21 - The Social and Environmental Context of Picky Eating for Children with Autism Spectrum Disorder and Other Special Health Care Needs

Publication Number: 4020.21

Keiko Marshall, McMaster University Michael G. DeGroote School of Medicine, Hamilton, ON, Canada; Anne Fuller, McMaster University, Hamilton, ON, Canada; Carol Duh-Leong, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States

Background: Picky eating (PE) that is severe or persists into adolescence can lead to adverse health outcomes including nutritional deficiencies, poor growth, and disrupted family dynamics. While children with autism spectrum disorder (ASD) are known to be at elevated risk, less is known about PE among children with other special healthcare needs (O-SHCNs), and the influence of socioenvironmental stressors.

Objective: (1) To compare the prevalence of extreme PE in children with ASD and O-SHCNs versus those without SHCNs (N-SHCNs), and (2) to examine associations between PE and socioenvironmental factors including food insufficiency, parental mental health, parental aggravation, and adverse childhood experiences (ACEs).

Design/Methods: We conducted a cross-sectional analysis of 67,455 children aged 6-17 years in the 2022-23 National Survey of Children's Health (NSCH). Logistic regression models assessed associations between PE and child health status (ASD, O-SHCN, N-SHCN), adjusting for sociodemographic factors. Additional stratified models examined associations between PE and socioenvironmental variables (food insufficiency, parental mental health, parental aggravation, ACEs) among children with ASD and O-SHCNs.

Results: Children with ASD had significantly higher odds of extreme PE (aOR = 6.05, 95% CI: 5.16-7.09) compared to children with N-SHCNs. Children with O-SHCNs also had higher odds (aOR = 2.27, 95% CI: 2.10-2.46). In stratified analyses, food insufficiency and parental aggravation were associated with greater odds of PE in both groups. For children with O-SHCNs only, poor parental mental health and experiencing ≥2 ACEs were also significantly associated with PE.

Conclusion(s): Children with ASD and O-SHCNs are both at elevated risk for extreme PE, and socioenvironmental factors including food insecurity and caregiver stress contribute meaningfully to this risk. These findings underscore the importance of incorporating caregiver and contextual supports into PE interventions and highlight the need for trauma-informed, family-centered approaches across SHCN populations.

Table 1: Participant Characteristics
1N-SHCN: Children Without Special Healthcare needs; 2O-SHCNs: Children With Other Special Healthcare Needs; 3ASD: Children with Autism Spectrum Disorder and Special Healthcare Needs; 4Standard Deviation

Table 2. Comparing Picky Eating in Children With N-SHCNs vs. O-SHCNs vs. ASD
1N-SHCN: Children Without Special Healthcare needs; 2O-SHCNs: Children With Other Special Healthcare Needs; 3ASD: Children with Autism Spectrum Disorder and Special Healthcare Needs; 4Models adjusted for child age, child sex, child race, parent age, parent education, parent marital status, parent employment status; 5Unadjusted Odds Ratio and 95% Confidence Interval; 6Adjusted Odds Ratio and 95% Confidence Interval

Table 3: Associations between Picky Eating and Food Insufficiency, Relational Health, Parent Mental Health, and ACEs by Child Health Status
1O-SHCNs: Children With Other Special Healthcare Needs; 2ASD: Children with Autism Spectrum Disorder and Special Healthcare Needs; 3Unadjusted Odds Ratio; 4Adjusted Odds Ratio; Models adjusted for child age, child sex, child race, parent age, parent education, parent marital status, parent employment status