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Sensory Challenges

This article discusses those who are extreme picky eaters, including those who have sensory challenges and what some red flags are to indicate you would benefit from some professional help.

This blog is not a substitute for professional help.

I had a lovely discussion on the phone the other day with a mother who I supported in my work as an occupational therapist about 16 years ago. At the time, her yet-to-be diagnosed 13 month old son had significant eating challenges, which is what brought me to her doorstep. I noticed that this child was displaying signs of autism and had the classic food aversions and sensory aversions children at that age display. Her child is now 17 years old, and during our phone conversation, she told me that his greatest strength is eating and drinking in socially appropriate ways. This is the exception to the rule and I count our hard work at an early age as a huge success to help this child succeed with eating.

Those food aversions resulted in repeated frustrating mealtimes for this mom, and every meal resulted in her son demonstrating crying behaviors and refusal to eat and drink anything novel that was introduced to him. She was exhausted and I knew her sweet son was extremely exhausted also.

If you suspect your child has autism, or you know someone who is questioning, here is an excellent video with some great examples of what signs and symptoms of Autism look like. At about 1:49 is a great example of food refusal with meltdowns that I am sure many of you have experienced. It explains well via this example of sensory based meltdown vs. behavioral based meltdown.

It is also important to know that picky eating is typical in young children. Take toddlers for example. They are all about testing limits and quite inconsistent in their behavior. For example, they might reject a food they liked previously and then eat it, when offered at a different time, quite happily. If you have a toddler who is doing this, know that this is quite normal behavior, and if you let the behavior slide for that particular food at that particular time you will avoid limit testing, power struggles and control issues that are common during this stage of development.

Problem feeders or extreme picky eaters are those who are severely limited in the foods eaten. Often the child self-selects to one or two foods only, and will only drink milk. I have observed some children self-select to only eating a certain color of food within a select few options. You might observe gagging, choking, meltdowns, and other unhappy behaviors when a food outside the child’s repertoire of food is offered. At well child visits, the topic of conversation is always about your child not eating.

Problem feeders often have significant medical issues and/or developmental delays either clearly diagnosed at birth or yet-to-be diagnosed. Any one of these issues can compound the challenges revolving around consuming food and drink successfully.

If you have, or suspect you have a problem feeder, please get professional help as soon as possible. There are many caring people who are specifically trained in this area.

This blog is not a substitute for professional help.

For more significant or severe eating disorders, there are teams of feeding specialists housed in hospitals across the United States that evaluate: postural concerns, sensory integration issues, motor challenges, behavioral components with ability to learn, nutritional factors and medical history.

I will be writing a series of blogs addressing those who have more “sensory” based feeding/eating challenges. Often, children who have the following diagnoses will also have sensory based feeding challenges. These diagnoses may include the following:

• Autism
• Asperger’s
• PDDNOS (Pervasive Developmental Disorder Not Otherwise Specified)
• ADD (Attention Deficit Disorder)
• ADHD (Attention Deficit Hyperactivity Disorder)
• Extreme Prematurity
• Children who have had extended stays in the hospital from birth due to medical conditions
• Developmental Delays
• Some genetic conditions

In addition to the main diagnosis or diagnose(s) your child may obtain, a host of other disorders might be awarded to your child, including: sensory processing disorder (SPD), obsessive-compulsive disorder (OCD), oppositional defiant disorder (ODD).

