STEP 2

Make Sure Your Child Is Getting Enough Basic Nutrients

Now that you’ve transitioned your child to a healthier diet, it’s time to focus on making sure that his diet includes enough of the basic nutrients he needs. If your child is lacking basic nutrients in his diet, his brain and immune, gastrointestinal, and detoxification systems will not function to the best of their abilities. In this chapter, you’ll learn why protein, carbohydrate, fat, vitamins, minerals, and water are so important for your child and how to determine which of these basic nutrients he may be lacking. It’s important to understand that even if your child’s weight and height are within normal limits, he still may be “starving” for these basic nutrients—your child can easily consume enough calories from junk foods to gain weight and grow taller. Ensuring your child’s diet includes all these nutrients is a critical part of helping him function at his best.

Unfortunately, eating a poor diet is a very common problem among children with autism. When assessing the nutritional needs of an autistic child, I ask parents to keep a food diary for three days and record everything their child eats and drinks. I’ve found that most autistic kids’ diets look something like this: high-sugar dry cereal for breakfast, boxed macaroni and cheese for lunch, and fast-food chicken nuggets and soda for dinner. Snacks are usually junk foods, sweets, and several cups of apple juice. And of course, candy is often offered throughout the day as a positive reinforcer/reward system. It’s obvious that this kind of diet is lacking the protein, calcium, fiber, omega-3 fatty acids, water, vitamins, and minerals kids need for good health.

Most American children don’t eat well. Kids with autism aren’t the only ones eating substandard diets. The U.S. Department of Agriculture (USDA) conducted a study on children ages two to nineteen years and found that only 1 percent of children’s diets met all dietary requirements.

I know that getting your child to eat a diet that includes enough of all the basic nutrients is easier said than done. Many of the autistic kids I’ve worked with eat a very limited diet; some will accept only five or ten different foods. Their parents are frustrated because they’ve tried everything they can think of to expand their child’s diet, but nothing has worked. Autistic children often refuse new foods, throw tantrums when offered a food they don’t want to eat, will drink only apple juice, or seem to crave carbs. If this sounds familiar, then your child will probably not start eating a healthier diet just because you offer it to him. In Step 5, I discuss feeding problems like these in detail and offer advice on how to get your child to eat healthier foods. The information you’ll learn here will focus on the basic nutrients, why they’re critical for your child, and how much he should be consuming.

“When my child was diagnosed with autism, I felt hopeless. Once I moved past the initial shock and depression, I found the courage to search for answers to help my child, which started in my kitchen. I learned how to combine foods to provide proper nutrition at each meal, added healthy fats into his diet, and made sure he got basic nutrients like calcium and protein in his diet every day. Diet has become another piece of his therapy program. My son is responding well to all his therapies and moves farther from the spectrum every week.”

 

—Sharon, mother of a five-year-old boy on the autism spectrum

THE BASIC NUTRIENTS

As I mentioned earlier, nutrients are divided into six categories: protein, carbohydrate, fat, vitamins, minerals, and water. These basic nutrients provide a total of forty-five essential nutrients, which our bodies are dependent on to sustain life. An essential nutrient is a substance that your body is unable to make on its own and must be consumed through your diet. Protein provides the essential amino acids histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine. Fat provides the essential fatty acids linoleic acid and alpha-linolenic acid.

PROTEIN

Protein is a critically important basic nutrient, especially during infancy, childhood, and adolescence when children are growing and developing rapidly. The body uses protein to manufacture hormones, antibodies, enzymes, tissue, and neurotransmitters and to repair body cells and produce new ones. Protein can also be turned into glucose for energy required by the brain when carbohydrates are not available. Lastly, our bodies need adequate protein in order to provide amino acids, which are the building blocks of the body.

When your child eats a food that contains protein, his body breaks the protein into amino acids that are used throughout his body for various purposes. Some amino acids are used to produce energy during times of starvation; others are used to produce enzymes that act as catalysts for biochemical reactions and antibodies to fight off illness. Still others build muscle tissue and generate cell signaling. Several amino acids function as neurotransmitters to generate cell signaling within the brain. Some of these amino acids are involved in activities such as learning, memory, and specification of nerves in the developing brain.

