Abstract: An 11 year old boy with autism presented with a 2-month history of agitated behaviour with associated weight loss. On examination he was wasted and distressed. He had severe hypoalbuminaemia. Gastrointestinal imaging revealed a gastric bezoar. At operation a large phytobezoar extending into the jejunum was identified and removed. Postoperatively he required intensive nutritional resuscitation and support, including treatment of multiple micronutrient deficiencies. Malnutrition is common in children with developmental disabilities, with a number of possible contributing factors. Gastric bezoar is a rare cause, which should be considered in mobile children who may engage in pica.