Research progress on dietary characteristics and feeding interventions in children with autism spectrum disorder: a narrative review.

BACKGROUND AND

OBJECTIVE

Children with autism spectrum disorder (ASD) often experience feeding difficulties, including extreme food selectivity (FS), disruptive eating behaviors, and in severe cases, avoidant/restrictive food intake disorder (ARFID). These issues can result in unbalanced nutrient intake, impaired growth and development, worsened gastrointestinal symptoms (GIS), and significant feeding burdens for families. This review aims to summarize the dietary characteristics of children with ASD, examine the underlying causes, and evaluate common treatments. The primary objective is to provide evidence-based guidance for child health physicians to implement scientific, individualized nutritional management strategies in clinical practice.

METHODS

We systematically reviewed journal articles published between 2010 and 2025. The analysis focused on dietary characteristics, related mechanisms, and corresponding dietary intervention strategies for children with ASD.

KEY CONTENT AND FINDINGS: This review summarizes the characteristic dietary profiles of children with ASD and discusses the underlying mechanisms from several perspectives: sensory processing dysfunction, microbiota-gut-brain axis dysregulation, food allergy or intolerance, and behavioral-cognitive abnormalities. It also systematically evaluates the effectiveness of mainstream nutritional and behavioral interventions. The main treatment is applied behavior analysis (ABA). It works best for improving eating behaviors. Other food-related treatments have mixed results: special diets [like gluten-free and casein-free (GFCF)] are not proven to help core autism symptoms for most children. They may be tried for a short period in certain cases. Probiotics/prebiotics can help with stomach problems, but their effect on autism symptoms is unclear. Omega-3 supplements do not clearly help autism symptoms. Vitamin/mineral supplements should only be used if blood tests show a lack of specific nutrients.

CONCLUSIONS

We conclude that ABA constitutes the primary behavioral intervention. Nutritional approaches must be implemented following comprehensive evaluation, targeting specific comorbidities-such as GIS or allergies-or confirmed nutrient deficiencies through precise supplementation. This individualized strategy effectively avoids generalized dietary protocols.