If your child eats a poor diet, takes in an insufficient amount of food, or refuses to eat meats, he may have a protein deficiency. Signs of a protein deficiency include the following:

• stunted growth

• poor muscle mass

• edema

• thin and fragile hair

• decreased mental alertness, comprehension, and concentration

As you can see, protein plays a major role in both your child’s body and brain function.

How Much Protein Your Child Should Eat

The chart below shows the Recommended Dietary Allowance (RDA) of protein your child should be eating based on his age. While the RDA chart will give you a good idea of the minimum amount of protein your child requires, keep in mind that he may need more protein, depending on variables such as illness, infections, stress, and genetics. It’s best for a registered dietitian (RD) to assess your child’s nutritional status and determine his individual protein needs and whether he’s meeting them in his current diet. The RD may want to run some blood tests—for prealbumin, retinol binding protein , transferrin, and serum albumin—to assess your child’s protein status. (See Appendix 1 on page 213 for more information on Registered Dietitians and how to locate one in your community.)

Recommended Daily Allowance for Protein

Source: Food and Nutrition Board, Institute of Medicine, National Academies

Choosing the Best Sources of Protein

When choosing protein-rich foods for your child, your best choices are complete proteins , or proteins that contain all of the essential amino acids. Complete proteins are found in foods such as:

• beef

• poultry

• fish

• pork

• eggs

• yogurt

• cheese

• soymilk

• milk

• tofu

You can also offer your child incomplete proteins, or proteins that lack one or more of the essential amino acids. Dietary sources of incomplete proteins include:

• beans

• peas

• nuts

• seeds

• grains

Different incomplete proteins can be combined to form a complete protein, meaning together they provide your child with all of the essential amino acids. This combination is called a complementary protein. An example of a complementary protein combination is beans combined with brown rice, wheat, nuts, seed, or corn; and brown rice combined with beans, wheat, nuts or seeds. See Appendix 2 for a full list of good dietary sources of protein and serving sizes.

When to Feed Your Child Protein

Many of your child’s body and brain functions depend on a steady influx of amino acids throughout the day to function properly. This is especially true for the amino acids acting as neurotransmitters in his brain. Since the body is unable to store excess dietary amino acids for later use, you need to divide your child’s daily protein requirement throughout the day, ideally over three meals and two snacks. Providing your child protein at every meal and snack will also help to stabilize his blood glucose levels, which will prevent hyperglycemia and reactive hypoglycemia (see Step 1 for more information on these conditions).

Many children with autism have severe feeding problems and consume a very limited variety of foods, which often results in a protein deficiency. If you’re unable to increase your child’s intake of high-protein foods, giving him a protein powder supplement is a good option until his diet can be expanded. There are rice, pea, soy, and whey protein supplements available that your child can use, or if he suffers from one or more food allergy or sensitivity, he could try a free amino acid-based protein supplement. As an alternative to protein supplements, you could try adding strained baby food meats to your child’s foods. Baby food meats are an excellent source of high-quality protein that you can sneak into gravies, sauces, and various recipes. If you decide to give your child a protein supplement or add baby food meats to his food, you must first determine how much protein your child is getting from his current diet so you know how much more you need to add to help him reach his RDA. Then you should start with a very small amount and gradually increase the quantity each day over the span of a few weeks. Many children with autism have sensory processing disorder or sensory processing issues, which makes them very sensitive to changes in their favorite foods. These kids will reject food with even the slightest difference in flavor, odor, color, or texture. Therefore you must take the process of adding a supplement to your child’s food very slowly to avoid rejection. It’s a good idea to consult a registered dietitian before giving your child a protein supplement.

CARBOHYDRATE

Carbohydrates, or “carbs,” are the body’s primary source of energy. Proteins and fats can also serve as energy sources, but the body prefers carbohydrates because they are more easily converted to glucose. Glucose is the only source of energy the brain can use, so it’s important that children take in enough carbohydrates to maintain a constant supply of glucose to the brain. This keeps their brains functioning at their optimum level throughout the day. There are two major types of carbohydrates: simple carbohydrates and complex carbohydrates.

Simple carbohydrates include monosaccharides and disaccharides. Monosaccharides, such as glucose, fructose, and galactose are composed of a single sugar unit, whereas disaccharides, such as sucrose, lactose, and maltose are composed of two sugar units. Simple carbohydrates are found in refined sugars, like the white sugar you’d see in a sugar bowl. Examples of simple carbohydrates are honey, corn syrup, high-fructose corn syrup, molasses, candy, soda, and sweets. Fruits and milk are also classified as simple carbohydrates, but they’re considered nutrient-rich simple carbohydrates because they contain vitamins, minerals, fiber, and important nutrients like calcium and protein.

