Drinking Concerns

There are many factors that need to be considered when thinking about drinking:

• Your child's ability to recognise when they need a drink - we all rely on our brains being able to process sensory signals from our bodies and respond appropriately. This is called interception, which is our body's internal sensory system that allows us to recognise our physical and emotional states. For example, hunger, thirst, hot and cold, or happy, sad and worried.
• Communication - if you consider how your child communicates that they need a drink. Is this through words or gestures? Does this vary, and is it understood across different settings with different people?
• Planning and organisation - does your child know how to make their own drink or what to do if something has changed, for example, they can't find their own glass? Do they need support to remember their drink bottle when they leave the house or go to school?

Think about when, where and why your child might not be drinking enough or drinking too much. Understanding these challenges can help you and your child to develop strategies to drink healthily. 

Not Drinking Enough

Not drinking enough can affect concentration, cause headaches, and tiredness, and worsen continence difficulties, such as constipation. If your child is not drinking enough, think about trying the following approaches:

• Letting your child choose their own water bottle, cup or fun straw
• Try alternatives like watered-down juice or squash if your child doesn't like the taste of water
• Setting up a hydration station at home with an easily accessible water bottle or cup
• Ask your child's teacher if they can have their bottle directly on their table as a visual cue to drink more 
• Incorporate drinking into their play (for example a family tea party)
• Try adding ice cubes or freezing their drink overnight (some children prefer very cold drinks)
• Some foods can act as a great source of fluid. Ice lollies, jelly, melon, cucumber and soups can contribute to your child's daily fluid intake
• Try buying a water bottle with timings on. This can help to remind children when to drink throughout the day
• Plan set times for drinks, such as with snacks and meals

Drinking Too Much

Drinking too much can also have unwanted side effects and affect your child's health. Drinking too much water can affect their toileting routine, appetite, and the electrolytes in their body. Too many sugary, caffeinated or fizzy drinks can negatively affect your child's toileting, teeth, weight, blood sugar and behaviour. 

Strategies to regulate their drinking habits include:

• Buying water bottles with timings on. This can help to regulate how much they are drinking.
• Planning set times for drinking, such as with snacks and meals
• Ensuring fizzy, sugary and caffeinated drinks are not easily accessible at home and only offered as an occasional treat
• Having set times for drinking at school (unmonitored access to their bottles and refills may need to be discouraged in excessive drinking)
• Offering set quantities of fluid (have certain times in the day when their water bottles are refilled)
• Using a smaller water bottle or cup (this can prevent large quantities of fluid from being drunk in one go)

If you have any concerns with your child's drinking, make sure you contact your child's teacher to ask if they can monitor their fluid intake and introduce strategies at school to help. 

If you suspect your child's drinking habits are affecting their health, speak to your GP for advice. 

Restrictive Eating 

Restrictive eating is described as when a young person has a limited diet in terms of range or quantity. It can be driven by many things, but the most common reasons that neurodivergent children develop eating problems are:

• Sensory differences related to food, including not recognising hunger or fullness
• Food, counting calories and exercise becoming an intense interest or obsession
• Developing strict routines and rules around food and exercise that are difficult to change
• A need for control and familiarity
• Using food to manage difficult emotions
• Feeling unable to make decisions so hyper fixating on particular meals or recipes
• An inability to manage time so reliance on quick foods

While it can be concerning, trying to understand your child's experience of food and eating will help you find the cause. Strategies that could help include:

• Involving your child in choosing and preparing food to get familiar with textures, colours and shapes
• First, let your child look at the food, then touch it and ask them to put the food on their plate. Work up to smelling, licking and eventually putting the food in their mouth, then biting chewing and swallowing it 
• Try not to react negatively to food being spat out, it's helping your child to become comfortable with food being near or in their mouth
• Being patient - every step could take weeks to complete. The goal is to let your child become more comfortable with each food without expectation, so try to manage your expectations and accept it can take time
• Keeping nutritious versions of their favourite convenience food around, like mini protein bars to help your child manage their diet during stressful periods, like exam time
• Pre-preparing favourite meals, or freezing meals so that they can eat nutritious food without having to make too many decisions

ARFID

Avoidant/restrictive food intake disorder is when a child or young person avoids eating certain foods, limits how much they eat, or does both. When a person develops ARFID they are less worried about their body shape and develop the eating disorder for other reasons, which could be:

• Sensory issues with smell, texture or taste
• Anxiety following a negative experience like choking or sickness
• Previous fussiness which develops into a more severe dislike of foods or food groups
• Lack of interest in food or not feeling hungry

If your child begins to lose weight rapidly, loses weight over three months or you believe their eating is out of control, seek urgent help. Speak to your family doctor (GP) for advice and to be referred to a specialist if needed.