Be aware, your child does NOT have to have any of the above diagnoses to have sensory based eating challenges. Commonalities within the above diagnoses as relates to eating/drinking are:

• Food refusal
• Behavioral meltdowns
• Disliking food textures and unable to tolerate the sensation of food in their mouth
• Brushing teeth is a nightmare for the caregiver and going to the dentist is a major struggle
• Some children refuse to swallow their food
• Gagging, coughing, choking and at times vomiting at the sight, sound, smell of food or the sound of the microwave
• Selecting down to eating only a few foods, usually refined carbohydrates and highly processed foods
• Only eating certain colors of food
• Only eating certain textures of food (smooth, crunchy, etc.)
• Having meltdowns if foods touch on the plate
• Inability to use utensils when they developmentally should
• Only drinking one beverage from only one cup, sippie cup, etc.
• They are the children who do not want to get their hands dirty or do not want to touch many things because it feels unpleasant and will rush to wash or wipe their hands making it difficult to finish what they are trying to do
• Messy art classes are awful for them
• Dislikes certain clothing, shoes, hats, mittens and complain about the tags, the fastening, the type of fabric, the style, etc.
• Dislikes hair combed, washed, or cut
• Some toddlers refuse to be held or touched
• They might cry out in pain if the wind touches their skin or grass gets on their feet

The above are a few symptoms of a larger challenge, and “picky eating” is a consequence of an overall global picture of what is known in occupational therapy language as tactile defensiveness. Often, working to correct this issue can have a positive impact on eating.

If you are concerned, and you identify with a lot of these symptoms, please look for some professional help. You will be looking for an occupational therapist trained in sensory, oral motor and feeding issues and if you seek out a speech-language pathologist, please make sure they are trained in oral-motor and feeding.

I encourage you to refer back to my series called “My Child is a Picky Eater” for some general tips that you can use even in these extreme situations.

Useful Websites

• I also really like Angie Voss, OTR’s website. She has great explanations on sensory issues and some fantastic inexpensive PDF downloads.
• I also like the Sensory Processing Disorder (SPD) website, it has some good information on it as well.

My next blog will discuss ways you can increase your awareness in what motivates your child from a behavioral/sensory perspective.

Please contact me if I can help you any further.

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Rosemary Slade, PLLC, OTR, NC is a practicing occupational therapist and mineral-nutritional balancing practitioner. She can be reached on this website. This article is not in any manner, shape or form intended to be considered or construed as medical advice or providing a medical diagnosis. This article is for entertainment purposes only. Please see your medical doctor for medical diagnoses.

Sensory Challenge Strategies

This article will discuss strategies to help with the child who has sensory challenges. Effective treatment depends on a child’s and family’s needs and this article is more for general information.

Treatment for sensory processing problems is called sensory integration. The goal of sensory integration is to challenge a child in a fun, playful way so they can learn to respond appropriately and function more normally. The idea is to help your child get used to things they can’t tolerate in a variety of ways, and create opportunities for the body to have input in a manner that is enjoyable and tolerable.

After using the Motivation Assessment Scale or MAS, you have discovered a specific reason that the behavior is happening. As you recall, the areas we are focusing on are: Sensory, Escape Demands, Escape Attention, Attention and Tangible.

Let’s say your child is not eating due to sensory reasons. Sensory, in this case, is best defined as how we as humans we sense our environment with our senses: touch, eyes, nose, ears, body. There is also a movement component.

I explain to parents that we begin building a library of information as relates to our senses from the time we are born. An infant is born nearsighted and sees in black and white. The optimal distance for babies to see is about 12 inches. By about 5 months of age, your child is able to see in 3 dimensions and see in color.

As infants, our first way to “know” and begin learning about our world is through our skin via touch receptors-the most sensitive receptors are in the face, mouth and hands, and this is why infants mouth everything in their first year of life. Infants also are learning about our world through their nose with smell receptors. There are studies that show infants recognize their mother’s smell from birth.

As your baby begins to move about by being on their tummy, rolling, crawling and reaching, a symphony of vision combined with movement really begins expanding on the “touch” library in our brains. The brain has a different understanding of touch with poor or no vision and touch attached with vision. It is really two different experiences to the brain and it is “filed” as two different experiences. It is the way we evolve as humans.

For example, most children who have sensory challenges have significant issues with the way the brain interprets touch information via the touch pathways in our brains. Since the brain is giving or receiving conflicting or inaccurate information via the touch and smell pathways, the child then begins using their vision to make decisions about what they will and will not touch or put in their mouths.

