Is Your Autistic Child a Picky Eater, or is something else going on?

As Thanksgiving approaches, we want to talk about something important: autistic people's relationship with food.

After spending hours and hours preparing a Thanksgiving feast for your family to enjoy, it can be frustrating when your child refuses to take a bite of their dinner (besides nibbling on a dinner roll).

Before jumping straight to punishing them, it might be a good idea to take a step back and look at the big picture. Are they actually a picky eater, willfully being difficult just to make you (the parent or grandparent) upset? Maybe not.

There can be other reasons why a child (especially if they have autism) might struggle to eat different foods. Some of these reasons you may have heard about, but maybe not! Many kids with autism also struggle with ARFID or PDA, and those can have an impact on their eating habits.

You can't always tell what might be making it hard for them from across the table. However, the good news is that the same response can help: less pressure, more patience, and a seat at the table no matter what's on (or not on) the plate.

(Author's Note: There are a lot of topics in this article, so buckle up for an info dump! :)

Before Assuming Your Autistic Child's Diet is Behavioral, Rule Out SIMPLE Medical Issues First

Sometimes it's easy to forget that our non-verbal or semi-verbal children can't always tell us exactly what's wrong. If they're suddenly not eating foods (even their favorites) take them to the pediatrician to rule out a sore throat or gastrointestinal issues. Behavioral intervention will do no good if they're simply not eating because it hurts to swallow, or they have a blockage in their GI tract.

Almost 5% of all pediatrician visits are attributed to constipation, so that is a common problem with all children. And if their tummy hurts, they may not want to eat. Please visit your doctor if it feels like something is wrong.

If these (relatively) easily fixable medical reasons are ruled out, read ahead to some other reasons why your child might have a hard time eating, even when there is a multitude of choices at the Thanksgiving Dinner table.

What typical picky eating looks like

Picky eating is common, especially in toddlers and young kids, and most children grow out of it. A typically picky eater has strong opinions about food, but their eating still works for them.

They usually will eat a decent range of foods (even if that range is shorter than the parent would like to see). Your child might complain, negotiate, or push food around their plate, but not panic. It's also common for them to try the new food if they've seen it a few times, or eat more of their food when they're hungry even if it's not their favorite.

As long as their energy levels are up and they are having regular bathroom breaks, their diet may not be a huge worry.

A picky eater might grumble about green bean casserole and then fill up on rolls and pie. That's frustrating for the cook, but it's pretty normal childhood behavior.

What is ARFID is, and How Do I Know If My Child Has It?

ARFID stands for Avoidant/Restrictive Food Intake Disorder. It's a recognized diagnosis in the DSM-5, and it has nothing to do with "being difficult" or even body image or wanting to be thin. It goes well beyond picky eating because the restriction affects a child's health, growth, and/or daily life.

The common symptoms of ARFID in kids are:

SENSORY ISSUES/SENSITIVITY

Certain textures, smells, colors, or temperatures feel genuinely intolerable, not just unpleasant. Mashed potatoes with the skins left in might just be a gag reflex waiting to happen.

FEAR OF A BAD OUTCOME

After choking, vomiting, or a painful experience, some kids become afraid that eating will hurt them again and will go to extreme measures to avoid repeating that experience.

LOW INTEREST IN FOOD

Some kids rarely feel hungry and find eating more of a chore than a pleasure.

The key difference is this: a picky eater won't eat the stuffing. A child with ARFID often can't, even when hungry, even when bribed, even when they want to please you. When urged or forced to eat a non-preferred food, the child may gag, panic, or start crying or having a meltdown from the stress.

Children with ARFID probably have a very short list of foods they will eat. These are often referred to as "safe foods." Sometimes their safe foods are a particular brand of food prepared one particular way.

ARFID will often affect the child's growth and overall health and well-being because they are unable to feed their bodies properly. ARFID is diagnosed by their doctor, who can come up with a game plan for treatments to improve their health. Their care team will often consist of help from a pediatrician, feeding therapist, occupational therapist, dietitian, and/or psychologist.

The best way to treat ARFID is not going to happen by having an argument at the dinner table on Thanksgiving. If you are worried about what other family members will say, make sure to inform them ahead of time of your child's challenges: that it's a real disability, and they're not just being "naughty."

Can Adults Have ARFID too?

Definitely! ARFID isn't only a childhood condition. Many adults live with it too, and some were simply labeled "picky" their whole lives because the diagnosis didn't exist when they were growing up. Grown-ups with ARFID often carry years of embarrassment about food, and holiday meals can bring up the same old comments they heard as kids. That aunt who quietly sticks to rolls and plain turkey deserves the same patience and the same no-comment courtesy as the youngest guest at the table.

