Feeding Therapy for Tube-Fed and Severely Restrictive Autistic Children

Feeding difficulties affect 70-90% of autistic children, ranging from mild food selectivity to severe restriction requiring tube feeding. Sensory processing differences drive most feeding challenges: textures, temperatures, colors, smells, and mixed foods can trigger strong aversive responses. Some children eat fewer than five foods. Others rely on supplemental tube feeding (NG or G-tube) to maintain nutrition.

Medical factors must be ruled out first. GERD, food allergies, oral-motor difficulties, and constipation are more common in autistic children and may cause pain during eating. A pediatric gastroenterologist should evaluate any child with severe feeding restriction before therapy begins.

Ontario offers several pathways to feeding therapy. Hospital-based multidisciplinary feeding clinics (Holland Bloorview, McMaster Children's Hospital, CHEO, SickKids) provide comprehensive assessment and treatment for severe cases including tube weaning. Wait times are 6-18 months. Children's treatment centres offer outpatient feeding therapy with shorter waits.

OAP core clinical funding covers feeding therapy when delivered by approved occupational therapists or speech-language pathologists. Private feeding therapists charge $120-180 per hour. When seeking a provider, look for specific training in the SOS Approach to Feeding, ABA-based feeding protocols, or pediatric feeding disorders. The combination of OT addressing sensory and motor components with BCBA addressing behavioural components often produces the best outcomes.