Over time, the child becomes quite selective about the food they are willing to eat-usually (not always) narrowing down to a few crunchy carbohydrates (like Cheerios), some soft chicken nuggets and milk. From the child’s perspective, anything that does not look or taste like the preferred food will be instantly rejected. When encouraged to go outside the comfort zone, the child will have a meltdown, refusal to eat and a cycle begins.

From a sensory perspective, the foods that your child is not eating is a threat and kicks in the fight or flight response. Something about the way the food looks, feels, tastes, smells or even sounds is extremely displeasing. (Some children cannot tolerate the sound of people chewing. ) Your child becomes ever more hyper-vigilant about foods tolerated.

Sensory challenges are typically not restricted to the dining table. Your child might only wear certain textures of clothing, or refuse to wear long sleeved shirts or long pants. Melt-downs and refusals with having hair washed and combed or brushed are common. Additionally, simple grooming like having nails trimmed can be a real challenge.

Sensory challenges can be addressed outside the eating experience, and providing a broad variety of sensory experiences to a sensory sensitive child will, over time, have a positive effect on eating, as tolerance to a wide variety of touch input (and other sensory inputs) over the day improves.

I encourage you to read up about the term tactile defensiveness. There are many resources that address sensory issues in-depth. I really like Angie Voss, OTR’s work. She has great handouts and a fantastic little book you can download for free.

Instead of reinventing the wheel, below are some of Angie’s suggestions about feeding from a sensory perspective. Hopefully, you get a gem or two from the list below.

• Do not force a child to eat anything. Do not insist on having the child touch it or put it in their mouth. Do not bribe with a reward or insist that they take just one bite, this will only back fire on the nervous system in the long run.
• Respect that trying new foods is a multi-sensory experience and that the smell and look of the food may be overwhelming in itself…never mind putting it in the mouth to experience the taste and texture of it all.
• If the child is having an “off” sensory day, then expect the food choices to be even that much more limited…it’s OK, each day may be different.
• Try not to talk about food all of the time. It is hard enough for the child as it is. Our society is so preoccupied with food and the child is constantly bombarded with food choices and experiences…all day long.
• If your child has a few balanced food choices, then let it be and let the food choices expand naturally (with a sensory enriched life of course to work on the sensory foundation and sensory processing).
• Offer daily opportunities to play and interact with food, yet in a fun and exploring kind of way. Refrain from even suggesting to “try it” or “taste it”. Let it happen naturally.
• Offer daily sensory activities involving the power sensations.
• Offer daily tactile experiences, since the oral sensory system is a part of the overall tactile system.
  Right before mealtime prep the nervous system and brain by 15 minutes of vestibular and proprioceptive play.
• Prep the oral structures by offering gum or an oral sensory tool prior to mealtime and offer an opportunity for resistive sucking or blowing, such as a bubble mountain.”

I am a big fan of, and highly recommend the concept of Food Chaining. This concept was coined and developed by Cheri Fraker et.al.

What is food chaining?

“Food chaining is a diet based on a child’s taste, texture, and temperature preferences,” says Cheri Fraker, a pediatric speech pathologist and co-author of Food Chaining: The Proven 6-Step Plan to Stop Picky Eating, Solve Feeding Problems, and Expand Your Child’s Diet.

The process begins with figuring out what foods your child already likes and gradually offer new foods that are similar to those favorites. “Gentle changes let your child expand their foods without anxiety,” she says, adding that she’s seen this double the number of foods a kid will eat.

