By Chris Purgatori, MOT, OTRL
Occupational Therapist
Mealtime for families without special needs kids can be
difficult, but for those with kids with sensory processing difficulties it can
really be an adventure. While there isn’t an easy way around these challenges, there
are a few helpful hints that may keep a child’s feeding issues from turning
into significant problems. Understanding the five main components that affect a
child’s ability to eat is a good place to start.
Sensory issues
Sensory-based feeding issues are the underlying factor to
most feeding difficulties in children. The combination of food texture,
temperature, and taste can be off-putting to kids, and cause frustration. Children
usually tend to stick to foods they are familiar with, and soon these foods are
the only ones that they will eat.
To help create a broader diet, begin to slowly alter the
child’s favorite foods. For example, if they enjoy elbow macaroni and cheese,
and will only eat that shape, toss in four or five pieces of different shaped
macaroni (wheels, characters, etc.). Next time, add food coloring to the elbow-shaped
macaroni. The changes in texture, temperature, color or taste should be slight but
noticeable.
Another way to help children with feeding difficulties is to
allow them to help choose foods at the grocery store and to let them help
prepare the meal, exposing them to different textures, smells and tastes along
the way.
Oral-motor issues
Oral motor-based feeding problems can be caused by tone and
strength issues. Kids need to achieve good gross-motor coordination and
movement in their body before they will achieve sufficient oral-motor skills. However,
oral-motor difficulties must be dealt with only after sensory issues have been
attended to. In the end, good sensory input will result in good oral motor
output.
There are many oral-motor exercises that can help strengthen
the jaw, tongue and lips, and parents with concerns should contact their
pediatrician, occupational therapist or speech therapist for guidance.
Behavior issues
There are many different behaviors that can affect feeding: the
child gets Mom’s and Dad’s attention when they don’t eat, or eating is one of
only a few things they have control of. Positive reinforcement (“If you eat
this piece of lettuce, then you’ll be able to play 10 minutes of video games”),
and extinction/planned ignoring (“Daddy doesn’t hear whining, he only hears big
girl words,”) work the best with behavior-based feeding issues.
Gradually work through the steps of eating. Start by having
the child touch and play with the non-preferred food, then increase the
difficulty: take a bite; take a bite and don’t spit it out for 2/3/4 seconds;
swallow it; take bigger bites; eat larger portions; decrease gagging. Progress
until the child is eating more or less on their own.
Keep in mind that behavior-based feeding issues can look a
lot like sensory-motor feeding issues, so it is important to treat both aspects
of feeding. The best outcomes result from the child’s engagement in a
voluntary, purposeful activity in a positive environment.
Medical issues
Gastrointestinal, cardiopulmonary and pharmaceutical issues
can affect feeding, along with prematurity of birth and visual impairment, when
the child simply can’t see what they’re eating. However, the biggest culprit of
medical-based feeding issues continues to be GERD. GERD in its simplest form is
spitting up or vomiting, causing children to refuse food. If there appears to
be medical issues interfering with feeding, it is important to consult your
pediatrician for more options.
Family issues
Family dynamics are one of the hardest feeding difficulties
to deal with. Parents and caregivers are the most important and pivotal
components in implementing feeding strategies. Many parents tend to feed their
kids foods that the parents enjoy. It is important to give the child many
options, including foods that the parents don’t regularly eat. It’s also important
to clearly define roles: the parents or caregivers are responsible to provide
the foods, while the child is responsible to eat and choose how much to eat.
Most importantly, the child should feel as comfortable as
possible when they are eating. Feeding is social, and feeling uncomfortable in
the social situation can cause problems. Parents and families should be open
and adapt when necessary. Go slow with the child and make the them feel as
comfortable as possible. Parents should try to avoid forcing children to eat.
Present children with both preferred and non-preferred foods and let the child
choose. When children feel like they have control over the situation, it’s
easier for them to try new foods.
Here are a few general tips and tricks to try for children
with feeding difficulties.
- If the picky eating seems to be sensory-based, encourage the
child to play with foods to get used to them. Getting messy is OK!
- Encourage the child to get more involved with food
preparation. Kids are more likely to try things if they help prepare the meal.
- Encourage the child to eat with other kids. In some
circumstances, peer pressure is a good thing!
- Provide the child with small amounts of the foods mom and
dad are eating along with a food the child usually eats. This way, the child
gets used to the foods being there and when they are ready to try them, they
will.
- Have a consistent routine at mealtime so the child knows
what to expect.
- Experiment with small, subtle changes in difficult foods.
Sometimes just a change in temperature makes it easier to handle.
- Make a schedule for the meal, and write a list of the food items that need to be eaten before going to the next activity.
Chris Purgatori, MOT, OTRL holds a Bachelor’s degree in
Kinesiology from Michigan State University and a B.A. in Health Science from
Wayne State University. He went on to earn his Master’s degree in Occupational
Therapy from WSU. Chris came to the KCC from the Pontiac school system, where
he worked with special needs kids and young adults. When he’s not coaching
young kids in the OT gym at the KCC, Chris coaches high school varsity boys on
the soccer fields at Rochester High School.
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