Nutrition guidelines to manage GI symptoms in autism

It is well known that gastrointestinal symptoms often accompany an autism spectrum disorder (ASD) diagnosis in children. Frequently seen issues include food selectivity, alternative diets and nutritional deficits.

A guideline for management of these issues was released last year by the Marcus Autism Center, an affiliate of Children’s Healthcare of Atlanta, and published online by the Journal of the Academy of Nutrition and Dietetics (JAND).

The JAND paper includes a decision-making flowchart; detailed description of intervention steps; and management examples of two GI concerns — constipation and eosinophilic esophagitis (a chronic allergic inflammatory disease), conditions frequently managed with nutrition intervention.

The guideline addresses some of the unique dietary, medical and behavioural challenges observed in children with ASD. This includes high rates of food selectivity observed in children with ASD, frequent use of caregiver-initiated complementary/alternative diet therapies and growing concern regarding possible nutritional deficits and excesses often observed in this population.

Sometimes food selectivity contributes to GI symptoms, but in other cases the selectivity is in response to a pre-existing problem such as a food allergy or gastroesophageal reflux. At the same time, alternative diets such as gluten-free, casein-free diets or other diets that restrict or eliminate certain food groups are often initiated by caregivers. Emerging evidence also suggests children with ASD may be at higher risk for nutrition-related conditions such as obesity or poor bone growth.

The guideline states that in cases of severe food selectivity, nutrition therapy should occur concurrently with feeding therapy. The guideline also advises on the use of nutritional supplements or liquid formulas in this population. Consultation with a registered dietitian nutritionist is recommended when working to create a nutritionally complete diet that also works to alleviate GI concerns.

A key take-home message from this guideline is that nutrition management in ASD should play a central role in a child’s overall plan of care, ideally from the time of diagnosis.