Nutritional management and autism spectrum disorder: A systematic review

Table 1 Feeding development in children with normal development vs. those with autism

Age range	Normal feeding development	Feeding development in children with autism
0-6 months	Suck-swallow reflexes are well-developed; begins to coordinate sucking, swallowing, and breathing during feeding	May exhibit weak suck, poor coordination of sucking and swallowing, or difficulties breastfeeding
6-12 months	Introduced to pureed foods; begins to develop pincer grasp for self-feeding; starts to handle a variety of textures	It may show oral tactile sensitivity or gagging, a preference for smooth, pureed foods, and delays in self-feeding skills
12-18 months	Progresses to more textured foods; begins to use utensils; starts to drink from a cup	Persistent preference for purees; resistance to textured foods; may continue using a bottle; difficulty using utensils
18-24 months	Eats a variety of foods; able to chew a wide range of textures; uses a spoon and fork more efficiently	Limited food variety; preference for specific textures or types of food; may have incomplete mastication and occasional choking
2-3 years	Further develops chewing skills; eats most family foods; drinks from an open cup; uses utensils independently	Continued rigidity with food choices; may insist on specific foods or avoid entire food groups; ongoing issues with chewing and swallowing
3-4 years	Expands diet to include more complex textures; shows improved self-feeding skills; less picky eating	Persistent selective eating; might insist on using a bottle or refuse sippy cup; difficulty with mixed textures
4-5 years	Eats a wide range of foods; improved social eating behaviors; uses utensils proficiently	Ongoing rigidity with food variety and textures; may still prefer smooth or specific-textured foods; potential social eating challenges
5+ years	Generally eats a varied diet, participates in family meals, fewer food-related issues	Continues to display selective eating patterns; may require feeding therapy; potential need for specialized diets to meet nutritional needs