• First, make a list of your child’s favorite foods-what they are currently eating. This is the “core” diet of your child.
• Next, take your list and add foods in that have a similar taste or texture and offer them to your child as a combo.
  • For example, consider different flavors of the same cereal (regular cheerios, honey and nut cheerios, multigrain cheerios).
  • For chicken nugget eaters only, add a different brand of chicken nuggets, or a homemade chicken nugget to the plate. They might not eat it at first and it might take 20-30 offerings or presentations for them to accept it.
• “Keep expanding by offering a ‘close cousin’ to the core-diet foods a few times a week until your child is not afraid of the new food,” says Fraker.
• If your child is verbal, ask them for grades. When your child tries a new food, ask them to grade it on a scale from 1 to 5 with 5 being the best. If a food is 3 or higher, try it again.
• Rethink what’s “new.” A tiny step can help kids get used to the idea of trying a “new” food.
  • If your child only eats cheese pizza, offer a slice of cheese pizza with a different color of cheese added.
  • If your child will only eat a certain shape of pasta, see if you can find that pasta shape in different colors or similar but slightly different shapes.
• For a child with eating challenges, any difference in their food is virtually a “new” food.
• Take the pressure off mealtime by adding an unexpected twist.
  • Put dry cereal in ice cube trays.
  • Let them dip their cereal in milk or yogurt.
  • Serve sauces on the side so children can have control of what they dip their favorite food in.

Be patient, practice your breathing and don’t cave in. Offer a range of foods, including foods that are similar and observe the success of eating over the course of a week instead of over a single meal.

If you are not having any success, do consider getting a professional to help you-look for an occupational therapist or speech language pathologist who is trained in eating and feeding disorders. Think about what your kid eats over the course of a week rather than the success of an individual meal.

Useful Resources

Food Chaining: The Proven 6-Step Plan to Stop Picky Eating, Solve Feeding Problems, and Expand Your Child’s Diet

I also love the book: The Out-Of-Sync Child by Carol Stock Kranowitz.

Feeding/eating is a complicated subject and a child with significant sensory issues makes that even more challenging. I hope this article has helped you in some way. My next article will discuss behavior interventions in a more general way.

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Rosemary Slade, PLLC, OTR, NC is a practicing occupational therapist and mineral-nutritional balancing practitioner. She can be reached on this website.  This article is not in any manner, shape or form intended to be considered or construed as medical advice or providing a medical diagnosis. This article is for entertainment purposes only. Please see your medical doctor for medical diagnoses.

What is a Picky Eater

There are many terms floating around-and if you do an internet search-terms like “fussy eaters”, “picky eaters”, “problem feeders”, “selective eaters”, and “extreme picky eater” are quick to populate. These terms are often used interchangeably with typically developing children, to children with moderate to severe eating challenges. It is quite helpful to define the term you are using when discussing your situation with friends or professionals.

Picky eaters usually have a food repertoire of approximately 15 to 30 foods and there is variety within those foods. They might drop a food, but will come back to eat it again. The behavior of the child at the table is typically within what is considered to be normal for children.

It is also important to know that picky eating is typical in young children. Take toddlers for example. They are all about testing limits and quite inconsistent. They might reject a food they liked previously, and then quite happily eat it when offered at a different time. If you have a toddler who is doing this, know that this is quite normal behavior-and if you let the behavior slide for that particular food at that particular time-you will avoid limit testing, power struggles, and control issues that are common during this stage of development.

Problem feeders or extreme picky eaters are those who are severely limited in the foods eaten. Often the child self-selects one or two foods only, and will only drink milk. I have observed some children self-select to only eating a certain color of food within a select few options. You might observe gagging, choking, meltdowns, and other unhappy behaviors when a food outside the child’s repertoire of food is offered. At well-child visits, the topic of conversation is always about your child not eating.

Problem feeders often have significant medical issues and/or developmental delays-either clearly diagnosed at birth, or yet-to-be diagnosed. Children who have undiagnosed autism spectrum disorder frequently fall in the problem feeder category and parental concerns are not often fully addressed by front-line medical professionals during routine office visits. Any one of these issues compound the challenges revolving around consuming food and drink successfully.

