ASD, Digestive Issues and Pica

Gastrointestinal symptoms (GIS) can occur more often among preschool children with autism spectrum disorder (ASD).¹ Some of these symptoms may be related to pica, a condition in which a person repeatedly eats things not considered food.² Learn what to do if your child with ASD eats non-food items.

Autism spectrum disorder (ASD) is a developmental disability characterized by varying degrees of difficulties with social, emotional, and communication skills. Gastrointestinal symptoms, such as vomiting, diarrhea, constipation, or abdominal pain, also may be more common among children with ASD.¹ Another less well-known issue among young children with ASD, ASD characteristics, and/or intellectual disability is pica, a condition in which a person repeatedly eats things that aren’t food such as dirt, paint chips, and clay.²  In a recent study, almost 1 in 4 parents of young children with ASD reported that it was sometimes or often true that their child ate non-food items and about 1 in 10 parents reported it was often true. ² Data also showed that GI symptoms were more common among children with ASD who ate non-food items; however, pica behavior did not fully explain the increased risk for GI symptoms among children with ASD and other developmental disabilities.³

Pica can lead to serious medical and surgical problems, including gastrointestinal parasites, lead toxicity, nutritional deficiencies, choking, poisoning, intestinal obstruction, and perforation resulting in surgery, and even a blood infection, which can be life-threatening. It’s important for caregivers and healthcare providers to be aware of this risk so that they can carefully monitor children, put safety measures in place, and intervene early if a child eats something they shouldn’t.

If Your Child with ASD Eats Non-food Items

It is not well understood why children with ASD are more likely to eat non-food items. However, there is a pattern of atypical eating behaviors, such as limited food preferences and hypersensitivity to food textures, among children with ASD.⁶ Furthermore, sensory processing difficulties that are commonly reported in children with ASD may result in both atypical eating and pica behavior.⁷ Additionally, some children with ASD and/or intellectual disability may not understand the difference between food and non-food items.⁷ Here are some things you can do if your child with ASD has pica:

• Discuss treatments for pica with your child’s healthcare provider, such as applied behavior analysis and functional analysis,⁸ which helps identify triggers for pica and determine if pica is secondary to sensory-seeking behavior, automatic reinforcement, or social factors such as seeking attention from caregivers.
• Closely monitor children, keep items out of reach, use childproof locks, find activities that occupy children’s attention, and inform other caregivers of concerns.
• Put the national Poison Control Center phone number, 1-800-222-1222, on or near every telephone in your home and program it into your cell phone. Call the Poison Control Center if you think your child has been poisoned but he or she is awake and alert; they can be reached 24 hours a day, 7 days a week.
• Call 911 if you have a poison emergency and your child has collapsed or is not breathing.

If You’re Concerned About Your Child’s Development

If you think your child might have ASD or you think there could be a problem with the way your child plays, learns, speaks, or acts, contact your child’s doctor and share your concerns.

If you or the doctor are still concerned, ask the doctor for a referral to a specialist who can do a more in-depth evaluation of your child. At the same time, call your state’s public early childhood system to request a free evaluation to find out if your child qualifies for intervention services. This is sometimes called a Child Find evaluation. You do not need to wait for a doctor’s referral or a medical diagnosis to make this call.

Your child’s age determines which state entity you should contact for a free evaluation:

• If your child is not yet 3 years old, contact your local Early Intervention system.
• If your child is 3 years old or older, contact your local public school system.
• Even if your child is not yet old enough for kindergarten or enrolled in a public school, call your local elementary school or board of education and ask to speak with someone who can help you have your child evaluated.
• If you’re not sure who to contact, call the Early Childhood Technical Assistance Center (ECTA) at 919-962-2001,

or visit the ECTA websiteexternal icon.

Research shows that Early Intervention services can greatly improve a child’s development.^4,5 In order to make sure your child reaches his or her full potential, it is very important to get help for ASD as soon as possible.

CDC’s Learn the Signs. Act Early

CDC offers the Milestone Tracker – a FREE app for tracking a child’s development in a fun and easy way. This app adds to the popular suite of free, family-friendly materials available through CDC’s Learn the Signs. Act Early. program.

The app is available in both English and Spanish. Download the app for FREE in the App Storeexternal icon and on Google Playexternal icon.

References

1. Reynolds AM, Soke GN, Sabourin KR, et al. (2021). Gastrointestinal Symptoms in 2- to 5-Year-Old Children in the Study to Explore Early Development. Journal of Autism and Developmental Disorders, 10.1007/s10803-020-04786-9. Advance online publication. https://doi.org/10.1007/s10803-020-04786-9external icon
2. Fields VL, Soke GN, Reynolds A, et al. (2021). Pica, autism, and other disabilities. Pediatrics, 147(2), e20200462. https://doi.org/10.1542/peds.2020-0462external icon
3. Fields VL, Soke GN, Reynolds A, et al. (2020). Association between pica and gastrointestinal symptoms in preschoolers with and without autism spectrum disorder. Study to Explore Early Development. Disability and Health Journal, 101052. Advance online publication. https://doi.org/10.1016/j.dhjo.2020.101052external icon
4. Handleman JS, Harris S, Ed.S. Preschool education programs for children with autism (2nd ed). Austin, TX: Pro-Ed. 2000.
5. National Research Council. Educating Children with Autism. Washington, DC: National Academy Press, 2001.
6. Mayes SD, Zickgraf H. Atypical eating behaviors in children and adolescents with autism, ADHD, other disorders, and typical development. Res Autism Spectr Disord. 2019;64:76–83.
7. Provost B, Crowe TK, Osbourn PL, McClain C, Skipper BJ. Mealtime behaviors of preschool children: Comparison of children with autism spectrum disorder and children with typical development. Phys Occup Ther Pediatr. 2010;30(3):220–233.
8. Matson JL, Hattier MA, Belva B, Matson ML. Pica in persons with developmental disabilities: Approaches to treatment. Res Dev Disabil. 2013;34(9):2564–2571.