Children who overeat, should be encouraged to replace high fat and sugary foods, drinks and snacks with more fruit and vegetables and other lower-fat and lower-sugar alternatives.

If over-eating is a problem, you could try:

• A structured daily routine to include set times for meals, drinks, and snacks.
• Reducing food portion sizes and use a smaller plate.
• Showing them the empty saucepan, confirming verbally that the food has all gone.
• Limiting access to food by keeping it out of reach, using locks or visuals such as ‘No Entry’ signs on fridges and cupboards, or not buying it at all in the case of snack foods like crisps and chocolate.
• Setting rules relating to restaurants and food shops e.g., ‘you can have a starter OR a pudding’.
• Creating a food timetable, e.g., snacks at 10am, 3pm and 7pm, reducing the amount of food intake gradually.
• Providing visual hunger and fullness scales to help with expressing and recognising cues. Discuss topics such as hunger and being full; some children and young people with autism are unable to recognise when they are full and do not always have the feeling of being full. A social story may be useful to explain portion sizes.
• Physical activity: this should be part of your child’s daily routine, engaging in physical activity before having a healthy snack.
• Choosing healthier foods to help your child learn about smart food choices. You could create a visual aid that includes pictures of healthy nutritious foods and foods that have little nutritional value and are only to be eaten in small quantities on special occasions.

Sensory experience

It is well documented that neurodivergent people have significantly different sensory experiences than neuro-typical individuals which include both hyper and hypo sensitivities. In the context of eating, this means being sensitive to how foods look, smell, taste & feel. Interoception (awareness of internal states) is another key factor to consider as it enables the recognition of hunger and the sense of feeling full.

Social stories

Social stories are short stories, often with pictures, which explain different situations to give them an idea of what to expect. A social story might help your child to understand why we eat and the function of food. Here is a short example. ‘We all need to eat food. This is because food is like fuel – it gives us energy/power. If we have energy, we will be able to do the activities we enjoy. Missing out food groups can make us tired.’

Binge eating

If you feel that you or your child is suffering from binge eating disorder, you may find the resources below to be useful.
https://www.beateatingdisorders.org.uk/

Overcoming binge eating, Christopher Fairburn: the proven program to learn why you binge and how you can stop.
https://www.cci.health.wa.gov.au/
Centre for Clinical Interventions binge eating disorder advice: Provides self-help modules which you can work through on your own or with a parent or carer.

Prader-Willi syndrome

Prader-Willi syndrome is a rare genetic condition that causes a wide range of physical symptoms, learning difficulties, behavioural challenges and persistent hunger. It’s usually noticed shortly after birth.

Prader-Willi syndrome is caused by some missing genetic material in a group of genes on chromosome number 15.  This leads to a number of problems and is thought to affect part of the brain called the hypothalamus, which produces hormones and regulates growth and appetite.  This may explain some of the typical features of Prader-Willi syndrome, such as delayed growth and persistent hunger.

The genetic cause happens purely by chance, and boys and girls of all ethnic backgrounds can be affected.

Typical symptoms of Prader-Willi syndrome include:

• an excessive appetite and overeating, which can easily lead to dangerous weight gain
• restricted growth (children are much shorter than average)
• floppiness caused by weak muscles (hypotonia)
• learning difficulties
• lack of sexual development
• behavioural challenges, such as emotional outbursts and physical aggression

Prader-Willi syndrome can usually be confirmed by carrying out genetic testing.  Genetic testing may be recommended if a child has the symptoms of Prader-Willi syndrome. Babies who are very floppy at birth may also be tested.  These children will usually already be known to Paediatrics for their complex needs.https://www.nhs.uk/conditions/prader-willi-syndrome/