Precise, not picky eating: Rethinking food and feeding in autism spectrum disorder and food allergy

Picky eating. This label is commonly applied when children progress through a developmental phase and refuse specific or new foods. While many children are thought to be picky eaters at one point or another, some children may refuse specific or new foods as a result of another condition. For children with autism spectrum disorder (ASD) or food allergy, the label of picky eating can be unfairly applied.

Consider a child with ASD. They may avoid foods of certain textures, smells or colours. Or, consider a child with a milk allergy. They may decline common “kid foods” like macaroni and cheese or ice cream, lest risk an allergic reaction. But, neither of these children should be labelled as picky eaters. Rather, these eating behaviours align with how their bodies experience food, including sensory perceptions and real physical reactions like food allergies.

Assuming that a child’s nutritional needs are being met, these behaviours are unlikely to need any intervention. But, when dietary restrictions result in nutritional deficiencies, there can be downstream impacts on the child’s physical health and on family functioning. In such cases, it would be prudent to reach out to the child’s healthcare provider.

In Canada, an estimated 2% (1) of children have ASD, and 3-7% (2,3) have food allergy. When a child has both ASD and food allergy, identifying foods that a child will accept and which align with their allergy-related restrictions can be additionally challenging. Yet, in a 2021 publication based on medical record data from children across Canada, those with a food allergy had an almost two-times greater odds of also having ASD (2)  In some cases, children with ASD or food allergy may be diagnosed with avoidant restrictive food intake disorder, or ARFID (4,5) which is characterized by an extremely restrictive diet, in variety and/or quantity, and has consequences for both physical and psychological health. Although there is an incomplete understanding of why this association exists, nutritional and family support are undoubtedly important.

While nutrition – and what we eat – serves as a foundation for health, we would be remiss the not consider the many other roles food plays. Food is how we express emotion, culture and hospitality. But, conditions such as ASD and food allergy limit the ability these expressions through food. Both ASD and food allergy are also managed through predictability – the selection of foods based on sensory perceptions and allergy risk management. The tension between expression through food, and what will be eaten can lead to substantial family stress, and complicate social and cultural activities at which food is served. On a daily basis, meal times take considerable planning and preparation, and are often based on a narrow range of foods.

As a child health nutrition researcher, I have long been interested in the holistic impact of dietary restrictions. Supporting the physical, nutritional and emotional food-related needs for families whose children have ASD or food allergy requires a patient-centered, nimble approach, in partnership with a skilled and dedicated multidisciplinary team. The child’s community – schools, extra-curricular environments, and friends – can similarly provide support by making the child feel welcome and valued, regardless of their food choice. Food is deeply tied to expressions of care, connection, and belonging. Recognizing that food restrictions are common amongst children with ASD and food allergy is the first step removing the incorrect label of picky eating.

• References

  1. Government of Canada. Autism spectrum disorder: highlights from the 2019 Canadian Health Survey on Children and Youth. Available online on 24 April 2026.

  2. Singer AG et al. Prevalence of physician-reported food allergy in Canadian children. J Allergy Clin Immunol Pract. 2021;9(1):193-99.

  3.   Clarke AE et al. Temporal trends in prevalence of food allergy in Canada. J Allergy Clin Immunol Pract. 2020;8(4):1428-30.e5.

  4. Nyholmer M et al. Neurodevelopmental and psychiatric conditions in 600 Swedish children with the avoidance/restrictive food intake disorder phenotype. J Child Psychol Psychiatry. 2025;66(9):1333-44.

  5.   Jafri S et al. Food allergy, eating disorders and body image. J Affect Disord Rep. 2021;6:100197.

Published May 1, 2026

About the author

Dr. Jennifer Protudjer PhD FAAAAI is the Endowed Research Chair in Allergy, Asthma and the Environment; and, an associate professor, the Associate Director – Research; and Director, Pediatric Graduate Program, in the Department of Pediatrics and Child Health, University of Manitoba; a research scientist at the Children’s Hospital Research Institute of Manitoba; She also holds an adjunct professorship in the Department of Foods and Human Nutritional Sciences, University of Manitoba; and, and is an affiliated researcher at the Karolinska Institutet, in Stockholm, Sweden, where she completed two post-doctoral fellowships.

Her primary research interests include environmental risk factors for, primary and secondary prevention of, and societal consequences of allergic disease.

She teaches locally and internationally on food allergy; and, quantitative, qualitative and mixed research methods. She was the lead architect on two educational programs: the Pediatric Graduate Program, at the University of Manitoba; and, the Canadian Society of Allergy and Clinical Immunology’s Food Allergy Educator Program.

Her service roles include Section Head, Allied Health, and, Co-Lead of the Research Pillar, for the Canadian Society of Allergy and Clinical Immunology; member, advisor to Food Allergy Canada; and, lead, Food Insecurity Working Group, American Academy of Allergy, Asthma and Immunology