Sensory-based Feeding

Picky Eaters

• decreased range or variety of foods; typically has 30+ foods in their food range

• food lost due to "burn out" from food jagging are usually eaten again after a 2-week break

• eats at least one food from most all nutrition or texture groups (e.g. purees, meltable foods, proteins, fruits)

• can tolerate new foods on their plate; usually able to touch or taste food (even if reluctantly)

• frequently eats a different set of foods at a meal than other family members; typically eats at the same time and at the same table as other family members

• sometimes reported by parents as "picky eater" at well-child check-ups

• learns to eat new foods in 20-25 steps on a steps to eating hierarchy

Problem Feeders

• restricted range or variety of food; usually etas less than 20 foods

• foods lost due to "burn out" from food jagging are not eaten again after a break, resulting in a further decrease in the # of foods eaten

• refuses entire categories of food textures or nutrition groups (e.g. soft cubes, meats, vegetables, hard mechanicals)

• cries, screams, tantrums, "falls apart" when new foods are presented; complete refusal

• almost always eats a different set of foods than their family' often eats at a different time or at a different place than other family members

• persistently reported by parents ot be a "picky eater" at mutlple well-child check-ups

• requires more tha n25 steps to learn to eat new foods

• Pediatric Feeding Disorder (PFD)

  • characterized by impaired oral intake that is not age appropriate, and is associated with medical, nutritional, feeding skills and/or psychosocial dysfunction

  • prevalence is about 1 in every 23-37 children under 5 yrs old

  • acute = less than 3 months

  • chronic = more than 3 months

• Avoidant Restrictive Food Intake Disorder (ARFID)

  • feeding difficulty is not better explained with another physical or mental health disorder, or the severity of the feedign difficulty exceeds what is routinely associated with their condition or disorder

  • behaviors include: 

    • selectivity about food

    • poor appetite

    • fear of feeding (e.g. vomiting/constipation)

  • most often co-occuring with an anxiety disorder

  • kids typically don't report getting hungry due to the consequences of feeding or eating (e.g. vomiting/constipation)

1. eating is the body's first priority

• #1 - breathing; #2 - protecting the brain/postural stability; #3 - eating

2. eating is instinctive

• eating is only instinctive for the first 6 months of life

3. eating is easy

4. eating is a 2-step process

• eating is a 32-step process

5. you can't play with your food

6. if a child is hungry, they will eat

• children will starve themselves and the less they eat, the lesser their appetite

7. children only need to eat 3x/day

8. eating problems are behavioral

• eating can be oral motor or sensory 

9. certain foods are only for certain parts of the day. certain foods are healthy for you

• avoid labeling! 

• do not use stereotypical eating trends as law -- different cultures have different expectations/behaviors

• don't use a dessert as a reward

10. mealtimes are for manners

• teach eating first, manners second

• 4-6 months - introduce baby food textures

  • 6 months - consumption of homemade fruits & veggies correlates with a higher consumption rate at 7 yrs

• 6-9 months - introduce chewy solids

  • if introduced after 10 months, less likely to eat family & healthy foods by age 2

• 12-14 months - develop flavor palate

  • 2-3 flavors per meal at a minimum

  • cook w/ different oils, seasonings, herbs, etc.

• 2+ yrs - commercial purees aren't enough

Sensory Responses to Food

• visual over-responses

• smell over-responses

• tactile over-responses

• taste over-responses

• auditory over-responses

• vestibular over-responses

• sensory under-responsive

• sensory cravers

32 Steps to Eating

• great way to explain to parents to show the progression

• tolerates

  • 1. In same room

  • 2. At table, other side

  • 3. At table, halfway

  • 4. At table away from child

  • 5. At table directly in front

• interacts with

  • 6. Assists with Prep/Setup

  • 7. Utensils; stir/pour

  • 8. Utensils; serve to plate

  • 9. Utensils; manip in own space

  • 10. Uses other food to interact with food (e.g.: twizzler to stir applesauce)

• smells

  • 11. Odor in room (think about a school cafeteria)

  • 12. Odor at table

  • 13. Odor in front of him

  • 14. Smells food (no touch)

• touch - SHOW and PLAY with food

  • 15. Fingertip

  • 16. Fingertips

  • 17. Whole hand

  • 18. Arm, trunk/chest

  • 19. Shoulder/neck

  • 20. Top of head

  • 21. Chin/cheek

  • 22. Nose

  • 23. Lips

  • 24. Teeth

  • 25. Tip of tongue (still touch, no taste here!!)

  • TOUCH IDEAS: phone calls, paint face, hide and seek, play Dr and test reflexes, make mustache and hold food, teeth marks to decorate

• taste

  • 26. Licks lips or teeth

  • 27. Full tongue lick

  • 28. Bites off piece and spits out immediately

  • 29. Bites off piece and holds in mouth for XX seconds and spits out

  • 30. Bites, chews, spits out

  • 31. Bites, chews, swallows some, spits some

  • 32. Chews and swallows whole bolus

  • TASTE IDEAS: “No hands” hold in mouth and drop, put in mouth and wipe tongue, drink water afterwards

• eat

Co-Feeding

• Child controls:

  • what to eat

  • how much to eat

  • the pacing along the 32 steps to eating

  • whether or not the eat at all

• Adult controls:

  • what food is offered

  • maintaining a consistent mealtime routine

  • behavioral limits

  • avoiding "food jags"

  • focus on the food, not the child

  • facilitation & demonstration

  • make it FUN

Models of Care for Feeding Disorders

• specialized inpatient programs:

  • high frequency

  • multidisciplinary team of specialist

  • disruptive to family routines

  • expensive; normally last resort if the child is not meeting nutritional needs/need feeding tube

• outpatient therapy: 

  • more flexible for family, may pose challenges for carryover (dependent upon home program compliance)

  • most common delivery system

• intensive feeding therapy

  • includes daily sessions, greater chance of carryover

  • outpatient

• group feeding therapy

  • most beneficial for children who are socially motivated

• telehealth & consultative therapy

  • "real life" observations & problem-solving & increased comfort for child

Dealing with Rigidity

• change up the food, one feature at a time (shape, color, taste, texture)

  • cookie cutters

  •  food coloring

  • eating with alternative utensils

  • add flavor

Tips for Mealtimes

• have children help with kitchen prep 1x/week

• think about level of sensory regulation prior to mealtimes

• no timeouts

• set-up routine - same plates, utensils, placemats

• eat with the child, family style

• start with preferred food

• over-exaggerate oral movements & imitate child

• cocktail forks

• the learning plate

• clean up routine

• don't eat meals for greater than 30 minutes

SOS Feeding Approach