A quarterly publication of the Autism Research Institute

The Autism Research Review International is quarterly publication of the Autism Research Institute

Spring, 2020 | Number 2, Volume 34

Severe iron deficiency anemia seen in child with ASD, restricted eating

A new case study adds to mounting evidence that selective eating in individuals with autism spectrum disorders (ASD) can have serious repercussions. 

Yoshitoki Yanagimoto and colleagues report on a two-year-old boy with ASD who had severe iron deficiency anemia, stunted growth, pallor, and tachycardia stemming from his refusal to eat any solid foods. The boy drank only breast milk and certain brands of juice, and only if he could use his favorite tableware. 

The authors were able to successfully administer an oral iron supplement and enteral nutrients, and they report that “his anemia, nutritional condition, and clinical symptoms improved by treatment within one month.” Overall, the boy required iron supplementation for five months and enteral nutrients for two years. 

The researchers say that treating the boy’s nutritional deficiencies led to other significant benefits. “It is of note,” they say, “that nutritional treatment improved not only his malnutrition and stunted growth but also his food selectivity and developmental delay, suggesting that malnutrition worsens developmental delay and food selectivity. We believe that malnutrition and anemia due to iron deficiency caused hypocirculation in the brain and digestive organs and promoted repetitive eating. As the iron deficiency anemia improved, physical growth and repetitive eating improved.” 

The researchers conclude, “We recommend that iron deficiency anemia and nutritional condition should be evaluated when an autistic child presents with restricted eating behavior and pallor.”


“Iron deficiency anemia, stunted growth, and developmental delay due to avoidant/restrictive food intake disorder by restricted eating in autism spectrum disorder,” Yoshitoki Yanagimoto, Yuko Ishizaki, and Kazunari Kaneko, BioPsychoSocial Medicine, Vol. 14, No. 8, 2020 (free online). Address: Yoshitoki Yanagimoto, [email protected].