ABSTRACT
To investigate the effect of multiple factors, including breast-feeding and modes of birth, on gastrointestinal (GI) symptoms of children with autism spectrum disorder (ASD). Methods This was a cross-sectional study. A total of 92 children, aged 2 to 10 years, with a diagnosis of ASD by DSM-5 criteria, along with 84 age-matched typical developing (TD) children as control, were enrolled in this study. The six-item gastrointestinal symptom index (6-GSI) was used for symptomatic survey. The self-made questionnaires were used to collect information on dietary preferences, sleep problems and breast-feeding. Results Constipation from 6-GSI was higher in ASD group than in TD group (P＜0.01). Stratified analysis revealed that total GI symptom scores (P=0.030), fecal odor (P=0.028) and abdominal pain (P=0.022) were higher in ASD children born by c-section than ASD children born vaginally whereas only abdominal pain was higher in TD children born by C-section than TD children born vaginally (P=0.016). ASD children with pick eating had higher scores in diarrhea (P=0.048) and abdominal pain (P=0.013) than those without. ASD children with sleep disorders had higher scores in constipation (P=0.008), diarrhea (P=0.020) and fecal odor (P=0.027) than those without. There was also a significant difference in constipation from 6-GSI between mainly breast-fed children and mainly formula-fed children among all subjects (P=0.026). Conclusion ASD children have more severe constipation than TD children. ASD children with pick eating or with sleep disorders tend to have more GI symptoms, including diarrhea, fecal odor, and abdominal pain, while breastfeeding can alleviate these symptoms.