Sensory Feeding Difficulties: Is Your Child a Picky Eater?

Takeaway: If your child dislikes certain textures, colours, and consistencies, she’ll likely become a picky eater. And this can affect her physical and psychological health. But a specialist can help reverse these issues by using tools and techniques like the SOS approach, sensory bins, and food chaining.

By age 3, most children have experimented with all kinds of food — fruits, vegetables, meat, grains, etc. But some haven’t. And it’s a sign that they’re selective (or ‘picky’) eaters.

Food comes with different textures, colours, and consistencies. And while most children like a bit of everything, some are put off by certain types of food. Take Emma, for example. She’s a 5-year-old who will eat only yoghurt or specific flavours of baby food, and will drink only from her favourite plastic cup. Interestingly, as a baby, she preferred to drink while lying down and would gag every time her mother tried to spoon-feed her. These are the sorts of unusual needs you’ll notice in many selective eaters.

Selective eaters often have a ‘sensory food aversion’. That is, they react strongly to some sensory elements of food and eating.

Children like Emma might develop a complicated feeding routine because they like or hate certain sensory elements of the food they’re given. For example, they might repeatedly spit out food that has a particular texture or smell. Sadly, this sort of sensory aversion quickly transforms a child’s life. She might begin to fixate on how her food looks, dread mealtimes, and have meltdowns if her food isn’t just right. Also, since she’s not getting enough fuel, she’ll likely grow much slower than she should.

But problems with feeding aren’t always because of a sensory aversion alone. They’re often intertwined with other issues.

There’s sometimes more than one reason for a food aversion. For example, it might be linked to a larger ‘sensory processing difference’ beyond food. Here, your child might also dislike certain types of fabric, loud noises, or even the feel of a toothbrush in her mouth. Then, her food aversion might develop because her mouth muscles don’t work right (i.e., an oral-motor difference). So her tongue might not be able to move food around properly and direct it towards the back of her mouth — causing her to choke. Things get complicated when there’s a mix of these sensory and oral-motor issues. But that’s often the case, especially for children with autism spectrum disorder (ASD).

Emma — who we met earlier — has this complex combination of factors causing her food aversion.

For example, her paediatrician soon spotted that her head muscles were weak, meaning she couldn’t correctly prop herself up to feed. That’s why she wanted to drink while lying down. This way, her food pipe would automatically be angled just right. Also, her care team soon discovered that she objected to spoon-feeding because she didn’t like the spoon’s feel. So she had no problem eating if they scooped the food into her mouth without the spoon touching her lips. Once her team put this puzzle together, they could go about solving Emma’s problems. And this strategy will apply to your child, too.

To simplify complex cases, specialists have a well-supplied toolkit of useful techniques. One of these, for example, is the SOS approach.

According to the sequential oral sensory (SOS) approach, feeding consists of a chain of 6 significant steps. And our task is to move your child along this chain.

1. Tolerating the physical presence of food: First, your child has to feel comfortable simply being next to the food she doesn’t like. This might mean seeing it in front of her or just having it in the same room.
2. Interacting with the food: Second, she needs to interact with the food, even if she doesn’t touch it. This might mean prodding at it with a napkin, for example.
3. Being okay with its smell: Next, she needs to tolerate the food’s smell. This can be tough, especially with strong-smelling food like eggs or ham.
4. Touching the food: Now it’s time to touch the food — either putting her fingers in it or bringing it to her nose to smell it some more.
5. Tasting the food: This is the big one. She’ll need to lick it or put it in her mouth.
6. Chewing and swallowing: The final step involves chewing and swallowing at least a part of what’s in her mouth. (Often, it’ll help to give her permission to spit food out if she doesn’t like it. This way, she’ll stop worrying about it tasting bad since she has a backup ‘eject’ button.)

We can move your child up the SOS ladder by making mealtime an extension of playtime.

The idea is for your child to move up the SOS ladder systematically. For example, if she doesn’t like the feel of squishy food like mashed potatoes, she’s not going to put it in her mouth (step 5) unless she’s okay sticking her fingers in it first (step 4). And to move her up the ladder, she’ll need to get her comfortable playing and being messy — two invaluable tools to desensitise her to sensory issues. For example, here’s what you could do if she doesn’t like mashed potatoes. First, you’ll put her favourite toy car in the mashed potatoes and encourage her to play with it. She might start by moving the car along the surface of the mash, taking great care not to touch it. At some point, though, she’ll inevitably touch the potatoes. But playing with the car might distract her from the unpleasantness. And over time, it will begin to feel less unpleasant. From here, you could encourage her to smell the mash, taste it, put it in her mouth, and so on. It’s surprising how useful ‘play’ is in this process of systematic desensitisation.

Since textures are a huge element of sensory aversion, you can also try out the concept of playing with ‘sensory bins’.

Here, you gather differently-textured food items in separate bins and get your child comfortable playing with them. So, you might have a ‘dry’ texture bin with things like rice, beans, salt, flour, jelly beans, oatmeal, etc. And a ‘wet’ texture bin with things like ice, pumpkin guts, cooked pasta, jello, pudding, cornstarch mixed with water, etc. You’d let your child put her fingers in all these items in turn, but also provide things like cups, spoons, ladles, etc., so she can scoop and dump them too. You might then drop random objects into the bins and get her to fish them out, all the while chatting and playing with her.

Another useful technique is called ‘food chaining’. Here, you make tiny changes to your child’s diet, chaining new textures and food to the things she already likes.

For example, if she’s a fan of chopped-up apples, you could gradually make the pieces larger till you’re feeding her a whole apple. Then you’ll change the type of apple — red, green, yellow, etc., and introduce her to apple juice. This way, you’re chaining new textures to old ones without changing the food item. Once she’s conquered apples, you might chain in a new type of food. Say, peanuts? For this, you could start by dipping a piece of apple in peanut butter. And once she’s okay with the taste, you’d restart chaining new textures of peanut. You can follow this process indefinitely as long as the changes are tiny and gradual.

Dealing with feeding challenges is sometimes counter-intuitive, which is why you’ll eventually want to consult a specialist.

If you indulge your child’s preferences (e.g., give her only soft, bland food), you might weaken the muscles of her mouth further or reinforce her love for only certain textures. And this becomes a vicious circle. Here’s where an experienced specialist can help guide you. For sensory food aversions, you’ll want an occupational therapist. And for oral-motor issues, you’ll need a speech and language therapist.

Looking for a care team to help your child with her sensory feeding difficulties?

The Ed Psych Practice offers consultation, advice, and problem solving for parents, nurseries, schools, and colleges in London. We have paediatricians, psychologists and therapists who can help assess your child and offer guidance and support.

• Phone: +44 (0) 78 3344 7356
• E-mail: Office@TheEdPsych.com

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