Early Feeding Challenges in Children with Autism Spectrum Disorder: A Developmental Milestone Checklist

Aims: To develop and validate a developmental feeding milestone checklist for typically developing children and to identify early feeding related signs and symptoms in children later diagnosed with Autism Spectrum Disorder (ASD), highlighting feeding as a potential early red flag for ASD.

Study design:  Cross sectional observational study.

Place and Duration of Study: The study was conducted in clinical and educational settings in Chennai,

India, among children aged 3 – 8 years, over a period of

Methodology: A feeding developmental chart was developed based on literature review. The checklist was validated by speech language pathologists. Ten typically developing children (4 – 6 years) were assessed to confirm typical feeding sequences. Thirty children with moderate to severe ASD (3 – 8 years), diagnosed using ISSAA, were included. Feeding milestones were tracked through caregiver interviews focusing on breastfeeding, weaning, texture transition, and mealtime behaviors. Data were analyzed descriptively to identify common early feeding difficulties in ASD.

Results: All typically developing children followed a similar developmental feeding sequence. Among children with ASD, early feeding difficulties were highly prevalent: poor weight gain or reduced nutrition (96%), sucking/biting/chewing difficulties (93%), vegetative skill delays (93%), texture difficulties (90%), and food neophobia (90%). Ritualistic feeding behaviors, oral aversion, and breast/bottle feeding difficulties were reported in 86% of cases. These difficulties were present during infancy but remained unnoticed as early indicators of ASD.

Conclusion: Feeding difficulties in ASD are early, persistent, and multidimensional, involving oral motor, sensory, and behavioral components. Early feeding related abnormalities may serve as developmental markers for ASD and should be incorporated into early screening and referral protocols.