REFILE-Algorithm guides GI management in children with autism

Last Updated: 2015-07-20

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By Megan Brooks

NEW YORK (Reuters Health) - A new clinical guideline from an expert panel outlines an 11-step algorithm for management of gastrointestinal (GI) symptoms in children with autism spectrum disorder (ASD).

The guideline is "intended to serve as a tool to individualize treatment to address GI symptoms, while lessening the risk of exacerbating potential nutrient deficits due to behavioral feeding concerns and caregiver-initiated restriction," the authors wrote online July 9 in the Journal of the Academy of Nutrition and Dietetics.

"There is mounting evidence children with autism are at increased risk for feeding and GI concerns compared with peers and both of these issues involve nutrition management. Up to this point, however, no guideline existed regarding nutrition management of GI symptoms in children with ASD," Dr. William Sharp, a co-author of the guideline and director of the Pediatric Feeding Disorders Program at Marcus Autism Center in Atlanta, told Reuters Health by email.

Rashelle Berry is the lead nutritionist for Dr. Sharp's program and the primary author of the guideline. "We conducted a nationwide search to establish a six-member committee of dietitians with a combined 125 years of clinical experience working in the field of nutrition and autism," she said in an email.

In developing the guideline, the committee considered the unique dietary, medical, and behavioral challenges of children with ASD. "This includes high rates of food selectivity observed in children with ASD, frequent use of caregiver-initiated complementary/alternative diet therapies, and growing concern regarding possible nutritional deficits and excesses often observed in this population," Berry said.

The first step in the algorithm focuses on identifying and finding solutions to any barriers that could impede the development of a prescriptive diet that targets specific GI concerns. Subsequently, the focus is on assuring that all nutrition-related concerns are evaluated and addressed by the intervention.

Multidisciplinary collaboration in the evaluation and treatment of GI issues is emphasized. Specifically, the authors recommend coordinating care with a pediatric gastroenterologist and involving a feeding therapist in cases of severe food selectivity or behavioral issues during meals that might fall outside a nutritionist's scope of practice.

"At this time, behavioral intervention is the only treatment for severe food selectivity in ASD with well-established empirical support, yet treatment must also consider factors influencing eating, such as GI discomfort, food allergies, sensory processing, and oral-motor skills, during assessment and intervention to maximize effectiveness," the authors write.

"A key take home message from this guideline is that nutrition management in ASD should play a central role in a child's overall plan of care, ideally from the time of diagnosis," Dr. Sharp told Reuters Health.

"Children with autism, like their typically developing peers, present with medical conditions that require nutrition intervention," Berry wrote to Reuters Health. "Awareness of the unique challenges seen in this population is needed so that clinicians are well-equipped to plan effective interventions. The ultimate goal of nutrition management in autism is resolution of symptoms, promoting adequate growth, and assuring a nutritionally complete diet."

SOURCE: http://bit.ly/1JZy7hX

J Acad Nutr Diet 2015.