Sensory-Based Feeding Problems

 

Does your child eat and enjoy their food more when the food is separated? Is your child insistent on having meals in a divided plate to ensure that foods don’t touch? Is there an instant meltdown when the mac & cheese accidentally touches a green vegetable? If this sounds familiar, your child might have a sensory-based feeding issue.

Phobia: Some children and adults actually have a fear of foods touching, and it is called brumotactillophobia (broo-mo-tack-till-oh-FOH-bee-ya). This fear can be extremely detrimental because the child is oftentimes unable to eat if any of their food is touching. In the severe cases I have had in feeding therapy, they can’t even have the juices or condiments of one food touch another food. So, if the syrup on the waffle slowly drips to the scrambled eggs…the meal is OVER! Even if the child is still hungry, he/she literally cannot continue eating. Some medical professionals consider this phobia to be a form of obsessive compulsive disorder and others believe it is a sensory processing disorder. Some experts believe it’s a blend of the two, that starts as a sensory issue and slowly transforms into an obsession. In my experience, it all begins as a sensory-based feeding issue.

Processing: Sensory processing (sensory integration) is when the child’s nervous system takes in the information in their environment through the traditional five senses (touch, smell, taste, vision, hearing) and two additional senses, vestibular and proprioception (body motion and body positioning), in order to understand what is going on around them. In regards to mealtime, some children have difficulties processing all of this information and may react in three ways. They can 1) over-respond to it (e.g., scream when their food touches) 2) under-respond to it (e.g., has no reaction to food touching and just refuses to eat) or 3) sensory seek/crave (e.g., want to put their hands in the food and play in it but not necessarily eat it).

Plate: It is common for children who struggle with sensory issues at mealtime to require that all their food be placed in a divided plate. In feeding therapy, it’s important to meet a child where they are at. That is why I start my 7-step Sensory Plate Program with a sturdy, three-sectioned plate that is dishwasher and microwave safe (like the ezpz Happy Mat). Ideally, the divided plate should 1) have three separate sections 2) be used for each meal and snack and 3) be easily reheated if your child is hesitant and takes a long time to eat. As you work on their sensory feeding issues through the program, you can eventually move from a three-sectioned plate to a non-divided plate.

Program: Your goal as a parent or feeding therapist is to eventually have the child eat off a regular plate and have the child tolerate foods that slightly touch. Not all the food on the plate has to touch. Even adventurous eaters like to have some separation of our food, tastes and textures (unless, of course, we are at a BBQ cookout with a very small paper plate or trying to pile on as much food as we can at Thanksgiving!). Keep in mind that change is difficult for their nervous system, so starting slow and being patient is the key to success. Here is 7-step Sensory Plate Program to help you obtain this goal!

Step 1

• Meals: Use your three-sectioned plate to separate all food for all three meals.
• Snacks: We do not want your child to refuse meals, which is why we start off with only snack alterations for Steps 1-4. As you build out the snack, you can have standalone foods in two sections of the plate, but in the third section they should visually see foods slightly touching. If they refuse to eat the entire snack, that is okay, they have a healthy meal coming up soon.
• Next: Continue with this step until your child is comfortable with snacks slightly touching in ONE section of the divided plate (no sensory meltdowns, food refusal, etc.).

Step 2

• Meals: Use your three-sectioned plate to separate all food for all three meals.
• Snacks: Snacks should be slightly touching in all three sections of the divided plate.
• Next: Continue with this step until your child is comfortable with snacks slightly touching in all three sections of the divided plate (no sensory meltdowns, food refusal, etc.).

Step 3

• Meals: Use your three-sectioned plate to separate all food for all three meals.
• Snacks: Snacks are now presented on a regular plate without the food touching.
• Next: Continue with this step until your child is comfortable with snacks presented on a regular plate (no sensory meltdowns, food refusal, etc.).

Step 4

• Meals: Use your three-sectioned plate to separate all food for all three meals.
• Snacks: Snacks are now presented on a regular plate with some of the food slightly touching.
• Next: Continue with this step until your child is comfortable with snacks slightly touching on a regular plate (no sensory meltdowns, food refusal, etc.).

Step 5

• Meals: Use your three-sectioned plate to separate all food for two meals a day.
• Snacks: Snacks and ONE meal are now presented on a regular plate with some of the food slightly touching. Pick only one meal a day, preferably the meal where they eat the least amount of food. We want your child to continue to eat two solid meals a day in a way that is comfortable for them. If they refuse to eat the entire snack or meal, show them how they can move the food and separate it with their hands or utensils.
• Next: Continue with this step until your child is comfortable with snacks and ONE meal slightly touching on a regular plate (no sensory meltdowns, food refusal, etc.). If they consistently refuse to eat and nutrition is a concern, go back to Step 4.

Step 6

• Meals: Use your three-sectioned plate to separate all food for one meal a day.
• Snacks: Snacks and TWO meals are now presented on a regular plate with some of the food slightly touching. Decide which meal your child gets the most nutrition from and save that meal as the final transition. If they refuse to eat the entire snack or meal, show them how they can move the food and separate it with their hands or utensils.
• Next: Continue with this step until your child is comfortable with snacks and TWO meals slightly touching on a regular plate (no sensory meltdowns, food refusal, etc.). If they consistently refuse to eat and nutrition is a concern, go back to Step 5.

Step 7

• Meals: Use your regular plate with some of the food slightly touching for all three meals.
• Snacks: Use your regular plate with some of the food slightly touching for all snacks.
• You did it!

SHIJINA RIJESH