Background: Children with autism spectrum disorder (ASD) have a number of associated feeding difficulties and problematic mealtime behaviours. These problems can have a negative impact on the child's nutritional intake and little is known about the food preferences and characteristics of food choices. In addition, these difficulties can be exacerbated for children and caregivers living in low-and middle-income countries such as South Africa due to limited access to food, resources and health care. Objectives: The purpose of this study was to determine (1) types of feeding difficulties prevalent in children with ASD, (2) food items that children in South Africa prefer, (3) the relationship between age and ASD severity on food preferences. Method: A cross-sectional quantitative research design was employed using an online questionnaire. There was a total of 40 respondents from different provinces in South Africa. The data were analysed using descriptive statistics as well as multiple linear correlation analysis. Results: The study has identified common feeding difficulties in children with ASD and those being diagnosed as picky eaters in South Africa and compared them with difficulties that were found in the international literature. The study also highlighted the food groups that were preferred by children with ASD, showing a preference for starches and snack items compared with fruits and vegetables. In addition, there were significant correlations between ASD severity and ASD age on food preferences, suggesting that both age and severity may be predictors of food choices made by children with ASD, and highlighted a need for multidisciplinary intervention. Conclusions: This study adds to the existing literature on feeding difficulties in children with ASD but provides additional insights into children living in low-and middle-income countries and can be used to improve appropriate and responsive interventions. This study provides evidence that supports the influence of context and family environment regarding feeding in children with ASD.

Background: Evidence suggests that caregivers of children with autism spectrum disorder (ASD) and associated feeding difficulties have specific mealtime challenges in the home environment because of the limited interventions that are appropriate and responsive to the needs of the child as well as the family.Objectives: To describe: (1) common feeding difficulties in children with ASD, (2) mealtime challenges for the caregiver and (3) mealtime strategies used by the caregiver.Method: Forty caregivers were purposively sampled to participate in the study. Participants were recruited through ASD-specific schools in Johannesburg, South Africa. Participants completed an online questionnaire focusing on their mealtime experiences with their child with ASD.Results: Findings from the data after thematic analysis indicated the multitude of challenges caregivers have when feeding their child with ASD as well as their individualised way of dealing with these difficulties.Conclusion: The findings emphasised the importance of incorporating the family’s beliefs, values and needs into feeding management and highlight the importance of a holistic approach to intervention. The study also provided information about mealtime strategies that are being used in the home environment to support the child as well as the caregiver. This information can be used to inform management to improve therapeutic outcomes and feeding challenges in the home environment.