms. Arthi Gawatre advised, as a parent, we need to ensure that children

1. Eat healthy food
2. Good quality sleep
3. Physical activity daily.
4. Healthy bowel habits

But this is not as easy as it seems. It can be overwhelming for the parents to tackle the feeding issues without professional help.

Occupational Therapy interventions

• Feeding is a sensory-rich activity. All our senses spring into action. But children on the spectrum may have challenges with these sensory inputs. They may not like the texture and smell of food or maybe irritated due to the sounds in the kitchen.
• Occupational therapists can help plan sensory strategies to make mealtime pleasant for both parents and children. These strategies can be infused with a child's daily routine.
• Introduction of non-preferred in a stepwise manner and in small quantities along with preferred food items. Studies have shown that it takes 11-15 exposures to new food items to be accepted.
• Proper positioning while sitting for a meal. If seated on a chair, feet should be well supported.

Proper Eating Position

• Bowel intervention: to avoid constipation or leaky gut. Maintaining a voiding diary. Use of positive reinforcements like stickers to encourage regular bowel movement or to avoid soiled underpants. Proper posture for voiding.
• Encouraging and giving opportunity for self-feeding: Use of adaptive utensils to help children self-feed. Different types of spoons, sippers, and straw bottles can be used.
• Maintaining a food diary and meal routine: A food diary helps in knowing the effect food has on a child. A meal routine helps set a healthy eating schedule with a regular interval of no snack and juice in between.
• Use of play to introduce children to food items, texture, and smell. Behavioral changes: like no gadgets while mealtime, more water, and less milk and juice, proper sleep routine.

For more queries, you can reach out to Arthi Gavatre, arthi.gavatre@gmail.com