What Happens When a Child With Autism Refuses Most Foods?11/08/13
FRIDAY, Nov. 8 (HealthDay News) -- 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
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
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
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
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