July 24, 2015
3 min read

Experts release GI symptom management guidelines for children with autism

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Despite the critical nature of nutrition management in children with autism spectrum disorder, no guidelines previously existed for parents or practitioners, prompting a team of experts to release guidelines for the management of gastrointestinal symptoms in these pediatric patients.

“Children with autism are at increased risk for feeding and gastrointestinal (GI) concerns compared with peers and both of these issues involve nutrition management. We viewed the lack of an evidence-based guideline regarding nutrition management of GI symptoms in children with ASD as unacceptable,” William Sharp, PhD, director of the Pediatric Feeding Disorders program at Marcus Autism Center and assistant professor of pediatrics at Emory University School of Medicine, said in a press release. “Our goal was to establish a standard manual of care for nutrition management which clinicians around the world could refer to.”

Sharp and colleagues developed an 11-step algorithm for clinicians to utilize in “navigating potential barriers associated with food selectivity, caregiver-initiated complementary/alternative diet therapies and/or nutritional deficits/excesses often observed in this population.”

The algorithm starts with the identification of possible barriers to therapeutic foods as the practitioner develops a prescriptive diet to address the child’s GI dysfunction, commonly constipation due to food preference or diets initiated by a parent. The practitioner, assumed in this algorithm to be a registered dietitian nutritionist (RDN), must then look at the flexibility of the child’s diet to determine what intervention would be most fitting. Working within these confines, the prescriptive diet would indicate the increase or decrease of certain foods to achieve a more balanced diet. This process should also allow for determination of any foods causing the child GI pain.

If the RDN believes there will be a strong behavioral reaction from the child or if caregivers are reluctant to modify an implemented diet, a pediatric gastroenterologist should be consulted for alternative medical solutions.

Additionally, the algorithm helps practitioners determine gaps in the child’s diet that remain after intervention. These gaps might need to be addressed through feeding intervention or nutrition supplementation. The assessment should also screen for intolerance of any foods, allergies that went undiagnosed or any other foods causing discomfort.

The published algorithm presents constipation and eosinophilic esophagitis as examples of using the algorithm to alleviate GI pain for a child with ASD.

Need for more research

“The committee developed the guideline with consideration of the unique dietary, medical, and behavioral 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,” Rashelle Berry, lead dietitian at Pediatric Feeding Disorders program at Marcus Autism Center, said in the release.

The expert panel noted that this guideline “reflects a more general need to further elucidate the role of nutrition management in ASD” because the risks presented by food selectivity or nutritionally unbalanced diets may go undetected in traditional pediatric exams because growth and energy are often not affected. Yet these nutritional deficits do seem to translate into long-term effects because adults with ASD are at an increased risk for obesity, hypertension and diabetes and there is thought to be an effect on bone density.

“Children with autism, like their typically developing peers, present with medical conditions that require nutrition intervention,” Berry said. “Awareness of the unique challenges seen in this population is needed so that clinicians are well-equipped to plan effective interventions. The ultimate goal of nutrition management in autism is resolution of symptoms, promotion of adequate growth, and assurance of a nutritionally complete diet.”

The panel also warned that while many diets have been put forth as treatments for ASD, none have been empirically proven and without dietary guidance, the risks of these diets may outweigh the perceived benefits.

“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,” Sharp said.

The panel concluded the report by acknowledging that this algorithm needs to be field tested for further confirmation and refinement. – by Katrina Altersitz

Disclosure: The researchers report no relevant financial disclosures.