With only twenty minutes to eat, kids with autism spectrum disorder (ASD) should have "fast" foods that are healthy, tasty, loaded with nutrients and free of the culprits that are common problems: gluten, milk products, soy, and artificial additives and coloring.   Add to the list sensory issues involving food texture, color and taste along with unusually picky appetites so common in ASD  - and the task seems insurmountable.  Beyond the challenges with foods are the safety issues of the food containers themselves, especially plastics containing phthalates and bisphenyl A (BPA). And of course there is the "cool" factor which affects pre-school through high school. Food that is different is totally uncool for kids who already face so many social and learning stigmas.

Knowing the challenges, we can now focus on the solutions.

As is the case with any meal, there are some basics to follow.  Blood sugar control is critical.  All people are affected by rapidly rising blood sugar which then cascades down too quickly and too low.  The most noticeable effects are on brain function especially mood and attention. As the blood sugar drops too quickly, there can be irritability, hunger headaches, lack of focus, behavior problems, and cravings for a "quick sugar fix" which keeps the cycle going. This interferes with learning and can be disruptive to the class. Protein and fiber stabilize blood sugars. Below is a summary of the basic rules for any meal including school lunch.

All food suggestions are GFCF (gluten-free, casein-free).  Glutens include wheat,        oat, barley, rye, spelt and kamut.  Milk products and milk casein include milk,        yogurt, cheese, creams, ice cream, cream sauces, and butter.

       

Glycemic foods which raise blood sugar (glucose) quickly include:  sugars, sodas        of any kind, candy, sweets, juices, and any refined grains (pretzels, bread, crackers, bagels, chips)  on an empty stomach.  Limit the sugars and keep the refined carbohydrates limited. If small amounts are consumed at the end of the meal, the negative effect is less.

A word on sodas - both regular and diet.  They have no place in a healthy diet. They are high in phosphorus which depletes healthy nutrients. Consider them removers of electrolytes, not drink options.  Water is best, but other good choices include:  dilute juices, seltzer water with juice to flavor, vegetable juices (V8)

Promote Protein at every meal or snack 

Choices include fish, poultry, meat, eggs, beans, nuts and seeds. 

Avoids: milk products 

The serving size for protein for each person is the size of the palm.  A child's may be 1 to 2 ounces of meat/chicken/fish and a teen and adult may be 3 to 5 ounces. See the chart for guidelines

For beans, the serving size is two cupped palms full.  See the chart for guidelines.

               

Choices include fruits, beans, nuts, seeds and grains.

Avoid: glutens

If your child eats very few vegetables, fruits, grains, nuts, seeds and beans, added fiber is important.  Fiber as pure guar gum is easy to add to any recipe and also to drinks.  It is GFCF and more fine than sugar, mixing completely in water or juice.  See the table for fiber intake suggestions.

Include at least one food that is a favorite in order to promote more interest in the meal.

Take a tip from the fast food marketers and include a surprise gift in the lunch. It might be a small collectable such as cars, baseball cards, characters, hair clips, stickers, or child's ring or bracelet.  Home made "giftlets" (tiny gifts) are perfect.

Go organic as much as possible.  "USDA Organic" means the food is produced without the use of harmful pesticides, artificial fertilizers, antibiotics, growth hormones human waste, or sewage sludge, and that they were processed without ionizing radiation or food additives. Children with ASD are already coping with their own excess metabolites and really can not handle the burden of harmful chemicals in the environment and foods. The less the exposure the better. Anything you can do for your child is a benefit.

There are numerous resources for GFCF foods and recipes online and in many books.  Utilize all of these to find the commercially available foods your child will eat as well as recipes that are not just GFCF, they are nutritious and delicious.  Test them at home - not in the school lunch.  There are GFCF juice boxes, pretzels, breads, wraps and snacks.

Establish three to five basic lunches that work.  If your child is willing and interested, engage him or her in the process. Test new foods out at home until you have the food right and the combination of foods right.

Use freezer packs for keeping foods cold and thermos for hot foods.  Include non-toxic hand sanitizers which are commercially available (avoid the commercial sanitizers).  You can also send two paper towel pieces - one moistened with soap and one moistened with water..

Again - go with the marketers - jazz it up!  Select a lunch container your child loves. Young children love to decorate a lunch box with stickers and paints. Make the lunch box the child's own work of art personalized with a name. Reusable containers and boxes are the green way to go.  Older children will definitely want to        select whatever is considered cool.  The most cool may be a paper bag or small recycled bag carried in a back pack.  Go with the trend and your child's own choice.  There are companies who make safe, BPA-Free, safe lunch box sets with inserts for the different foods.

To avoid plastic wraps for sandwiches, use wax paper or parchment paper.  Avoid containers with BPA by avoiding items with the recycle number 7.  There are many BPA -Free containers which can be washed and reused.    Your child will need to know to bring these back home rather than throw them away.

For napkins, use washable cloth napkins or dishcloths, or choose processed chlorine-free (PCF), post-consumer-waste (PCW) paper napkins available in stores and on line.  If utensils are needed, use stainless steel appropriate to the child's skill level and age.