Complex carbohydrates are polysaccharides, which consist of many sugar units strung together to form long, complex chains. Examples of complex carbohydrates include foods such as rice, potatoes, peas, beans, corn, and whole grain products like flour, bread, and pasta. As with simple carbohydrates, some complex carbohydrates are better choices than others. Refined complex carbohydrates, such as white flour and white rice, have been processed, which removes nutrients and fiber. But unrefined grains still contain their original vitamins and minerals. Unrefined grains also are rich in fiber, which helps your child’s digestive system work well.

Choosing the Right Carbohydrates for Your Child

Unrefined complex carbohydrates and nutrient-rich simple carbohydrates are far better choices than simple and refined complex carbohydrates. As I discussed in Step 1, simple carbohydrates (with the exception of fruit and milk) are digested, broken down into glucose, and enter the bloodstream rapidly, which causes hyperglycemia and reactive hypoglycemia. On the other hand, complex carbohydrates are digested, broken down into glucose, and enter the bloodstream slowly, which in turn stabilizes your child’s blood glucose levels. The protein in milk and fiber in fruit prevent them from triggering the rapid fluctuation in blood glucose levels as do other simple carbohydrates.

Another helpful guide to choosing the right carbohydrates for your child is to consider their ranking on the glycemic index. The glycemic index ranks carbohydrates based on how they affect blood glucose levels. Carbohydrates that are digested slowly, resulting in a gradual release of glucose into the bloodstream, have a low glycemic index. Carbohydrates that are digested more quickly, resulting in a rapid release of glucose into the bloodstream, have a higher glycemic index. If your child is sensitive to fluctuations in his blood glucose levels, he may benefit from eating carbohydrates with a lower glycemic index. When he does eat a carbohydrate with a high glycemic index, he should combine it with another food that contains healthy fats, protein, or fiber to lower the glycemic index effect. The chart below categorizes common foods as low, medium, and high glycemic index for your convenience.

CLASSIFICATION	GLYCEMIC INDEX RANGE	FOODS
Low	55 or less	Whole grains, dried beans and peas, pinto beans, lentils, brown rice, popcorn, rice bran cereal, Kellogg’s All Bran Fruit & Oats cereal, Special K cereal, soymilk, milk, macaroni, spaghetti, orange juice, apple juice, fruit cocktail, most fruits (except watermelon), and vegetables (except potatoes).
Medium	56-69	Wheat bread, pita bread, croissants, Life cereal, Grape-Nuts cereal, Frosted Mini-Wheat cereal, taco shell, cheese pizza, white rice, boiled white potato, sweet potato, angel food cake, macaroni and cheese, pineapple, raisins, and honey.
High	70 or more	White bread, donuts, bagels, waffle, rice cakes, cream of wheat, corn chips, pretzels, Cheerios, Corn Flakes, Golden Graham cereal, Rice Krispies, instant rice, mashed potatoes, French fries, microwave potato, instant potato, baked potato, and watermelon.

FIBER—A SPECIAL TYPE OF CARBOHYDRATE

Fiber is the indigestible portion of plants. It’s considered a complex carbohydrate, but it passes through the human digestive system virtually unchanged, without being broken down into nutrients. Many children with autism have gastrointestinal problems (turn to Step 6 for an in-depth discussion on this topic), and getting an adequate amount of fiber is key to healing their gastrointestinal tracts and promoting normal daily bowel movements, which help rid their bodies of toxins. There are two types of fiber: soluble and insoluble.

Soluble fiber resists digestion and absorption in the small intestine and undergoes fermentation in the large intestine. This process results in a broad range of health benefits. For instance, short-chain fatty acids are created that promote increased proliferation of bacteria such as Bifidobacteria and Lactobacilli, which help keep the intestines healthy. In addition, soluble fiber lowers LDL (bad) cholesterol levels, helps prevent colon cancer, and keeps blood sugar levels stable by slowing the digestion of carbohydrates and the subsequent release of glucose into the blood. Soluble fiber is found in beans, peas, soybeans, psyllium seed husk, oats, barley, fruits, prune juice, and root vegetables.