If you have, or suspect you have a problem feeder, please get professional help as soon as possible. There are many caring people who are specifically trained in this area. For example, a qualified in-home or clinic-based occupational therapist or speech language pathologist is a great place to start. If your child is under three years old, contact the early intervention program in your area. Here is a link: https://www2.ed.gov/programs/osepeip/index.html. For more significant or severe eating disorders, there are teams of feeding specialists housed in hospitals across the United States that evaluate: postural concerns, sensory integration issues, motor challenges, behavioral components with ability to learn, nutritional factors and medical history.

Up until about the age of five or six, children are in the learning stage about food. Taste, texture, variety and exposure all play their roles and children develop food preferences. It typically takes 12-25 exposures to a new food for a child to accept it. Exposure means any time a child is in contact with the food through looking at it, listening to caregivers talk about eating it, helping prepare it, shopping for it, tasting it or actually eating it. Picky eaters may take even more exposures, and problem feeders may take hundreds of exposures before they accept the food.

Caregivers also have a significant role at the dinner table (or high chair). If caregivers place a lot of pressure on the child to eat a food the first time and it doesn’t go well, the following exposures will certainly not go well.

How can you expect your child to consume and learn about food if you, as a caregiver, do not enjoy a wide variety of food or expose your child to a wide variety of food? I have repeatedly experienced this in my work with families. A surprising number of caregivers I have worked with had their own issues with food from buying it, to preparing it, to eating it. Please remember your child has no “experience” with food-from touching it to tasting it to actually eating it. Variety truly is the spice of life and food exposure certainly is no exception.

My next article will discuss the emotional toll on caregivers and increasing personal awareness to the seemingly never-ending dialogue in our minds.

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Rosemary Slade, PLLC, OTR, NC is a practicing occupational therapist and mineral-nutritional practitioner. She can be reached on this website.  This article is not in any manner, shape or form intended to be considered or construed as medical advice or providing a medical diagnosis. This article is for entertainment purposes only. Please see your medical doctor for medical diagnoses.

The Emotional Toll on Caregiver and Increasing Personal Awareness

Having a picky eater creates an emotional toll on caregivers. We all have “self-talk” and it is often less than flattering. When the upheaval comes from all the dynamics of a child who will not eat, the self-talk becomes even more negative. This article takes a peek at how we unconsciously create our realities through our thoughts, feelings, words and vibrations. If you can imagine it, you can create it.

In my work extensively with children and families in the home environment, and in my own personal work of spiritual evolution, I have come to some interesting conclusions.

Caregivers typically intuitively know something is wrong with their child via the feedback of “picky eating” behaviors. The stories I hear from caregivers-typically women-is that they have been given plenty of advice from friends and family. Internet searches really haven’t fully addressed the issues that are affecting their family dynamics. Social media feeds reveal all their friends having no issues with their children eating. What used to be a niggling problem has now become a major issue at the dinner table with their spouse and the conversations at the table revolve around “the problem”. Frequently, caregivers have been told by their doctor that the child will “grow out of it” and to be patient.

To make matters even worse, as the problem of picky eating continues, and when repeated interventions by the primary caregiver are unsuccessful, blame, fatigue, self-doubt and recriminations erode self-esteem, confidence and the willingness to keep trying.

We as a society, place a high social value on eating. At this time in the United States, women remain at the forefront of child-rearing. Many women are socialized from an early age that food equals love. In other words, food that is prepared and served is a love offering from the woman to whomever the food is presented to. To have a love offering such as this rebuked repeatedly after going to the effort of thinking about the meal, preparing the meal, offering the meal, etc. will wear anyone out. And, positive feelings for a child who is repeatedly refusing food that you have so painstakingly gone to the effort to present begin to erode with time.

The above scenario plays out in some form or another repeatedly in the United States. If this applies to you, please know that you are not alone. Stress, worry, and repeated advice (which often turn into criticism when the “problem” isn’t fixed quickly) create a ripe feeding ground for negative self-talk. This negative self-talk can become a self-fulfilling prophecy and a vicious cycle begins with over-stressed caregivers losing sight of who they are as participants in the family dynamic and even further devolves into lower self-esteem.

