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Feeding problems are evident among children with autism spectrum disorders (ASDs) from infancy, researchers found.

Compared with children without ASDs, those ultimately diagnosed with an ASD were more likely to be slow eaters by 6 months, and also accepted solid foods later in the first year (P≤0.02 for both), according to Jean Golding, PhD, of the University of Bristol in England, and colleagues.

From 15 months on, children with ASDs were also more likely to be called very difficult to feed and very choosy and had less varied diets (P≤0.002 for all), the researchers reported in the August issue of Pediatrics.

However, total energy intake and growth were not impaired compared with children without ASDs.

"A clinical implication of these findings is that the possibility of an ASD should be considered for young children who present with feeding problems, pervasive food refusal, and limited food preferences, and appropriate questions should be asked about the child's social communication, shared attention, and stereotypic and self-stimulatory behaviors," the researchers wrote.

Although children with ASDs are often reported to eat a narrow range of foods and have behavioral difficulties surrounding feeding, when these symptoms arise is not well understood.

Golding and colleagues looked at data from the Avon Longitudinal Study of Parents and Children (ALSPAC), conducted among families living in southwest England, to find out.

Parents completed questionnaires, including questions on feeding and dietary habits, when their children were ages 6, 15, 24, 38, and 54 months. Investigators measured height and weight when the children were 7 years old.

The current analysis compared feeding and dietary patterns of 79 children with ASDs and 12,901 children without ASDs.

The early difficulty in accepting solid foods and the pattern of slow feeding among children later diagnosed with an ASD "could be seen as early symptoms of an autistic child's difficulty in accepting change," the researchers wrote.

Along with less varied diets, children with ASDs were more likely to have different meals than their mothers from age 24 months on than those without ASDs.

By 54 months, a greater percentage of children with ASDs had been placed on a special diet for allergy, according to the parents (8% versus 2%; OR 3.41, 95% CI 1.35 to 8.63).

"Although many parents of children with ASDs do try special diets for their children, a recent update of a Cochrane review on gluten- and casein-free diets in children with ASDs concluded that the evidence for the efficacy of these diets remains poor," Golding and colleagues noted in their paper.

Children with ASDs consumed fewer vegetables and less salad and fresh fruit, but also consumed fewer sweets and carbonated drinks.

Although intake of vitamins C and D was lower in children with ASDs (P≤0.007 for both), the finding could have been due to chance because of the large number of comparisons made, according to the researchers.

Total energy intake, as well amounts of carbohydrates, protein, and fat, however, did not differ between the two groups.

At ages 18 months and 7 years, there were no differences in weight, height, or body mass index.

"Clinicians and parents will be reassured by the finding that, despite the limited food preferences, the children with ASDs took adequate amounts of energy from their diet and grew normally," the researchers wrote.

They acknowledged some limitations of the study, including the diagnosis of ASDs by clinical teams instead of structured research assessments, and the use of data reported by mothers without validation.

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