Insoluble fiber absorbs water as it passes through the intestinal tract, softening stool, increasing stool bulk, and keeping things moving through the colon. Insoluble fiber is found in whole grain products, bran, nuts, seeds, vegetables, and skins of fruits.

There are three ways to figure out how much fiber your child should be consuming:

1. A study by the Child Health Center recommends that children over two years of age consume an amount of fiber that equals their age in years plus 5 grams per day (e.g., for a six-year-old child, 6 + 5 = 11 grams fiber per day).

2. The American Academy of Pediatrics recommends children eat 0.5 grams fiber per kilogram body weight. To determine your child’s body weight in kilograms, divide his weight in pounds by 2.2 (e.g., for a 46-pound child, 46 ÷ 2.2 × 0.5 = 10½ grams fiber per day).

3. The Institute of Medicine has set the adequate intake of fiber at 19 grams for one to three year olds; 25 grams for four to eight year olds; 31 grams for nine- to thirteen-year-old males; 38 grams for fourteen- to fifty-year-old males; 26 grams for nine- to eighteen-year-old females; and 25 grams for nineteen- to fifty-year-old females.

I usually use the first or second method because it’s a lower amount. Autistic children are already typically consuming a very small amount of dietary fiber, so I prefer to start low and gradually increase the amount of fiber in a child’s diet.

Turn to Appendix 2 on page 216 for a list of high-fiber foods.

Do Autistic Children Crave Carbs?

I can’t tell you how many parents I’ve worked with who believe their child craves or is addicted to carbs. This concept is part of something called the Opiate Excess Theory, which I discuss in detail in Step 8. It’s a controversial topic, and the medical community is divided over it. Based on my years of clinical experience, I can tell you that children with autism do consume an excess amount of simple and refined complex carbohydrates. Over the years, I’ve analyzed hundreds of three-day food diaries, and I’ve seen that autistic children’s diets consist mainly of the following few foods: chicken nuggets, pizza, French fries, macaroni and cheese, crackers, Goldfish crackers, cookies, pancakes, apple juice, and some fruits. With the exception of the chicken nuggets, which are a source of protein and carbohydrate, the other foods are primarily simple and refined complex carbohydrates. This preference for mainly unhealthy carbohydrates is a huge nutritional concern.

There’s speculation that some children crave carbohydrates in response to the rapid brain growth that occurs during certain periods of their lives. Brain growth spurts occur between the ages of three and five, nine and eleven, and twelve and fourteen years. Interconnections within the brain increase dramatically during these times, helping the brain develop the ability to function at a higher level. During a growth spurt, there’s an increase in synaptic connections between brain cells and an increase in neurotransmitter production and activity, which requires a larger-than-normal amount of glucose. As you now know, glucose is the only source of energy the brain can use, and carbohydrates are the primary source of glucose. It’s possible that some children increase their intake of carbohydrates to meet this increased energy demand of their brain. Rather than limiting carbohydrates during these time periods, you should focus on providing your child with healthy, unrefined complex carbohydrates and nutrient-rich simple carbohydrates along with adequate protein.

FAT

Our bodies need fat to function properly. Besides being an energy source, fat is a nutrient used in the production of cell membranes, as well as in several hormonelike compounds called eicosanoids. These compounds help regulate blood pressure, heart rate, blood vessel constriction, blood clotting, and the nervous system. In addition, dietary fat carries fat-soluble vitamins—vitamins A, D, E, and K—from our food into our bodies. Fat helps maintain healthy hair and skin, protects vital organs, keeps our bodies insulated, and provides a sense of fullness after meals. It’s also critical for brain function, especially in the developing brain of a child. About two-thirds of the human brain is composed of fats. The myelin sheath, which serves as a protective insulating cover for communicating neurons (brain cells), is composed of 70 percent fat. Docosahexaenoic acid (DHA) is the most abundant fat in the brain. DHA is an omega-3 essential fatty acid, which means that the body can’t produce it and, therefore, must be consumed through our diet. Essential fatty acids are key building blocks of the brain and a deficiency will compromise your child’s brain function, ability to learn, memory, attention, and behavior. In fact, omega-3 fatty acid deficiencies have been linked to autism, dyslexia, ADHD, dyspraxia, and depression. (See Step 4 for more information on the critical role omega-3 fatty acids play in your child’s brain function.)

