Feeding:Picky Eaters and Sensory

Processing

Presented by Jan Van Horn, School PsychologistKat Hyatt, Occupational Therapist

Age (months)

Feeding Expectations

Motor Sensory Cognition Social

5-7 Takes food from spoon: baby food, soft cereal

Good head and emerging sitting stability

Explores & accepts textures: fingers/rattles

Simple cause and effect (i.e. hitting or shaking); mouths objects

Beginning to play and interact during meals

6-8/9 Supervision.Holds and eats cracker (sucking more than biting).Grabs at spoon, inappropriate use.

Good sitting.Purposeful reach. Hand to mouth with objects (palmer grasp)

Emerging object permanence.Familiar actions. Explores.

Easily distracted. Recognizes strangers.

9-13 Finger feeds self a portion of the meal.Soft table foods: macaroni, peas, dry cereal)

Varying grasp patterns with emerging radial use on small objects.

Increasing organized/ purposeful activity.Still has difficulty with attention to objects outside visual field.

Prefers to “do” than “watch”

12-14 Continued emerging spoon use

Functional place and release of objects

Emerging appropriate tool use. Joint attention between objects.

Watches family routines/ activities

15-18 Scoops food with spoon and brings to mouth, increasing success.

Increasing shoulder and wrist stability.

Exploring how objects work, emerging problem solving through action experimenting

Begins to internalize and use learned “rules” for how to play with/ use objects.

24-30 Interest in forks.Proficient spoon use.

Increasingly efficient movements

Tolerates various food textures.

Verbal requests.Simple sequence imitation.

Copying peers. Seeking adult affirmation for successes.

30+ Continuing mature tool use

Adapted from Case-Smith p 460

The Fundamentals

• Sensory Processing• Posture• Motor Planning

Problems: what do we see

• Overstuffing/Overeating• Gastrointestinal/Digestive problems• Selective (refusal and aversions)– Type of food– Texture of food– Presentation/meal ritual

Factors to Consider

• Overeating– Sensory seeking– Not registering– Emotional factors

• Selectivity:– Hyperresponsive (texture, taste, smell, temperature,

vision, mixture)– Motor deficits– Ritualistic

• Digestive:– Pediatrician input

Causes for Hypersensitivity

• Early noxious experiences• Lack of exposure• Neurological impairment• Combined factors• Hyposensitivity

Assessing the Problem

• Food records: what, when, where, and how

• Questionnaires• Interviews• Observation• Review the fundamentals

Now What

• Social Stories• Social Factors• Behavioral– routine and structure for meal times

• Elements you can control– Bite size, food type, texture, flavor,

color, shape, auditory/visual distractions

The Motor Component

• Work within endurance abilities• Special seating: upright posture

without working too hard to eat• Movement breaks• Weighted utensils/cups• Non-slip plate/bowl surface

The Sensory Component

• Guidelines to Approach: – Rapport– give control/offer choices

• Desensitize• Progressive presentation– Introduce non-preferred items to one

sense at a time– Gradual mixing

Desensitizing- Child explores mouth with own hands- Use of rubber/hard toys- Brush and massage: NUK, toothbrush, warm

washcloth, ice cube/ice pop- Blow toys (bubbles, whistles)- Start dipping in variety of pureed foods/juices

to introduce flavors/textures. Between meals or during snack time can be a good time to work on desensitizing, as nutritional intake is less important at those times than during full meal times

- If a desensitizing routine is established, use a fast version “warm up” prior to meal times to prepare to eat the meal

Interventions for Hyposensitivity

• Typically it is more difficult to train the body to feel something that it is not registering– Try “warm up” activities with sucking,

blowing to “wake up” oral area• Compensatory strategies–Mirror– Hygiene–Meal planning

References

Case-Smith, J. (2001) Occupational Therapy for Children St. Louis, Missouri: Mosby.

Therapy West, Inc./pLAy Studio class: Hands-On Sensory Integration Treatment for the Child with Autism: An Interdisciplinary Approach. October 8-9, 2010. Contributers: Erna Blanche, PhD, OTR/L, FAOTA; Janet Gunter, MA, OTR/L; Juliana Gutierrez, MA, OTR/L, SWC; Christy Skura, PT, DPT, PCS; Shelby Surfas, OTD, OTR/L

Yack, E., Aquila, P., Sutton, S. (1998) Building Bridges Through Sensory Integration. Las Vegas, Nevada: Sensory Resources.