Children with autism often display feeding problems like extreme food refusal, especially when they are younger. Appetite stimulants are not the answer to help autistic children with feeding issues.

If you have an autistic child, you may be worried about your child’s physical health because of the types of food they eat. Your child may not eat enough. This means they don’t gain sufficient weight to be in a healthy weight range for their age.

These are serious concerns, and asking your pediatrician about potential medical interventions for short-term solutions makes sense.

Your pediatrician is not likely to prescribe appetite stimulant medications, and you should not use appetite stimulant supplements on your child. Appetite stimulants are potent substances that come with several side effects. They can be dangerous if you do not understand the underlying causes of your child’s food refusal.

Feeding Problems Like Food Refusal Are Common in Autistic Children

Feeding problems are very common in young children with autism.

Regardless of their developmental condition, many children refuse food, develop picky eating habits, and become fussy or have tantrums at mealtimes. But children on the autism spectrum are more likely to develop specific struggles with food and eating. This includes refusing most food, refusing to try foods with certain textures, developing rituals around how to eat certain foods, and even stopping eating altogether.

One scientific study found that between 46% and 89% of children on the autism spectrum have some type of feeding problem, with food selectivity being one of the most common.

Parents of autistic children may worry much more about their child’s overall health than parents of neurotypical children. Because autistic children refuse far more types of food, refuse to try new foods, and sometimes even fail to move away from baby food, they may suffer from malnutrition, digestive disorders, and developmental problems related to being underweight. Parents want to help their children eat more and expand the range of the types of foods they eat. As a result, parents may turn to appetite stimulants to get their children to eat more.

In scientific literature, food refusal is measured as the proportion of food offered to the child that is refused. While all children reject a certain amount of the food presented to them, it is understandable that parents of autistic children become greatly concerned when their child refuses most of what is presented.

Appetite Stimulants: What to Know About Their Safety 

Appetite stimulants are also called orexigenics. Substances might be specifically marketed to increase appetite, which helps people who are underweight feel hungry and eat enough calories.

There are two basic categories of appetite stimulants: prescription medications and dietary supplements.

  1. Prescription medications: The United States Food and Drug Administration (FDA) has approved only three medications as safe appetite stimulants: megestrol acetate, oxandrolone, and dronabinol. Megestrol acetate is a hormone-based medication that boosts appetite and feelings of hunger in people who have cancer, HIV/AIDS, or anorexia. Oxandrolone is a steroid medicine to help patients regain weight after surgery, chronic infection, or trauma. Dronabinol is a cannabinoid-based medicine that improves appetite in people with AIDS-related anorexia. It can sometimes reduce nausea and vomiting associated with chemotherapy. While a doctor may prescribe some of these medicines off-label to treat different conditions, this practice is very limited. Because of the side effects and potency of these drugs, it is very unlikely that your child’s pediatrician will recommend these as a treatment for appetite issues.
  2. Dietary supplements: The FDA does not regulate dietary supplements, so it is important to be very cautious of the contents of these over-the-counter medicines. Some are safe to take. Good appetite-stimulating supplements may include:

    • Zinc

    • B1

    • Omega-3 fatty acids

    These are important vitamins that should be part of a balanced diet. For people who chronically undereat, like children with autism who struggle with food refusal, adding supplements with these vitamins can stimulate appetite in the short term and help children feel better in the long term. When they feel better, they may be more open to trying new foods. Bitter herbs are also a recommended dietary supplement to stimulate appetite. They may more commonly be found as bitters. Supplements containing gentian and wormwood may be taken to “support upper digestive activity,” but you should not give these strong supplements to your child without consulting your pediatrician first. 

It’s reasonable to want a short-term solution to improve your child’s appetite, but giving your child a potent drug or supplement is not the best approach. Working with a behavior therapist so you can understand food refusal and other feeding problems actually addresses the underlying issue.

Your child’s therapist can help you to understand when these issues are a behavioral problem and when there is an underlying physical problem like gastrointestinal distress.

Study Shows Food Refusal Behaviors Decline With Age

For many children on the autism spectrum, food refusal seems to occur when they are very young. Over several years, children with autism may age out of food refusal problems.

A study published in 2017 reported that many participants who struggled with high rates of food refusal, especially to fresh fruits and vegetables, decreased this extreme picky eating over the course of 6.5 years. The researchers noted that, while there was an overall decrease in this problem among the study’s participants at the follow-up, there was still a lot of variation in the rate of food refusal. Half the participants with high food sensitivity still refused a lot of food when they were surveyed again years later.

Additionally, food repertoire did not increase significantly, indicating some potential issues.

  • Children reportedly refused less food because parents stopped offering foods that were refused.
  • Even with more adventurous eating, parents likely leaned on food they knew their child enjoyed so that was still served more often.
  • Even when accepting more foods, the sameness and routine around food repertoire could remain intact.

At the follow-up point, many of the children qualified as obese. This suggests that the best method to correct feeding issues in autistic children is to focus on healthy eating habits.

Gradually introducing healthier foods like fruits and vegetables, and rewarding consumption of those healthy foods, will reduce the physical risks of feeding issues. If you only focus on the food you know your child enjoys, it does not help to expand their diet or support their overall health, even when they begin eating more.

While appetite stimulants undoubtedly increase appetite in the short term, they are not recommended as a way to get autistic children to eat more. Applied behavior analysis (ABA) therapy is the best approach to managing all kinds of autism symptoms, including feeding problems like food refusal. If you are concerned about malnutrition and developmental health, work with your pediatrician to find better solutions than appetite stimulants.

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