Types of Fat

As you can see, children need to take in a certain amount of fat for healthy brain and nervous system development. However, there are healthy fats and unhealthy fats, and it’s important to make sure you’re offering your child mainly healthy fats.

 

Healthy fats

• Monounsaturated fat is liquid at room temperature. Foods high in monounsaturated fat include olive, peanut, soybean, and canola oils as well as avocados, olives, and most nuts.

• Polyunsaturated fat is liquid at room temperature. Foods high in polyunsaturated fats include fish as well as vegetable oils such as safflower, corn, sunflower, soy, and peanut oils.

• Omega-3 fatty acids are polyunsaturated fats found mostly in seafood. Good sources of omega-3s include fatty, cold-water fish such as salmon, mackerel, and herring. Flaxseeds, flaxseed oil, and walnuts also contain omega-3 fatty acids, and small amounts are found in soybean and canola oils.

These fats are considered healthy because they lower LDL (bad) cholesterol and raise HDL (good) cholesterol, reducing the risk of coronary heart disease in adults. The polyunsaturated fats, particularly the omega-3 fatty acids, are especially healthy for children because they’re necessary for brain development and function.

 

Unhealthy fats

• Saturated fats are usually solid at room temperature and commonly found in meat; animal products such butter, cheese, ice cream, and whole milk; separated animal fats (tallow and lard); and palm and coconut oils.

• Trans fat is a common ingredient in commercial baked goods such as crackers, cookies, cakes and chips, and foods fried in partially hydrogenated oils. Vegetable shortenings and some margarines also are high in trans fat.

It’s fine for your child to eat foods containing saturated fats—just make sure he’s eating limited amounts. Too much saturated fat can raise total cholesterol and LDL cholesterol, which increases the risk of coronary heart disease in adults. Unfortunately, many parents are told that they should eliminate fat and cholesterol from their child’s diet—this is bad advice. For example, cholesterol is a major component of the myelin sheath in the brain and is critical to your child’s brain development and function. The common recommendations adults are given to lower their fat and cholesterol intake are not appropriate for infants and young children. My advice is to limit saturated fat and trans fat, select more monounsaturated and polyunsaturated fats, and include omega-3 fatty acids in your child’s daily diet. Your child needs fats as part of a healthy diet.

MICRONUTRIENTS

Our bodies need micronutrients, also known as vitamins and minerals, in small amounts for normal growth, function, and health. Our bodies don’t make most micronutrients, so we have to get them from the food we eat or, in some cases, from dietary supplements. Vitamins and minerals are critical for brain development and function; regulating cell and tissue growth; processing and eliminating toxins from the body; maintaining a healthy gastrointestinal tract; supporting immune system function; converting protein, carbohydrate, and fat into energy; providing structure to bones; formation of blood; and numerous other body functions. Some vitamins also function as hormones, antioxidants, coenzymes, and precursors for enzymes. Each vitamin and mineral is unique and has its own specific role in the body.

The most important vitamins and minerals for brain function are calcium, iron, and some of the B vitamins:

• Calcium is required for the transmission of nerve impulses in the brain and aids in the release of neurotransmitters from neurons.

• Iron transports oxygen to the brain and is also needed to produce the neurotransmitter dopamine. A deficiency of iron can cause fatigue, impaired mental function, poor work and school performance, and decreased attention span, learning, and memory.

• Vitamin B₁ (thiamin) aids normal functioning of the nervous system and a deficiency can result in mental confusion and complications involving the brain.

• Vitamin B₂ (riboflavin) is required by the body for the production of energy, to form glutathione, and to convert vitamin B₆ to pyridoxal 5-phosphate.

• Vitamin B₆ (pyridoxine) helps the body break down protein and helps maintain the health of red blood cells, the nervous system, and parts of the immune system. Vitamin B₆ is also involved in the production of the neurotransmitters serotonin and dopamine, and a deficiency may result in depression and confusion.

• Vitamin B₁₂ (cobalamin) is involved in the production of certain amino acids, maintenance of the nervous system, formation of the myelin sheath, formation of neurotransmitters, and plays a role in preventing depression and other mood disorders. A B₁₂ deficiency can cause fatigue, confusion, delayed development, poor memory, depression, and neurological changes.

• Folic acid helps the body produce and maintain healthy new cells, especially during periods of rapid growth. A deficiency of folic acid may result in loss of appetite, irritability, forgetfulness, and behavioral disorders.