What PDA is, and why mealtimes can be hard because of it

PDA stands for Pathological Demand Avoidance. (Many families and advocates now prefer the name Persistent Drive for Autonomy.) It's usually described as a profile within autism rather than a separate diagnosis, and it isn't listed in the DSM-5, so you'll hear different terms from different professionals.

Simply put, PDA is an anxiety response. Everyday demands, even small or pleasant ones, can trigger a feeling of losing control that sets off fight, flight, or freeze. That includes demands that you've seen the child do/accomplish before, which can at first feel confusing when they suddenly seem to hate the idea of your request.

At Thanksgiving, demands are everywhere:

"Come sit down, it's time to eat."

"Try a little of everything."

"Say thank you to Grandma."

"Finish your plate before dessert."

To a child with a PDA profile, telling them to do something directly can feel like a real threat. Their brain immediately goes into fight or flight mode, and it actually hurts them to do what they're told. It may sound silly, but it's truly a profile of autism that is fairly common. They might refuse a food they actually love, simply because someone told them to eat it. They might argue, joke, change the subject, hide under the table, or have a full meltdown. To the parent, it may seem out of the blue or totally blown out of proportion, but it's a real anxiety disability that causes extreme reactions to demands.

This isn't due to defiance or a result of bad parenting. (You're doing great, I promise!) A child with PDA often eats best when food is simply available, nobody is watching, and the choice is fully theirs. For more information about PDA, you can read our article here.

Autism and food sensitivities are More Common than You think

Food challenges are especially common among autistic kids and adults. Research suggests autistic children are around five times more likely to have feeding difficulties than their peers, and ARFID shows up far more often in autistic people than in the general population.

It's hard to pinpoint an exact number, but experts estimate around 50-90% of people with autism also have food sensitivities. So if you're a parent feeling frustrated about their lack of variety in their diet, you're not alone!

Many autistic people experience sensory input more intensely, so a lumpy texture, a strong smell, or two foods touching on the plate can feel overwhelming - rather than merely unpleasant.

Predictability matters too. A familiar food, prepared the same way every time, offers the predictability that is comforting to autistic people. It's something they can count on when their day may already be loud, crowded, and full of unpredictable changes. At a holiday gathering, that safe food can grant them something that is familiar and comforting. Instead of insisting they are stubborn, take a step back. Letting them eat those chicken nuggets instead of the Thanksgiving turkey might help them feel included and able to enjoy the family atmosphere.

Why pressuring your child to eat Can backfire

Pressuring your child to eat rarely works, even if you're just dealing with picky eaters. For kids with an actual disability like ARFID or PDA, it can make eating harder for weeks or even months after the holiday is over. Anxiety shuts down appetite, and a stressful meal teaches a child that the table is not a safe place.

Here are a few well-meaning phrases that are worth retiring for good.

Don't say: "Eat just one bite!"

Try saying nothing at all. Just let the food be there on the plate (or next to their plate) so they can get used to it.

Don't say: "You'll eat it if you're hungry enough."

Actually, they won't eat if they're hungry enough. Feed them their preferred foods so they get the calories they need. You can leave their plate on the table for a little longer and say instead, "There's plenty here whenever you want it."

Don't say: "You're being rude to the cook. They worked hard on this meal!"

Say instead, "I'm so glad you're here with us." It can take the pressure off and keeps their mind calmer.

Don't say: "In my day, I ate what my mom cooked or I went to bed hungry."

Another way to guilt them and make them feel bad? Leave that saying in the past, (just like that old practice). Instead, include them in familial conversations: "What's your favorite part of Thanksgiving?" or "What are you thankful for?"

Don't say: "No pie until you finish your plate."

This can cause anxiety and pressure to eat food that can cause extreme physiological reactions, as well as resentment towards other family members who do get to eat pie. Just say, "Pie is on the counter for everyone later!"

Don't say: "Look how much your cousin is eating!"

Skip the comparisons entirely.

The most helpful thing many relatives can do is simply stop commenting on what a child eats. Talk about anything else!!

How to help Your Autistic Child if they're a picky eater on Thanksgiving Day

You don't need to know a child's diagnosis to be kind about food. These ideas help every kind of eater to not feel shame around food & eating.

If you're hosting,

ask the parents ahead of time if there's a safe food you can have on hand, or welcome them to bring their own. Let the safe food sit on the table like any other dish (no special announcement needed). Try serving the meal buffet or family style so kids can choose what lands on their plate. For bonus points: offer a quiet room for anyone who needs a break from the noise/overstimulation.

