Food selectivity affects a large majority of autistic children, to the point of being one of the major concerns for parents. A child who only eats a few foods, who categorically refuses anything new, who cannot tolerate certain textures: this situation generates worry about the child's health and stress during meals. However, adapted strategies can gradually expand the food repertoire while respecting the child's sensory peculiarities.

Understanding Food Selectivity

The food selectivity of autistic children is not a whim but the consequence of neurological peculiarities. Sensory hypersensitivities – tactile, taste, olfactory – make certain textures, flavors, or smells difficult or even unbearable. Resistance to change and the need for predictability lead to sticking to known and safe foods. Difficulties with oral motor skills can also limit the ability to chew certain foods.

Other factors may contribute: past or present gastroesophageal reflux that associates eating with discomfort, difficulties in interoception (perception of internal signals of hunger or fullness), or rigid rituals around food (same plate, same presentation, same order). Understanding these mechanisms avoids blaming the child or the parents and directs towards suitable solutions.

Manifestations of Selectivity

Food selectivity can take various forms. Some children only accept specific textures: smooth (purees, compotes), crunchy (chips, cookies), or soft (white bread, overcooked pasta). Others refuse mixed foods and want items separated on the plate. Color can play a role: some children only eat white or beige foods. Temperature, smell, or a specific brand of a product can also determine acceptance or refusal.

Principles of Gradual Expansion

Do Not Force

The first fundamental principle is to never force the child to eat. Coercion creates negative associations with food and increases resistance. It can also provoke vomiting, more intense avoidance behaviors, and generalized anxiety around meals. The goal is for the child to develop a positive relationship with food.

Proceed in Small Steps

Expanding the food repertoire is done in very small steps, spread over weeks or even months. Before eating a new food, the child must gradually familiarize themselves with it: seeing it in the environment, smelling it, touching it, bringing it close to their lips, tasting it, and finally swallowing it. Each step is validated before moving on to the next. Patience is key.

Start with Accepted Foods

New foods are introduced in connection with those the child already accepts. This "chaining" technique creates bridges between the known and the unknown. For example, if the child eats plain pasta, one can gradually add a drop of sauce, then a bit more. If the child eats dry cookies, one can offer cookies of a different shape before moving to another texture.

Practical Strategies for Meals

Create a Calm Environment

The atmosphere of the meal influences food openness. A calm, predictable, pressure-free environment fosters the relaxation necessary for exploration. Excessive distractions (television, tablet) can disconnect the child from their food sensations. A regular setting (same place, same time, beginning and end meal rituals) reassures the child.

Involve the Child

Involving the child in meal preparation can foster their interest in foods. Choosing vegetables at the market, helping to wash or cut (depending on age), stirring a preparation: these activities familiarize the child with foods without the pressure of consumption. Culinary play, outside the meal context, desacralizes food.

Adapt the Presentation

The presentation of foods can facilitate or block their acceptance. Some children prefer foods separated on compartmentalized plates. Others accept smaller quantities better than a full plate. Consistency in presentation (same cut, same arrangement) reassures. Conversely, slightly varying the presentation of an accepted food can help develop flexibility.

Managing Sensory Aspects

Identify the Sensory Profile

Understanding the child's sensory profile guides food choices. A child hypersensitive to touch may prefer smooth or distinctly crunchy textures, avoiding slimy or grainy ones. A taste hypersensitive child will react intensely to strong flavors. Identifying these preferences allows for proposing foods more likely to be accepted as first bridges towards diversification.

Work on Sensory Skills Outside Meals

Sensory activities around food, outside the meal context, can help familiarize with textures and sensations. Playing with modeling clay, manipulating various materials, doing messy activities prepares the sensory system. These non-food exposures reduce overall sensory reactivity and subsequently facilitate food exploration.

Ensuring Nutritional Balance

Work with Constraints

While waiting for the repertoire to expand, it is necessary to ensure nutritional balance with the accepted foods. A dietitian can help optimize intake with a limited choice of foods. Vitamin supplements can compensate for certain deficiencies, with a medical prescription. The goal is to maintain the child's growth and health without adding pressure to meals.

Avoid Pitfalls

Some strategies are counterproductive: hiding vegetables in other foods risks destroying trust if the child notices; bargaining ("if you eat your vegetables, you will get dessert") creates a hierarchy that devalues the "to eat for" foods; comparing with other children humiliates and increases resistance. Patience and positivity are the best allies.