By Maude Le Roux, OTR/L, SIPT, RCTC, DIR® Expert Trainer at A Total Approach
At A Total Approach, I support many children who are working through a sensory processing disorder (SPD) and learning to self-regulate their emotions. Many are picky eaters and may also demonstrate extreme sensory, emotional and behavioral responses to the taste, smell, sound and texture of foods when eating.
Research shows that from birth to age eight, 20 percent of all children struggle with feeding challenges. As parents and as occupational therapists, we must be aware that eating a meal is a complex sensory experience. It involves the ambience of the dining room and the family dynamics during dinnertime such as conversation, cooking sounds and other distractions in addition to the qualities of different foods. Children also engage their motor planning skills when learning to sit at the table and to use forks, spoons and other utensils when eating.
Who Is The Picky Eater?
For a picky eater -and their parents- mealtimes can be stressful events. The picky eater can complain that foods taste or smell funny while the parents are constantly negotiating with them to eat what’s on the table.
The picky eater may only eat certain foods like bread, pasta, crackers and white cheese -what’s known as a “white diet”. They may show signs of nutritional deficiencies due to these limited food choices as a result, such as being overly moody or sensitive, lacking vitality or looking unhealthy.
Children with SPD may struggle to deal with all the sensory messages of mealtime. They may not want different foods to touch on their plates or to eat the same meal as the rest of the family. They may eat very few foods and avoid trying new foods. SPD can produce symptoms similar to eating disorders, which can lead to poor nutrition, significant weight loss or obesity.
Feeding as Nurture
For children and their parents, feeding is part of nurturing and nurturing is part of feeding. Many parents show love for their children through food. When feeding is not going well:
- Mealtime becomes a source of conflict
- The opportunity for bonding is lost
- Both parents and children put up barriers to attachment
The goal is to develop equilibrium and balance with feeding, which starts in infancy. Successful feeding depends on:
- Mother and child maintaining a calm, alert state during feeding.
- The coordination of sucking, swallowing and breathing during breast- and bottle-feeding.
- The orientation of the mother’s body and baby’s mouth towards the nipple.
- The ability of the child to signal hunger and satiation and the ability of the mother to read the cues and respond.
- Mother and child tolerating the body contact of feeding.
Source of Worry
Feeding is a huge source of worry for parents. Babies can pick up on a parent’s anxiety and may become resistant to feeding. If the child is experiencing modulation or regulation difficulties, they might not distinguish between feelings of hunger and satiation. The parents may resort to feeding the child to console them, which can start a cycle of needing to be fed when distressed.
Biological factors can also come into play, such as malabsorption of food, tactile hypersensitivities and reflux, causing feeding to be a painful experience for the child.
In our collective experience as occupational therapists, the following parental interventions can cause more harm than good:
- Forcing the child to eat food by placing it in their mouth.
- Putting food in front of the child’s mouth or on their lips until they eat it.
- Making the child take more bites after they have gagged on or vomited a food.
- Bribing the child to eat.
- Ignoring the emotional upset of the child when eating.
- Shaming or punishing the child for not eating.
- Staying away from the child until they eat.
- Making no eye contact or interacting with the child until they start eating.
Guiding Principles To Help Parents with Picky Eaters
Follow the child’s lead when it comes to them tolerating the food on the table. Expose them slowly to the smell, taste and touch of a food. If the child is pushing back or fighting about eating food, look for other options to get them to eat. It is also important to consider to first work on regulating the autonomic nervous system before the child will let go of the external need for control through picky eating due to not feeling in control on the inside. For this work you would need to work with your occupational therapist.
You could try food chaining, which enables the child to try new foods that are similar to foods they currently enjoy and eat consistently. Use books about food during story time. Ask them why they like the foods they like and foods they don’t like. See if they can explain why they won’t eat a variety of foods. Help them by asking how the food tastes and feels in their mouth, what food flavors and textures do they prefer – salty, sweet, crunchy, creamy? Ask them if eating food makes their tummy hurt or makes them feel sick.
Serve foods you want to eat as a family, establishing feeding rituals and predictable mealtime routines. Compare the child’s behavior only to themselves rather than to a sibling’s or even a parent’s behavior.
Incorporate playful activities into eating like licking food, blowing bubbles in the food or spitting the food into a bowl or garbage can. Have them join in on meal prep in the kitchen, touching foods with their hands. Encourage the exploration of food and expect a mess.
If the child may have a food allergy, medical condition or has difficulty chewing, seek the advice of a medical professional. Avoid any therapy occupational or otherwise that does not build relationships.
Sensory Integration Therapy from A Total Approach
Over the years of working in the field of developmental delay and sensory processing difficulties, we have witnessed many children struggle with picky eating and to make sense of their emotional responses.
Here are a few clinical interventions that could help:
Tomatis Sound Training – This intervention is delivered through an electronic ear, a device that modifies music in a way that is stimulating to both sympathetic arousal and parasympathetic inhibition to impact the discrimination of different central nervous system pathways.
DIR/Floortime Therapy – A comprehensive, developmentally-based model for assessment and intervention for children with special needs that empowers the parent to validate and support the child’s social, emotional and physical growth.
Interactive Metronome Training – This is the only program that uses a patented auditory guidance system and a musical metronome plus interactive exercises to improve the foundational skills essential for learning and development by accurately measuring, assessing and improving rhythm and timing.
Sandplay Therapy – Play is the language of children and the sand tray provides a safe medium for expression, free from judgment. When unable to effectively communicate needs, Sandplay therapy gives expression to non-verbalized emotional issues.
Learn More About How to Help A Picky Eater
If you’d like to learn more about how to help a picky eater, schedule a free phone consultation with one of our therapists who can give specific insight into our approach.
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