If your child is deficient in any vitamin or mineral, his brain won’t be able to function at its optimum level. This in turn will prevent your child from fully benefiting from his various therapies and special education services. Say, for example, your child has an iron deficiency, which is a very common problem among children. As you now know, iron is essential to transport oxygen to the brain and is also involved in the production of the neurotransmitter dopamine. A low iron level could cause your child to experience symptoms such as apathy, short attention span, irritability, impaired memory, and reduced ability to learn. A recent study indicates that iron deficiency interferes with dopamine activity and may contribute to ADHD. Correcting the iron deficiency resulted in considerable improvement in these children’s ADHD symptoms and cognitive test scores. If just one mineral deficiency can have such a significant impact on your child’s brain function, imagine how several vitamin and mineral deficiencies can affect your child! Kids need to eat a variety of foods from all five food groups to get the basic vitamins and minerals they need for good brain and body function. However, autistic children tend to eat a very poor diet made up of only a few foods, so they often suffer from several vitamin and mineral deficiencies. If this is the case for your child, he’ll likely need to take a daily multivitamin and mineral supplement until you’re able to expand his diet. I discuss this topic in more detail in Step 3.

The autism community is particularly interested in vitamins B₆, B₁₂, and C because there’s some evidence that they can relieve some autistic symptoms when administered at higher therapeutic levels. I cover the therapeutic use of these vitamins in steps 9 and 10.

HOW MUCH VITAMINS AND MINERALS YOUR CHILD SHOULD CONSUME

The levels of vitamins and minerals your child should consume are based on the Dietary Reference Intake (DRI), which is a system of nutrition recommendations from the Food and Nutrition Board, Institute of Medicine of the National Academies. It consists of four nutrient-based reference values that were developed for different age and gender groups and are based on the average requirements for healthy individuals. Keep in mind that you should use only the DRI values as a guide because your child’s actual requirements for a particular nutrient may be more or less. Here’s an at-a-glance description of the four nutrient-based values:

1. The Estimated Average Requirement (EAR) is the average daily nutrient intake level estimated to meet the requirements of 50 percent of healthy individuals in a particular age and gender group.

2. The Recommended Daily Allowance (RDA) is the daily nutrient intake sufficient to meet the requirements of 97 to 98 percent of healthy individuals in a particular age and gender group.

3. The Adequate Intake (AI) is the daily nutrient intake estimated to be adequate for a group of healthy individuals. It’s used when a RDA has not been determined yet.

4. The Tolerable Upper Intake Level (UL) is the highest daily nutrient intake that is likely to pose no risk of adverse health effects. It’s designed to caution against excessive intake of nutrients that may be harmful in large amounts.

You probably recognize the Recommended Daily Allowance value—it’s the most commonly used nutrient standard on food packages. What you need to understand about RDA values is that they’re based on the assumption that your child is healthy. The RDA doesn’t take into account the fact that your child may be on medications, have a chronically poor diet, or have a gastrointestinal disorder that prevents him from properly absorbing nutrients. It’s also important to know that RDA values used for children are extrapolated from adult research. Some people are concerned that the RDAs don’t adequately reflect the amount of nutrients kids need for optimum mental functioning. Clearly, the RDA isn’t perfect, but it’s the best standard currently available. When deciding how much vitamins and minerals your child should consume, I recommend that you make sure he gets at least 100 percent of the RDA. If you decide you want to give your child more than the RDA for a particular nutrient, don’t exceed the UL (Tolerable Upper Intake Level). For a list of essential vitamins and minerals, their RDA or AI and UL, turn to Appendix 3 on page 222.

WATER

Water is the most basic nutrient our bodies need, and it’s also one of the most neglected components of our diet. Our bodies need a certain amount of water each day for proper body temperature regulation, muscle function, absorption of nutrients, transporting nutrients into body cells, transporting waste out of body cells, and the elimination of waste and toxins from the body. We get water not only from drinking it, but also from other liquids such as milk and juice and from vegetables and fruits. If we don’t have enough water in our diet, we are at risk for dehydration, which is a condition in which the body doesn’t contain enough water to function properly. For a variety of reasons, infants and children are more prone to dehydration than adults. Symptoms of mild dehydration include the following:

• thirst

• abnormally dark urine

• decreased urine volume

• tiredness

• muscle weakness

• lightheadedness

• headache

• slightly sunken eyes

In autistic children, these symptoms can be easily missed. Autistic children often have expressive language delays or are nonverbal and unable to express their thirst. Some autistic kids don’t recognize the sensation of thirst and therefore never ask for drinks. This makes them especially susceptible to dehydration. Dehydration symptoms are also often mistakenly attributed to something else. For instance, some multivitamin and mineral supplements can darken children’s urine, and it may not occur to you that dehydration may be to blame instead. Subtle though the symptoms may be, dehydration will have a major impact on how your child feels both physically and mentally, his ability to function normally, and his ability to participate in and benefit from his therapy sessions.

