Management of Feeding Refusal in Children with Autism and Ankyloglossia

Immediate Priority Actions

The American Academy of Pediatrics recommends immediate multidisciplinary intervention with speech therapy as the cornerstone, combined with behavioral feeding therapy, nutritional monitoring, and surgical evaluation for ankyloglossia release in children with autism and ankyloglossia 1
Surgical evaluation for ankyloglossia release is necessary if it is contributing to oral motor dysfunction and limiting the child's ability to manipulate solid foods, as the tongue restriction from ankyloglossia can significantly impair the oral preparatory phase of swallowing and food manipulation 1, 2, 3

The American College of Nutrition recommends continuing Pediasure temporarily while implementing feeding interventions, but recognizes this is not a long-term solution, and the child needs immediate nutritional assessment and monitoring every 3 months for malnutrition screening 1, 3
Meal fractionation and enrichment strategies should be implemented as feeding therapy progresses, to prevent severe malnutrition, micronutrient deficiencies, and developmental regression 1

The American Academy of Pediatrics recommends implementing Applied Behavior Analysis (ABA) principles for feeding, which has the strongest evidence base for addressing mealtime behaviors in autism, including breaking feeding tasks into smaller steps and systematic desensitization to new food textures 4, 1
Food textures should be modified systematically, starting with thicker liquids, then semisolid foods with high water content, progressing to soft solids, to compensate for poor oral preparation phase and ease oral and pharyngeal transport 2, 1

The American Academy of Pediatrics recommends providing intensive parent training on mealtime management strategies, including reducing mealtime anxiety and demands, using visual schedules for meal structure, and implementing consistent behavioral strategies at home 5, 4, 1

The American College of Nutrition recommends monitoring closely for signs of worsening nutritional status, including weight loss, development of edema, rash, or hair changes, lethargy, or behavioral regression, and constipation or other GI complications from limited fiber intake 3, 2
If the child continues to refuse solids despite intervention, a formal videofluoroscopic swallowing study should be considered to rule out aspiration risk or pharyngeal dysphagia 2, 1