If you have been reading our blog regularly or you know anything about The Children’s Therapy Center, you will already know that many of the children we treat have issues with their sensory systems. Some are hypersensitive in certain ways, over-responding to stimuli, and some are hyposensitive in that they need extra input to sense. So many of our kiddos have a combination of both. The areas affected may include the senses of touch, hearing, movement, and others. Due to these differences in the way sensation is perceived, and other issues such as dyspraxia (please see Motor Planning blog), some children have difficulty with tolerating the sensations that come with eating food.
The act of eating is complex, and it involves much more than sensory input, so you cannot assume that a problem is always directly related to sensory processing. Before determining if a child’s issues surrounding eating have to do with sensory processing, it will be important to know if he has any structural problems with his mouth or throat such as being tongue-tied or having enlarged tonsils or any other medical reasons impacting him. The therapist will need to know if there is any medical history dealing with his digestion or swallowing, any surgery or accidents? A history of being tube-fed or reflux? Does your child have low or unusually high muscle tone?
Do the child’s abilities change when the position has changed, such as when standing? Does she drool or usually have an open mouth? Are there also speech delays? Regarding dyspraxia, knowing how to properly move the tongue is integral to feeding, how to coordinate the lips and tongue and when to swallow. Can she move food around in her mouth? Does she have a hyperactive gag reflex, or perhaps one that is depressed and not working properly when it should?
Remember that our gag reflex is very important to keep our bodies safe, and it should be respected. A reflex operates without thought. Gagging is a primitive reflex, not a behavior, and when displayed shows how deeply uncomfortable the child is. I have worked with children who gagged just looking at a texture with which they were uncomfortable touching. Sometimes people mistakenly tell a child who is gagging frequently to just stop, assuming they have that kind of control, and it is just behavior. Yes, they can work on getting past the gagging, but with a great deal of understanding and patience, which is how we work on oral sensory motor issues at our clinic.
In therapy, after determining if it is safe to proceed, sometimes with a written note from the child’s pediatrician, the feeding therapist (OT or Speech) will do an evaluation to determine the child’s abilities such as overall coordination of the mouth and will take information from the family regarding health and feeding history such as the above questions. If the main issues surround oral motor ability, that will be the therapy approach. If they are more sensory in origin, then the approach will address that. Often one influences the other, and the child will be working on both.
There are different methods for therapists to use, and like anything else, it is best when a therapist has a variety of tools in the belt, so to speak. For example, when we look at the colors of what a picky child eats, we often notice that our kids stick to a soft beige diet (chicken nuggets, waffles, breads, cheese, pasta). So we start to expand the colors and textures. But remember we want mostly to add nutrition as our ultimate goal. Often this may mean changing family lifestyles a little. Your child will be facing that which may scare him, trying foods that something deep inside is trying to warn him may harm. The therapists at The Children’s Therapy Center approach these kids very gently, with respect, and gaining trust. The children are under minimal pressure but are supported emotionally. They are given food to play with and to interact with in ways that may not be appropriate at the dinner table but will help them increase in comfort. We try to get them to slowly increase their repertoire and gain better nutrition in a therapeutic non-judgmental environment.
The families are given instruction in what to try at home, how to approach this issue, special situations as they arise, such as holiday meals. One of the very best pieces of advice to start with is to lower the pressure. Try not to stare at your child or make a big to-do if they try something on their own. Many children will taste on their own when no one is looking, and it may take many times of trying the same food before it is actually added to their diet. Not eating what everyone else is can be a very upsetting situation for your child whether or not they show it. Shining a spotlight or shaming the child is not helpful. Eating together is a very social activity, and many cultures make it a priority. Your child most likely knows already that they are not “fitting in” at mealtime. Taking the focus off to start with will help make it that much more pleasant for everyone and may get your child on a better path towards opening up to improved nutrition. If you are interested in a feeding evaluation, please contact a professional who is trained in this specialized kind of therapy.
Nancy E.A. Weiss, MOT, OTR/L