Babies and small children have an increased chance of becoming dehydrated because

• a greater portion of their bodies is made of water;

• they have a higher metabolic rate than adults, so their bodies use more water;

• a child’s kidneys don’t conserve water as well as an adult’s does;

• a child’s immune system is not fully developed, which increases the chance of getting an illness that causes vomiting and diarrhea;

• children often refuse to drink or eat when they don’t feel well;

• and they depend on their caregivers to provide them with food and fluids.

To ensure your child is both quenching his thirst and getting enough water (especially if he’s nonverbal or you suspect he may not recognize the sensation of thirst), you should offer him water several times a day. If your child doesn’t currently drink water or refuses it, it’s probably because he’s drinking too much juice or milk. Your child should be drinking two to three cups of milk and only one cup of juice a day. The rest of his fluid needs should be provided as drinking water. If your child is drinking more than one cup of juice a day right now, start cutting him back by diluting his juice 50 percent with water and gradually decrease him to one cup a day. High-sugar beverages should be eliminated from his diet altogether.

How Much Water Your Child Should Drink

The chart below lists the total amount of water your child should consume on a daily basis. When I say total water, I mean everything—drinking water, beverages, and water contained in foods (fruits and vegetables contain 85 to 95 percent water). The amount of total water your child needs will vary according to the level of his physical activity, medical problems, and weather environment in which you live. A registered dietitian can calculate more exactly the total amount of water your child requires based on his individual needs.

Eliminating Toxins from Your Child’s Drinking Water

It’s important to consider the source of the water you’re giving your child, because safe, uncontaminated drinking water is vital to his health. In the autism community, neurotoxins are a major concern and many parents try to eliminate heavy metals from their children’s environment as much as possible. Common sources of water pollutants include the following:

• biological agents (bacteria, viruses, and parasites)

• inorganic chemicals (arsenic, lead, mercury, chromium, and nitrates)

• organic chemicals (pesticides, benzene, polychlorinated biphenyls, and trichloroethylene)

• disinfectant chemicals (chlorine, chlorine dioxide, chloramines, haloacetic acid, and trihalomethanes)

• and radionuclides (radon)

These pollutants can affect major body organs such as the kidneys and liver; promote certain forms of cancer, leukemia, and anemia; and may affect the neurological and gastrointestinal systems.

Adequate Intake (AI) of Water

Source: Food and Nutrition Board, Institute of Medicine, National Academies

Public Tap Water

Under the authority of the Safe Drinking Water Act (SDWA), the EPA has set standards for approximately ninety contaminants in public tap water. For each of these contaminants, the EPA has set a legal limit, called a maximum contaminant level, or requires a certain treatment. Water suppliers are not allowed to provide water that doesn’t meet these standards. However, there are concerns that some of the standards for contaminants are set too high and don’t protect the public against health problems. The allowable amount of pesticides in our public drinking water is of particular concern because there’s been little research done on how chronic and mixed exposure to different pesticides may affect our children neurologically.

Private Well Water

Private water wells are not federally regulated, and testing of the water is the responsibility of the individual homeowner. There are numerous common contaminants found in well water. Certain contaminants should be tested for at least once, others at least once a year, and still others every five years, or prior to pregnancy or when an infant is born. For information on how to test your well water, contact your state health and environmental agencies. Some state agencies and local health departments provide the testing for free.

Home Water Purification System

Before you buy a home water purification system, I recommend that you have your water (public or well) tested by a certified laboratory. You can go to the EPA’s Web site (http://www.epa.gov/safewater/labs/index.html) or call 800-426-4791 to locate a Certified Drinking Water Laboratory in your state and find out how to go about getting your water tested. Once you know what specific chemicals are in your water, then you can decide whether you want to invest in a home water purification system.

