Feeding Behaviors Among Children With Autism Spectrum Disorder

Background: Feeding difficulties are a prevalent and significant concern among children with autism spectrum disorder (ASD), affecting their nutritional status and overall health. The objectives of this study were to identify difficult feeders amongst ASD children under our follow-up, to describe the multifaceted nature of feeding difficulties in these children, to ascertain if these findings were similar to those in other populations and finally to identify children who are underweight and obese whilst looking at the correlation to feeding struggles. Children with ASD often exhibit a range of feeding difficulties, including food selectivity, mealtime behaviors, and sensory sensitivities. These challenges are commonly associated with the fundamental characteristics of ASD, including repetitive behaviors and sensory processing issues. These traits can result in strong preferences for food textures, colors, or types, as well as aversions to others. Methods: This is a cross-sectional study of children diagnosed with ASD between 1 and 7 years on follow-up at the Child Development and Rehabilitation Center (CDRC), Hospital Tunku Azizah, Kuala Lumpur between October 2022, and August 2023. The Brief Autism Mealtime Behavior Inventory (BAMBI) and Montreal Childrens Hospital Feeding Scale (MCH-FS) were used to assess childrens mealtime behaviors. BAMBI contains 18 items which are scored by parents on a one to five-point Likert scale. It entails domains of limited food variety (eight items), food refusal (five items) and features of autism (five items). MCH-FS contains 14 items which are scored by parents on a one to seven-point Likert scale. It entails domains of parental concern (three items), family reaction (two items), compensatory strategy (three items), appetite (two items), mealtime behavior (two items), oral sensory (two items) and oral motor (two items). Results: The sample consisted of 70.7% male and 29.3% female children from numerous ethnic backgrounds. Most of the children were ASD level 2 and had received the diagnosis of ASD at an average of 40 months. Among the 341 children, 72.7% (248) parents reported feeding difficulties on the BAMBI and 44.6% (152) on MCH-FS. The BAMBI mean total score of 41.46 was comparable to similarly studied Asian populations but was significantly lower compared to Western populations. This suggests cultural similarities of feeding challenges amongst Asian ASD population. Understanding cultural differences in caregivers beliefs and feeding styles can improve the effectiveness of feeding strategies. We also found that higher levels of repetitive restrictive behavior (RRB) were associated with a greater likelihood of feeding difficulties. These findings imply that interventions addressing RRB should be considered for their possible benefits on tackling feeding difficulties. Restricted food intake can lead to nutritional insufficiency if the types and variety of the food remain limited. Interestingly, 25.2% (86) of the studied population were underweight (body mass index (BMI) < fifth percentile) whereas 9.1% (31) were categorized as obese (BMI > 95th percentile). The median BAMBI score was higher in the overweight and obese group, indicating more severe feeding behaviors. This statistically significant difference indicates BMI may have an influence on the overall outcomes measured by BAMBI. Conclusions: Problematic feeding behavior is a major problem amongst ASD children, and limited food repertoire remains the highest reported domain. BAMBI and MCH-FS questionnaires provide excellent overview to identify feeding difficulties amongst children with ASD. Identifying causative domains of the behavior enables clinicians to establish focused interventions in managing difficult feeders. Int J Clin Pediatr. 2024;13(3):73-85 doi: https://doi.org/10.14740/ijcp547