Food Aversions and Eating Challenges: An OT Perspective
What is the relationship between mealtime challenges and a child's sensory system?
Eating requires use of all seven senses.
We use SIGHT to look at our utensils and the people at the table around us, SMELL for the flavors of food, TASTE to determine the flavor of our foods, HEARING while food is being pushed along a plate or cooked on the stove, and TOUCH to determine if a food is cold or hot, crunchy or slimy. We also use our VESTIBULAR system to keep our bodies positioned upright at the table, and PROPRIOCOEPTIVE sense to coordinate bringing a utensil or cup to our mouth. For kids with sensory modulation challenges, this may result in over-sensitivities or defensiveness, which can result in a child being highly resistant to certain textures or flavors. A child may also have decreased awareness of food, and may present with postural or motor control problems resulting in difficulty sitting at a table or managing utensils.
What is the difference between a picky eater and a resistant eater? When should a parent seek help?
Eating can be viewed on a continuum. Many children may enter a normal period of development when they are picky eaters due to developmentally typical fears or behaviors. A picky eater may present with some aversions to food as well as with negative behavior with non-preferred foods. However in contrast to resistant eaters, picky eaters typically get enough of a variety of foods to maintain a healthy diet. A resistant eater will often experience a significant amount of stress and anxiety around new or non-preferred foods. Resistant eaters tend to have a very limited food selection (<10 foods), gag or tantrum when presented with new foods, and are more likely to be diagnosed with a developmental delay such as autism.
Play with your food! Playing with food and eating with one’s fingers is the first step to learning about new foods and can provide a new tactile experiences and opportunities for exploration prior to putting food into the mouth.
Expose your child to new foods repeatedly, but do not force a child to eat anything. Force feeding or intimidating a child over food may result in children developing a “fight or flight” response to food, and feeling anxious or fearful of mealtime.
Offer at least one preferred food item every meal.
Get your child involved with mealtime rituals. If a child seems interested, get them involved with shopping for and preparing food, or setting up the dinner table.
Keep distraction at mealtimes to a minimum. Turn off the TV, put the phones away and remove toys from the table.
Establish a predictable mealtime routine to help children understand what is expected. It may be helper to use a timer to indicate when the next meal will begin, and to set the pace and the length of the meal.
Use mealtime to focus on the events of the day, not the resistant eater’s behavior. Focus on the positive conversation, not the amount that the resistant eater is consuming.
How Can Occupational Therapy Help?
If you notice that your child is drooling, choking, gagging, or pocketing their foods, it may be appropriate to seek out a speech therapist or occupational therapist with feeding therapy training to help assess and develop oral motor skills. If your child tantrums frequently during meals, fatigues with eating, or is highly specific about the foods he or she will eat, an OT may be able to help assess how your child processes sensory input and gather information about mealtime behaviors. Here at Advanced Orthopedic Physical Therapy we are offering free screens where you will have an opportunity to discuss any questions or concerns you may have with our Occupational Therapist.
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1-S48. Ernsperger, L., Stegen-Hanson, T. (2004) Just Take A Bite: Easy, Effective Answers to Food Aversions and Eating Challenges