There are two styles of water purification systems. A point-of-entry system filters all the water you use in your home from the point at which it enters your home. A point-of-use system is generally a filter mounted to a faucet or installed under a sink and filters water only where it’s installed. There are also many types of systems to choose from—absorption filters, reverse osmosis, softeners, distillers, and ultraviolet, to name a few. Whichever water purification system you choose, make sure that it’s certified by the NSF. NSF International is an independent tester of water purification systems that evaluates the manufacturer claims of reducing various contaminants and assures the consumer that the product meets performance requirements. For more detailed information on water purification systems, visit NFS International’s Web site at www.nsf.org.

Bottled Water

The major types of bottled water are mineral water, spring water, artesian water, sparkling water, purified water, and fluoridated water. Bottled water is regulated by the FDA and must meet EPA tap water standards; however, it’s not necessarily more pure than public tap water. If you choose to drink bottled water, make sure the brand you choose is certified by NSF International. NSF has developed a voluntary certification program for bottled water, so first look for the NSF label on the bottle. If you don’t see it, you can contact NSF International at www.nsf.org or 800-NSF-MARK (800-673- 6275) to see if the brand you’ve chosen is certified or to get a list of bottled water companies that they’ve certified.

PUTTING IT ALL TOGETHER

The chart below serves two purposes. First, you can quickly assess whether your child is getting enough nutrients from the right variety of foods and in the proper amounts. After you’ve figured out what areas of your child’s diet need work, you can use the chart to plan his meals and ensure he’s getting the nourishment he needs. Remember, your child should be eating three meals and two to three snacks each day.

The types and amounts of food children need each day are the following:

• Milk, yogurt, and cheese, 2 to 3 servings

• Vegetables, 3 to 5 servings

• Fruit, 2 to 4 servings

• Bread, cereal, rice, and pasta, 6 servings

• Meat, poultry, fish, eggs, beans, and nuts, 2 to 3 servings

SERVING SIZE GUIDELINES FOR CHILDREN

Food Group	2-3 years	4-6 years	7-12 years
Milk
Milk	½ cup	½-¾ cup	½-1 cup
Cheese	½ oz	½-1 oz	2 oz
Yogurt	4 oz	4-6 oz	8 oz
Vegetables
Cooked Raw	¼ cup few pieces	¼-½ cup several pieces	¼-½ cup several pieces
Food Group	2-3 years	4-6 years	7-12 years

Source: ADA Pocket Guide to Pediatric Nutrition Assessment © American Dietetic Association. Reprinted with Permission.

PROJECT NO. 2: IDENTIFY AREAS TO IMPROVE IN YOUR CHILD’S DIET

1. Keep a food diary, or a record of everything your child eats and drinks, for three days.

 

2. Next determine if your child is taking in enough of each basic nutrient:

Protein: Add up the total grams of protein your child consumed for the three days and divide by three for a daily average. Then compare your child’s protein intake to his RDA.

Is your child consuming adequate protein?

Fiber: Add up the total grams of dietary fiber your child consumed for the three days and divide by three for a daily average. Compare your child’s fiber intake to his suggested intake.

 

Is your child consuming adequate fiber?

 

Water: Add up the total ounces of water (drinking water, milk, and juice) your child consumed for three days and divide by three for a daily average. Don’t forget to take into account the water content of fruits and vegetables. Compare your child’s total water intake to his AI.

 

Is your child consuming adequate water?

Fat: Did your child have at least 1 serving of a healthy unsaturated fat each day?

 

Variety of food groups (meat, milk, bread, fruit, and vegetables): Add up the total number of servings your child consumed from each of the food groups and divide by three for a daily average for each food group. Compare to your child’s recommended number of servings.

 

Is he consuming an appropriate number of servings from each food group?

Did your child consume at least 1 serving from each of the food groups at each meal?

 

Did your child eat three meals and two to three snacks each day?

 

3. Choose a source of safe drinking water for your child.

Have your tap or well water tested by a Certified Drinking Water Laboratory. Based on the results, consider buying a home water purification system that can remove the contaminants in your drinking water.

The goal of Step 2 is to make sure you’re offering your child a variety of foods that contain the basic nutrients he needs for his body and brain to work to the best of their ability. Once you accomplish this, you’ll have successfully laid a solid foundation for all other autism therapies to build upon. Now it’s time to choose a daily multivitamin and mineral supplement for your child.