Autism spectrum disorder (ASD) is a complex group of neurodevelopmental disorders characterised by impaired social communication and restricted interests/repetitive behaviours. In this regard, sensory processing difficulties and delayed oral motor skills often predispose individuals with ASD to food selectivity (FS). It is usually associated with repetitive eating patterns that can lead to multiple malnutrition conditions. The objective of this narrative review is to present an overview about the existing nutritional interventions aiming at promoting a healthy eating pattern and addressing food selectivity among individuals with ASD. Regarding the interventions targeting nutrition education, the majority of the analysed studies failed to demonstrate their effectiveness. On the other hand, many educational interventions involving taste or cooking sessions, as well as behavioural interventions for FS, demonstrated effective results. Moreover, multidisciplinary in tailoring such programmes, including psychology speech therapy and nutritional skills, is acknowledged as a key approach.

Early childhood feeding problems can be challenging. Children who limit their food consumption may significantly impact multiple critical areas of development. Effective treatment should be accessed as early as possible but has been limited to a handful of US hospital programmes. Feeding problems affect both children with and without disability, and families may struggle with multiple children having feeding difficulties. We provided short-term (less than 2 weeks), in-home, intensive, behaviour-analytic feeding intervention to two children with typical development who were younger siblings of children already in the programme. We used a withdrawal/reversal design to assess the effects of nonremoval of the spoon, re-presentation, contingent and noncontingent access to tangibles, differential attention, and response cost. This multi-component intervention was effective in increasing the consumption of a wide variety of foods at regular texture and self-feeding for both participants. Variety was increased to over 60 foods from all food groups. Admission goals were met (100%). We trained caregivers to high procedural integrity and generalised the protocol. We provided actual plate picture examples of family meals consumed where the brothers and parents ate the same meal. Caregiver satisfaction and social acceptability were high. Gains were maintained at 3-year follow-up where parents reported problems were fully resolved.

Picky eating is a common behaviour in early childhood. There is neither a universally accepted definition of picky eating, nor is there agreement on the best tool to identify it. Causes of picky eating include early feeding difficulties, late introduction of lumpy foods at weaning, pressure to eat and early choosiness, especially if the mother is worried by this; protective factors include the provision of fresh foods and eating the same meal as the child. The consequences for the child's diet include poor dietary variety and a possible distortion of nutrient intakes, with low intakes of iron and zinc (associated with low intakes of meat, and fruit and vegetables) being of particular concern. Low intakes of dietary fibre, as a result of low intakes of fruit and vegetables, are associated with constipation in picky eaters. There may be developmental difficulties in some children with persistent picky eating. There is little evidence, however, for a consistent effect of being a picky eater on growth trajectories. There may be a small subgroup of children in whom picky eating does not resolve who might be at risk of thinness during adolescence, or of developing an eating disorder or adult picky eating: these children need to be identified at an early age to enable support, monitoring and advice to be offered to parents. Strategies for avoiding or ameliorating picky eating include repeated exposures to unfamiliar foods, parental modelling of eating fruit and vegetables and unfamiliar foods, and the creation of positive social experiences around mealtimes.