If you're a relative or guest,

Refrain from commenting on a child's plate, portions, or choices, whether positive or negative. There's no reason to do so. Trust the parents. They know their child far better that one holiday meal can show, especially when being surrounded by more people than usual can cause heightened anxiety to begin with.

Connect with the child in other ways, such as playing a game, taking a quiet walk outside for a break together, or ask about their favorite things. If a child leaves the table, let them go without making a scene. Let the parents decide to intervene or not.

If you're the parent,

and you anticipate your child refusing all foods offered at Thanksgiving dinner, you can try feeding them before you arrive so hunger doesn't add stress. Bring their safe foods, even if you're afraid of being judged. Your child needs to eat more than you need to give into peer pressure. It's totally okay to give relatives a heads-up ahead of time, with one simple ask, like "Please don't comment on what she eats."

Plan an exit route and a spot to take a break if needed.

Building a healthy relationship with food, all year long

Recently I was ordering some dinner for my oldest son and his friends. When McDonald's was presented as an option, one girl said she couldn't eat McDonald's because it would make her fat. She was 11. It broke our hearts to hear that kind of talk from someone so young... because you know she had to learn it from somewhere.

The way adults talk about food shapes how kids feel about eating for years to come. Eating disorders can have many causes, not necessarily always caused by the home's environment or parents' comments. But a calm, shame-free food environment gives every child (picky or not) a strong foundation to build on.

Try these practices at home:

Share the job. 

Adults decide what food is offered and when. Kids decide whether to eat and how much. This approach, known as the Division of Responsibility, takes the power struggle off the table. Clear responsibilities for each family member can help lighten everyone's mental load.

Drop the "good" and "bad" labels. 

All foods can fit in a balanced diet. Calling foods junk or sinful teaches kids that eating them makes them bad. Instead, teach them which foods have more nutrients and tell them to "listen" to their body and how it feels after eating certain foods (such as which foods make them feel sluggish and which foods give them more energy).

Don't use food as a reward or punishment. 

Dessert isn't something to earn, and it shouldn't be taken away for misbehavior. (Note: Giving a treat as a reinforcer can be used in ABA therapy, within reason.)

Trust hunger and fullness. 

Let kids stop when they're full, even if food is left on the plate. Let them "listen" to their body to tell them when they are full, instead of teaching them to eat even when they are stuffed.

Skip body talk. 

Avoid comments about anyone's weight or size, including your own. Kids notice when adults diet, skip meals, or call themselves "bad" for having seconds. Bodies come in all shapes and sizes, and everyone has space in this world.

Model enjoyment. 

Eat a variety of foods yourself, and let kids see you relaxed and happy at the table.

Visit the doctor periodically.

Your child's pediatrician will have the best insight into your child's health. They can track progress, growth, and levels in the body, and can bring up any concerns that may arise. It's okay to ask your doctor if your child is getting enough nutrition and get recommendations. If your child listens to the doctor, you can have them tell them directly what they could be improving (if needed).

Swap the bad talk for something better!

Don't say "That's junk food."

Instead, say: "That's a sometimes food, and it's fun to have today."

Don't say: "You have to clean your plate before you can leave the table."

Instead, say: "Listen to your tummy. Are you full or still hungry?"

"Don't say: "Don't you think you've had enough?"

Instead, say: "There's more later if you're hungry then."

Don't say: "I'm being so bad eating this pie!"

Instead, say: "This pie is delicious. Grandma's recipe is the best. I'm glad we get to enjoy it today!"

Don't say: "You'll have to work this off tomorrow."

Instead, say: "Let's go for a family walk after dinner. It's a tradition!"

Don't say: "Wow, look at how much weight he's gained."

Instead, say: "It's so good to see you!"

If a child starts to show worrying signs, like intense fear of certain foods, secretive eating, or distress about their body, reach out to their pediatrician early. Getting help sooner makes a big difference.

Making them feel like they belong matters more than the menu

Thanksgiving is about gratitude and being together, not about who cleaned their plate. A child who eats only rolls but laughs with their cousins had a good Thanksgiving. A child who ate everything but cried in the car afterward did not.

Whether the kid at your table is a classic picky eater or is living with ARFID or PDA, they need the same things from the adults around them: patience, trust, and the message that they belong here exactly as they are.

Autistic children might be picky eaters more often than their neurotypical siblings, but they still deserve respect and trust.

If you're worried about a child's eating, the best next step is a conversation with their pediatrician, not a showdown over the sweet potatoes. This year, let's make room at the table for every kind of eater.

Nova Supports is dedicated to giving everyone the Space to Thrive, which means everyone is valued and deserves to exist just as they are. If you'd like us to join your autistic child's care team through ABA therapy, send us a message.