       

Remember Odysseus from seventh grade mythology?   Seeking to gain entrance into Troy, he cleverly ordered a hollow wooden horse so large that the Greek army could hide inside. What looked like a huge horse was really a disguise to conquer the city.  We have used this concept for decades to hide nutritious food to nourish picky eaters.   

Rather than introduce a new food in its natural form, begin by hiding a very small amount (about a tablespoon) of it as puree mixed or blended into a well-liked and well-tolerated food.  This approach allows the body to accept the new food. As the child accepts the taste, include more.  Children who have food texture issues are especially good candidates for blended foods because their sensory development may be younger than their chronological age. Adapt to the sensory level and return to purees until sensory issues improve. Rather than focusing on getting a child to tolerate foods that he perceives as "lumpy" or unpleasant to chew, the goal is getting a child to eat nutritious food, however you can.

       

Assume the new food is a vegetable, use organic baby food purees or make your own. Puree the new food into an established food that does not change the overall color, texture, smell, or taste.  If a child eats nothing but white food, start with very light-colored vegetables including squash, cauliflower and corn. If the child likes ketchup or tomato sauce, then introduce deeper-colored vegetables such as beets, greens, peas and beans.  Pureed vegetables can be beaten into batter for pancakes, muffins, brownies, and cookies or into tomato and other pasta and pizza sauces, and even into ketchup.

Vegetable juice makes a healthy addition to fruit juice. Try mixing carrot juice with orange juice, and then adding a teaspoon or so of another vegetable juice. Serve in a brightly colored sippy cup to camouflage any color changes. Blend pureed vegetables into cooked fruits such as applesauce or pearsauce, into meatballs, and even into nut butters. Expand ideas as tolerance improves. Be sure to carry out the Trojan Horse technique out of the sight of your child! 

       

Many families have developed what we call muffin casseroles. One resourceful mother developed a GF/CF muffin for her child who ate only breads and muffins, and then gradually added fruit puree to the batter. As he tolerated fruits, she moved to vegetable purees, and finally added pureed meat. Until he was able to transition to eating foods in a traditional manner, he ate his muffin casseroles at every meal and snack-and loved them!

       

The Trojan Horse technique is especially useful for kids who need more protein in their diets. Add eggs, especially the high-protein whites, and rice-protein powders to batters, breads, smoothies, meat sauces and meatballs. Do not add raw eggs to smoothies.

AS your child expands to eating vegetables, try vegetables dipped in honey or mayo/ketchup mix or hommus.  It is a start .  As a child accepts an increasing number of foods presented in a sneaky manner, eventually, he/she will accept the food alone - we promise! All it takes is patience, and a lesson from Greek mythology!

Choose one from each column.  This list is GFCF.  Also avoid any foods which provoke reactions or those forbidden at school (nuts for examples) or foods The "Other" column is optional.

Protein Choices	Vegetables  & Fruits	Drinks	Other
Chicken strips GFCF chicken nuggets w/ketchup to dip Meat slices rolled up Shrimp (send frozen, will thaw by lunch) - seafood sauce to dip. Organic "deli" chicken slices Hommus plain, on bread or crackers or as dip for veggies Muffin "pot pies" Soy yogurt Egg salad. Hardboiled eggs or Deviled eggs. Peanut butter on crackers or apples. Nuts - all varieties: almond, cashew, pecan, pistachio, hazelnut Hot foods for thermos Chili or soups Turkey hot dogs cut up GFCF Pizza	These can be eaten plain or dipped in GFCF sauces, ketchup or honey Cup up vegetables Baby carrots or carrot strips Broccoli "trees" ……………………………. Apples, Banana, Berries, Oranges, Peaches, Grapes, Pineapple, Melon Fruit cocktail combo in natural juice. Raisins, apricots Applesauce in cups Any blended fruit sauce	Water Fruit juice V8 V8 + fruit Seltzer w/ juice Fruit smoothie Other milk     (soy, rice,  coconut, almond) Keep drinks partially frozen so they will remain cold	GFCF pretzels Rice crackers Baked tortilla chips GFCF dry cereal GFCF vegetable gummies Small GFCF cookie

1 oz. Meat, Fish or Poultry

1 egg

1/4 cup tuna

1/2 cup baked beans, dried peas, lentils

2 tablespoons peanut butter, almond butter

2  ounces nuts / seeds 

1 cup soy milk (8 oz)

1 cup soy yogurt (8 oz)

Child's  serving is 1 to 2 x = 8 to 16 grams

Adult serving is 3 to 4 x  = 24 to 32 grams

Pamela J. Compart, M.D., is a developmental pediatrician in Columbia, Maryland. She combines traditional and complementary medicine approaches to the treatment of ADHD, autism, and other behavioral and developmental disorders. She is also the director of HeartLight Healing Arts, a multidisciplinary integrated holistic health care practice, providing services for children, adults, and families.

Dana Godbout Laake, R.D.H., M.S., L.D.N., is a licensed nutritionist in Kensington, Maryland. Within her practice, Dana Laake Nutrition, she provides preventive and therapeutic medical nutrition services. Her practice includes nutritional evaluation and treatment of the full spectrum of health issues affecting adults and children with special needs.