Question 2 - Gina
posted by Unknown @ 8:07 PM
10 comments
ISU Dietetic Internship Journal Club
Objective: To become familiar with current scientific literature on a variety of nutrition topics and to gain experience in gathering, organizing, critically evaluating, presenting and facilitating group discussion of the literature and the implications to practice.
10 Comments:
I do think my perspective changed after reading the articles provided. It was surprising to me that according to the Hubbard et al. study, children with ASD are significantly more likely to refuse foods based on texture/consistency, taste/smell, mixtures, brand, and shape. I hadn’t thought that kids with ASD would have that much of an increased selectivity towards food. I felt that kids without ASD would be pretty comparable. I really enjoyed the guidelines provided by Berry and colleagues in the main article from the Academy. Particularly, Figure 4 would be especially useful for us, as future dietitians, should we ever encounter a pediatric ASD patient. Some of the questions that are recommended to ask parents are ones that I might not have otherwise considered asking. I will certainly keep those recommendations in mind if I ever work with a similar patient.
I think these articles pose many more aspects of sensory perceptions and characteristics of continuity/familiarity into the rationale for picky eaters than I had ever truly considered. Typically when I think of picky eaters, I think of increased exposure to different foods - similar to what Amanda discussed in her comment to question #1. These articles definitely opened my eyes to other factors that could be at play in food refusal for children, such as shape, brand, and certain foods mixed together.
The addition of ASD children within this study certainly highlighted various factors that contribute to food refusal and picky eating. One factor that I wish was discussed in these articles, however, was the prevalence of food allergies in the ASD population. I grew up with a friend at church who had a severe form of ASD. He was additionally challenged with multiple food allergies that limited his food availability even more than his sensory/textural preferences. I am curious to know if food allergies are highly prevalent in this population, which creates even more barriers to food refusal and nutrition interventions.
My perspective of “picky eaters” has not really changed after reading this article. However, I do have more of an understanding of why “picky eaters” are in fact “picky.” Understanding why a child is refusing certain food items is very important because if you can understand why the child does not like the food you can try to adapt it to a more pleasing or acceptable food choice. For example if texture is an issue the parents might purée certain food items for their child. I also think it is important for dietitians to learn more about children with ASD’s habits and particular preferences. I think some people do not understand why children with Autism get upset about certain things such as a food that is not the right temperature or texture. Having a better understanding of why these foods and textures upset the child will help the dietitian come up with a better care plan and diet for this child. If the dietitian is willing to learn about the child’s habits I think adherence rates for particular diets will improve.
Jenn brought up a great point about food allergies in the ASD population. The children I know with severe forms of ASD also have a lot of allergies and therefore are put on radical diets such as gluten free diets or no dye diets. I think more studies need to be done on how these diets create barriers for an already “very picky” population.
I also agree with Amanda that using these articles as resources when working with an ASD patient and their parents can be very beneficial. The questions suggested could be a great tool to get the conversation started with parents especially when they are very set on their child’s current diet.
I agree with Carly's perspective of using the information discussed in the articles to modify food textures and sensory characteristics to best meet the child's preferences. This is certainly coming up with a proactive solution to introduce additional foods into picky children's diets. Knowing this information and food characteristics that children have negative attitudes towards will assist in coming up with effective diet recommendations for future interventions and improve care overall.
Seeing actual statistical values tacked on to what is considered picky eating in a non-ASD pediatric population vs an ASD pediatric population has definitely changed the way I look at picky eating. I think if anything these articles have highlighted the importance of the creation of a diagnostic algorithm like the one by the Academy’s Expert Panel. The statistically significant differences between the two populations really opened my eyes, as did the reasons behind the picky eating.
I had never considered the motivations behind food refusal in the different groups. The Hubbard article talked about ASD pediatrics refusing foods based on sensory/ processing impairments, oral/ tactile sensitivities, and behavioral rigidity. Those types of mental and physiological food barriers will take more than a little bit of food coaching from mommy to overcome and I think that is just another testament to the benefits of working in a multidisciplinary team.
I was quite surprised myself to see the large differences between the ASD population and typically developing population. Great suggestions to try and change sensory qualities of foods. What about supplements in these populations?
I thought that I had an understanding of picky eaters, but it was interesting gaining an understanding of why some people may be picky eaters. As Des mentioned, I also thought that it was interesting seeing the statistics comparing non-ASD vs ASD population. I think that once I have children of my own I will have a better understanding of children eating practices, but I think I would need additional education to work with the ASD pediatric population.
Gina, I think that you bring up a great point when you ask about supplements. I think that supplements should be made based on an individual basis. Like the article said, this population often has a diet low in fiber, fruits, and vegetables, so I think that a multivitamin could be important because they are most likely missing out on several nutrients.
My perspective on management of children who present as picky eaters has changed slightly. From our internship experiences and education we know that we have to individualize treatment to the each patient/client. Taking that into account, I believe that individualizing a plan is a crucial step for every child who is a picky eater. What I did not consider in the case of a child with ASD is that many other professionals can play an important role in the management of their food aversions and selections. An interdisciplinary team was described at the end of Hubbard and colleagues article including speech pathologists, and social workers. I believe using an interdisciplinary approach could be very effective.
My perspective of picky eaters has changed to be more understanding of picky eaters as children. However, it is still being "picky", but with reason. Carly worded it well, expressing that understanding why a child doesn't like a certain food or a certain type of food helps us and the caregiver to find foods the child will accept or a way to make the food more acceptable. The article emphasizes to me that children with ASD struggles to accept a food mentally, so they aren't just being picky because they want to or because they can. I think it's important for caregivers and healthcare professionals to understand this point when working with "picky eaters".
After reading the article, my perspective of picky eaters has changed slightly. Through working with several different populations, it has become apparent to me that everyone has their personal preferences and that is something that, we, as nutrition experts should be aware of and able to work with to best benefit our client. We wouldn't suggest lean meat to a vegetarian client who is looking to include more protein in their diet, so it is our responsibility to find alternatives that the client enjoys that will benefit their health. The article helped me to see that a child with ASD with selective food preferences should be treated just the same as an adult with selective food preferences. Introducing new foods to these kids is still important to make an impression for later in life to promote consumption of healthy foods, however if they choose to not eat fruits and vegetables, it is our job to find ways they can still obtain these nutrients whether it be through smoothies, fruit/vegetable juices, frozen, canned, etc., we should continue to work with the caregiver of the child to find ways to work around their preferences.
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