Binge Eating

Every child has a unique relationship with food, however eating disorders are more frequent in neurodivergent children. 

Compulsive, uncontrolled overeating even when full or not hungry (binge eating) can be caused by a combination of differences in children with a neurodevelopmental condition:

• Interception - differences in the way your child's brain and body recognise hunger or feeling full
• Anxiety and stress - your child's coping response (in this case eating) to the body's fight or flight reaction or overwhelming emotions
• Executive function - differences in the skills that help your child to organise and achieve goals, such as planning and cooking meals
• Impulsivity - differences controlling the impulses that prevent overeating
• Understanding consequences - difficulties pausing to consider the possible consequences of their actions
• Pleasure - eating can release a chemical messenger in the brain responsible for pleasure called dopamine. Eating when bored or under-stimulated can give instant enjoyment

Symptoms of binge eating that your child might experience include:

• Eating large amounts of food in a short period of time
• Feeling out of control
• Eating when they are full or aren't hungry
• Eating quickly
• Eating until they are uncomfortably full
• Feeling upset, depressed, or embarrassed about their eating habits 

If you are concerned your child is binge eating, contact your GP for advice. They may refer or signpost you to other health services for support. This could involve Cognitive Behavioural Therapy (CBT), medication changes, or support with creating and maintaining healthy habits. 

Hyperfixation

Hyperfixation refers to a strong and extended interest in, or focus on an activity, object or item. It typically happens with things that a child or young person enjoys, like a hobby, activity, TV show, person or type of food. 

In neurodivergent young people, hyperfixation can happen more often and for various reasons. These could be:

• To provide a sense of comfort and security from safe foods
• As a dopamine hit for instant pleasure
• To avoid anxiety through repetitive behaviours
• As a way of coping or distracting from low mood and unpleasant thoughts or feelings

A hyper fixation with different types of food, or ingredients can look like this:

• Repeating the same recipes over and over again
• Eating a food item 
• Focusing on one food group or an item of food at the expense of others
• Not eating a healthy or varied diet

If you are concerned that your child cannot eat a healthy diet due to hyperfixations, speak to your family doctor (GP) who can offer guidance and refer your child or young person to a specialist if needed. 

Eating Inedible Items

The urge to eat non-food items, called pica, can be related to some neurodivergent conditions. Some possible reasons children may engage with pica include:

• For sensory feedback - to feel texture or crave a chewing motion
• To relieve anxiety or stress
• To gain attention or avoid a demand
• A lack of awareness of what is and isn't food

If your child has been eating non-food items it's important to get some advice from your GP. Other strategies for parents include:

• Keeping a look out for dangerous items and keeping a log of items that are eaten
• Tell others, including your school, your GP and any health professionals who work with your child
• Provide a safe alternative to chew, bite and eat
• Distract away from eating non-food items with other activities
• Request support from appropriate services linked to your child's condition, if they have a diagnosis

Hypersensitivity

Some neurodivergent conditions can be affected by diet. Small changes to what a child eats can have a positive impact on their physical and emotional health. Examples of foods that harm behaviour, attention and energy include:

• Sugar
• E-numbers
• Caffeine

There are lots of ways to help your child reach for healthier food items and avoid stimulants that may negatively affect them, for example:

• Involve your child in choosing healthy alternatives from the supermarket
• Add new foods at meal times to encourage different healthy food items
• Give rewards or reward charts for eating all or specific foods
• Try to have protected meal times with no distractions
• Limit snacks and keep foods high in sugar, caffeine or additives out of reach

Sensory Strategies 

Everyone has a unique response to sensory stimuli, but this can be particularly challenging for neurodivergent children. Food can be very unpredictable in texture, taste and colour. An apple, for example, can taste sharp or sweet, be bright or bruised, and be hard or mushy. 

Some strategies that can help with oversensitivity during mealtimes include:

• Warning your child that a meal is nearly ready (about 5 minutes before) so they have time to prepare their sensory system.
• Avoid cooking in the same room as them if possible, some children can find cooking smells overwhelming.
• Make sure your child is sitting somewhere comfortable where they can eat. If they are sitting at the dining table, make sure their feet can touch the floor, or rest on a stool or box under the table. If they prefer to eat with their feet tucked underneath them, or kneeling up, let them. The extra sensory feedback from these positions may calm other sensitivities in their body. 
• Some children find the sight of food off-putting if they are visually oversensitive. In this case, you could offer a distraction, like the TV or an iPad. While it might feel counterproductive, it can be a helpful way to take the pressure or emphasis off food. 
• Considering their environment, busy school dining rooms or noisy restaurants can be overwhelming for a child who has noise sensitivities. If so, ask for a quieter space for them to eat their food.