Your child, who may have initially been at a developmentally appropriate level of demonstrating their independence and experimenting with power and control, is now the leading actor and center stage of “the problem” about picky eating and even potentially getting reinforced for the behavior of not eating!

Children don’t have a lot of power or control when they are young. As they get a bit older, typically around the time they can walk independently, they begin to realize they are independent beings and are starting to express their opinions. The things that children can absolutely control at this young age are: 1) what goes in their mouth (food and drink) and 2) what comes out of their bodies (number 1 and 2). It is developmentally appropriate for “melt-downs”, for emotional outbursts and refusals to reasonable requests at around the time a child begins walking, through about three years old. The challenge is to successfully manage the behavior(s).

Before I really became aware of how powerful language and personal awareness creates realities, I used to create plans with the caregiver with the intent toward changing the child’s behavior. As a professional, I was there talking about “the problem” with the child in attendance. This, in my opinion, was not so different than the discussion about “the problem” with parents and child at the table in the child’s eyes.

I now realize what great mastery that child had at the time-to not only have friends, spouse, family, social media and doctors working on “the problem”-now a “professional” is coming in to address “the problem” also!

In the past, although my approach was somewhat effective, I came to the conclusion that behavior is a two-way street and I realized that I was inadequately addressing underlying belief systems of the primary caregiver. This in turn impacts the dynamics of child and caregiver (and by extension everyone else in that caregiver’s orbit).

Currently I find that if I can provide supports to the primary caregiver (who by this time is being pretty hard on themselves), and we work together to unravel belief systems as revealed by their unconscious negative self-talk and replace it with conscious positive self-talk then this can be a major game changer with picky eating and any other area of life/parenting that is a challenge.

Helping caregivers remember that they have a built in “truth meter” is core to helping any issue in life-and picky eating is no exception. If you get a good feeling and resonance by running thoughts, ideas, and other notions presented by others regarding a situation-or by doing a bit of self-reflection and you get a good feeling-execute that plan. If you get a twisting in your gut, or a bad feeling about a plan of action, then you don’t do it. It is that simple.

We human beings consciously and unconsciously create our world around us through our thoughts, words and actions. What if problem eating is unconsciously created if you or other family members have issues with food and eating–or have arguments and disagreements with other caregivers about what the child should eat (especially in front of the child)? What type of interpersonal dynamic is set up and supported by this?

What if …

• Through the language we use, and especially the language we use in front of our “problem” eater, we are unconsciously reinforcing the problem?
• Through the language we use combined with the behaviors (verbal and non-verbal) we are doing in front of and to the “problem” eater, we are unconsciously reinforcing the problem?
• The child is unconsciously using this to escalate their behavior as a way of power struggle?

I can’t tell you how many times I have listened to caregivers tell me “my child won’t eat”, or “my child won’t eat that” or “my child is lazy” or “my child will never ______ (fill in the blank (eat, walk, talk, drink anything besides formula), or “my child always gags when I offer new foods so I now only offer my child the foods they will eat”-you get the picture.

These series of articles are in no way intended to imply that you-as a caregiver-are inadequate or doing anything wrong. You are acting and behaving on a belief system through your “self-talk” that was probably installed when you were a young child and you have had this “self-talk” tape running all this time.

Louise L. Hay, author of “You can Heal Your Life“, says that the way we use our minds are habits and any habits can be changed. The trick is to take notice and be aware of the language of the “self-talk” in our minds. Once we have the awareness of that self-talk we can change it!

My next article will discuss “self-talk” and how to bring awareness to the seemingly never-ending often negative dialogue in our minds.

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Rosemary Slade, PLLC, OTR, NC is a practicing occupational therapist and mineral-nutritional practitioner. She can be reached on this website.  This article is not in any manner, shape or form intended to be considered or construed as medical advice or providing a medical diagnosis. This article is for entertainment purposes only. Please see your medical doctor for medical diagnoses.