Managing Editor's Note: The red headline below begins Judy Converse's letter to the journal Pediatrics in response to the article titled, Feeding Symptoms, Dietary Patterns, and Growth in Young Children With Autism Spectrum Disorders. Judy runs Nutrition Care of Children.
Alan Emond, MD, Pauline Emmett, PhD, Colin Steer, MSc, Jean Golding, PhD Here's the abstract:
Centre for Child and Adolescent Health, Department of Community Based Medicine, University of Bristol, Bristol, United Kingdom
Objective To investigate the feeding, diet and growth of young children with autism spectrum disorders (ASD).
Method Data on feeding and food frequency were collected by questionnaires completed at 6, 15, 24, 38 and 54 months by participants in the Avon Longitudinal Study of Parents and Children. A food variety score was created, and the content of the diet was calculated at 38 m. The feeding and dietary patterns of 79 children with ASD were compared with 12 901 controls.
Results The median ages of ASD children were 28 months at referral and 45 months at diagnosis. ASD infants showed late introduction of solids after 6 months (p = .004) and were described as "slow feeders" at 6 months (p = .04). From 15–54 months ASD children were consistently reported to be "difficult to feed" (p < .001) and "very choosy" (p < .001). From 15 months, the ASD group had a less varied diet than controls, were more likely to have different meals from their mother from 24 months, and by 54 months 8% of ASD children were taking a special diet for "allergy."
ASD children consumed less vegetables, salad and fresh fruit, but also less sweets and fizzy drinks. At 38 months intakes of energy, total fat, carbohydrate and protein were similar, but the ASD group consumed less vitamins C (p = .02) and D (p = .003). There were no differences in weight, height or BMI at 18 months and 7 years, or in hemoglobin concentrations at 7 years.
Conclusions ASD children showed feeding symptoms from infancy and had a less varied diet from 15 months, but energy intake and growth were not impaired.
Pediatrics: Nutrition Doesn't Matter For Kids? 22 July 2010
Judith M Converse MPH RD LD,
pediatric RD
Nutrition Care of Children
Send letter to journal:
Re: Journal of Pediatrics: Nutrition Doesn't Matter For Kids?
According to this research, kids with autism tend to eat terrible diets, but this doesn't affect growth or nutrition status.
I'm a licensed registered dietitian who has been in practice for more than ten years, working with special needs children. I have quantified food intakes and assessed growth patterns on hundreds of children with autism.
My experience in practice strongly disagrees with this conclusion, but I will leave it to a parent to illustrate with her own quote how preposterous this study’s conclusion is (as printed in The Chelsea Standard (Parents Adjust To Life With Autistic Child ) "...he suddenly stopped talking. He stopped eating any food except for pretzels. Instead, he ate sand, wood and rocks."
The message from the Journal of Pediatrics on this permits clinicians to conclude that this should trigger no particular concern. It's okay for kids to eat nothing but pretzels, sand, wood, and rocks. No medical intervention required.
Did the research mean to suggest this is only okay for kids with autism? In a fashion similar to how it has become acceptable and too frequent for young school children with autism to be tasered (as in HERE), but not typical kids?
Is this where we are going - classifying children with autism as something other than human?
I've seen eating patterns like this in kids with autism many times. Any classic nutrition text describes "pica". This research even noted that the children with autism had pica at nearly six times the rate of their typical peers – but inexplicably, the authors don’t mention that finding in their discussion or conclusions. Mercury poisoning, lead toxicity, poor zinc status, copper imbalance, or iron deficiency tend to accompany an eating pattern like this, in any child. Pica is not benign; it is associated with poor impulse control and obsessive compulsive behaviors - common features for children with autism - and with dangerous exposures to metals that can injure the brain. This is just one of many nutrition problems I routinely find when I assess children with autism.
In fact, in 11 years in practice, I have never encountered a child with autism who did not have a treatable nutrition problem. They do typically eat extremely limited diets. It isn't unusual for me to see no more than three items on a food diary: "Gogurt x 3; chocolate milk 4-5 cups/day; plain noodles, 1 big bowl" …and this is what a child will have been eating year in and year out. It's no stretch to intuit that this will leave any child bereft of adequate nutrition to learn, grow, sleep, thrive, or behave to their potential. We would never leave a typically developing child on a diet of nothing but literally only coffee cake and milk for years (another example from my practice).
What happens to children who eat like this? My case files illustrate that they get sick more often, become constipated, behave poorly, acquire anemia, acquire deficits of nutrients that impair them functionally, can't focus, don't sleep, and may not grow as expected, just for starters. But now, we can rest assured knowing that this is okay, as long as your child has autism, thanks to this research.
I noted astounding methodology flaws in this paper that let the data show - essentially, nothing. Here's where the study went wrong – the errors are many, and egregious:
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