What Happens When a Child With Autism Refuses Most Foods?
FRIDAY, Nov. 8 -- The life-threatening health problems that a 9-year-old boy with autism faced recently shed light on an issue that is rarely discussed.
Many children with autism or other developmental disorders tend to eat an extremely narrow range of foods, and this may put them at risk for serious health problems, said Dr. Melody Duvall, lead author of the case report, which was published online Nov. 4 in the journal Pediatrics.
What is it about autism that often makes children resistant to eating a normal and varied diet? One expert had some theories.
"We know many children with autism spectrum disorder have sensory issues, are overly sensitive to certain textures, sounds and perhaps tastes," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at the Steven & Alexandra Cohen Children's Medical Center in New Hyde Park, N.Y. "And many children with an autism spectrum disorder will have an insistence on sameness, are comfortable with routines and have difficulty with transitions."
Those traits often make children insist on eating only a very limited combination of foods, Adesman explained.
"This case report highlights how atypical and narrow the diets are with some children with autism or other severe developmental problems, and that the potential for serious health consequences can follow," said Adesman.
In the case of the 9-year-old boy, the situation was extremely challenging to figure out, explained Duvall, his physician at Boston Children's Hospital. He came to the emergency department twice, complaining of hip pain so severe he refused to walk. Physicians looked for neurological or orthopedic reasons for the limp, but found no underlying cause. Physical therapy only worsened his discomfort. He had the usual blood tests, and they were normal.
The physicians then thought he might have Lyme disease, but it was ruled out, Duvall said. He then started developing serious lung and heart problems, had a rapid heart rate, dry cough and difficulty breathing. Eventually, he became so ill he was taken to the intensive care unit, she added.
A chest x-ray showed his right lung and the lower parts of his left lung were filling up with fluid. Tests showed the right side of his heart was functioning poorly. Physicians thought he might have pneumonia, or even cancer, but those possibilities were eliminated by further tests.
The physicians had no idea what was happening. "The definitive diagnosis of what was underlying his pulmonary hypertension [lung problems] was hard," recalled Duvall. "But then his mother told us he had bleeding gums when his teeth were brushed."
That simple clue led to the boy's diagnosis: severe nutritional deficiency. The bleeding gums were a classic sign of scurvy, a disease caused by not getting enough vitamin C. The doctors ordered a blood test to check his vitamin and mineral levels. They discovered he had a completely undetectable level of vitamin C and inadequate amounts of vitamin B1, B6, B12 and D.
It was then that the physicians asked about the boy's diet. His mother told them that he would only eat chicken nuggets, crackers, cookies and water. He refused milk, juice, vegetables and fruits, and would not take any form of vitamin.
To treat him, the physicians put him on "an intravenous concoction of vitamins to replete his total body deficiency," explained Duvall. His heart and lung problems were soon resolved, as was his limp, which had been caused by bone disease associated with his poor diet.
Once home, his mother finally found a way to get him to accept taking a vitamin, Duvall said. She crushed the pill and mixed it into a "peanut butter fluff" sandwich, which involves putting marshmallow cream and peanut butter on bread. That combination successfully disguised the taste of the vitamin. He also started getting regular vitamin injections from his pediatrician.
Duvall emphasized that the risk of severe health problems from nutritional deficiencies goes beyond children with autism or behavioral problems. Those also at risk include people with anorexia and other restrictive eating disorders; the elderly; those with severe mental illness, such as schizophrenia; alcoholics; immigrants and refugees; and patients with chronic diseases, such as HIV/AIDS.
The researchers noted that while they did not prove definitively that the nutritional deficiency caused the boy's problems, his health issues were resolved soon after he was given vitamins.
Physicians, especially pediatricians, often overlook the topic of nutrition, Duvall said.
"Pediatricians are supposed to talk about immunization, diet and weight maintenance, blood pressure, bullying, parent violence, all in a 10-minute visit," she said. "They have to pick and choose what they talk about."
Duvall said physicians should routinely screen for vitamin and mineral deficiency with a simple blood test.
The bottom line for young and old on less-than-ideal diets? Take a multivitamin, Duvall said.
Learn more about healthy diets from the U.S. Centers for Disease Control and Prevention.
Posted: November 2013