An Overview of Feeding Difficulties in Children with Autism Spectrum Disorder: A Narrative Review

Abstract

Aims: To critically synthesise current scientific evidence on feeding difficulties in children with autism spectrum disorder (ASD), considering the sensory, behavioural, gastrointestinal, nutritional, and oral-motor domains. Study Design: Structured critical narrative review informed by recent reviews, with or without meta-analysis. Methodology: A targeted PubMed/MEDLINE search was used to identify recent English-language reviews, with or without meta-analysis, relevant to feeding difficulties in children and adolescents with autism spectrum disorder. Medical Subject Headings (MeSH) and free-text terms related to autism spectrum disorder, feeding behaviour, food selectivity, sensory processing, gastrointestinal symptoms, nutritional status, and oral-motor function were combined using the Boolean operators AND and OR. Reviews addressing at least one of the five predefined domains were considered, and evidence was synthesised descriptively and thematically. Results: Feeding difficulties in children with ASD were consistently characterised as multidimensional. Sensory processing alterations, particularly responses to texture, taste, smell, temperature, appearance, and consistency, showed the most consistent association with food refusal and restricted dietary variety. Behavioral rigidity, repetitive behaviours, gastrointestinal symptoms, nutritional inadequacies, and oral-motor impairments contributed to the persistence and clinical impact of feeding problems. Reported consequences included reduced dietary diversity, risk of micronutrient inadequacies, impaired growth in some subgroups, and adverse effects on family dynamics. Isolated interventions showed limited and heterogeneous effectiveness, whereas individualised multidisciplinary management was more consistent with the multifactorial nature of these difficulties. Conclusion: A multidimensional understanding of feeding difficulties in children with ASD is essential for comprehensive clinical assessment and for planning individualised, evidence-based interventions aimed at improving nutritional, functional, and quality-of-life outcomes.