School nurses are critical to the health care of children with autism spectrum disorder (ASD) since they work with a population susceptible to malnutrition, says a Ball State University nursing professor.
“These children are often picky eaters,” said Connie McIntosh, an associate professor in the College of Health. “Parents and schools struggle to meet these children’s nutritional needs and getting them to eat a variety of foods.”
ASD, a developmental disorder, is characterized by deficits in communication and social skills and coupled with at least two forms of restrictive or repetitive behaviors and/or interests. Because of the variety of symptoms associated with ASD, children may experience a number of difficulties with varying degrees of intensity.
McIntosh said issues with food arise for an assortment of reasons: sensory processing symptoms, allergies, medications, and gastrointestinal complications.
Because of these factors, she points out that school nurses need to collaborate with registered dietician nutritionists (RDNs) to assist school staff and parents in being flexible when meeting their children’s nutritional requirements.
Since the prevalence of autism is 1 in 59, it is critical that school nurses become more knowledgeable of eating problems in children with ASD and identify strategies to improve the nutritional status of this population.
Symptoms of autism such as sensory sensitivity contribute to why these children refuse to eat food, but medications, food intolerance, and even financial status can cause this issue to become concerning to a student’s overall health.
McIntosh provides the following tips:
- Refer the child to an RDN who will screen and assess nutritional needs.
- Work with the primary care physician to assess serum blood levels of various nutrients, evaluating other chronic conditions and behavioral issues that maybe prevalent.
- Ask parents about a child’s sensory needs, encouraging them to offer foods that are acceptable and tolerated without overwhelming the child’s senses.
- Create a quiet and consistent environment that is stress free and model proper eating habits. Parents and school staff should understand the importance of consistent and distraction-free mealtimes.
- Use healthy edible reinforces (e.g., dried fruits) rather than candy or sweets in class or at home.
- Expand food repertoire by encouraging parents to add items of the same color and introducing new foods one at a time (e.g., vegetables with pasta).
- Add extra foods to items the child already likes. For example, add mashed cauliflower to their mashed potatoes.
- Encourage parents to include an assortment of varied brands and packaging of foods (e.g., changing brands of the same foods frequently to help prevent a child from getting stuck on one brand’s look or flavor).
- Engage in eating as a dynamic process; have parents encourage a child to use their hands and ask questions about their food (e.g., origin, flavor, nutritional value, color, etc.).
- Encourage parents to use reward schedules to encourage a child to eat their meals, like a toy at the end of the week if they eat a variety of foods a certain number of times. For every new veggie or fruit tried, give a reward.
McIntosh notes that all children with ASD are unique and encourages school nurses remain flexible in how they adapt these tips to meet children’s needs.
School nurses may continue to advance their knowledge of about ASD by reading research, attending seminars, and seeking guidance from other health professionals with more expertise in the field, she said.
Watch a video about McIntosh and her research: https://magazine.bsu.edu/2019/12/02/connie-mcintosh/
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