FUSSY EATING AND FOOD REFUSAL: Is It Due to a Sensory or Oral Motor Difficulty?
Feeding and fussy eating are one of the most popular topics that are discussed amongst parents. Life is about growth and development and without adequate nutriton, this cannot be fulfilled. Parents that I see often report that feeding their children and ensuring that they are getting in the right amount of calories and adequate nutrition almost defines their success as a parent. Due to this the frustration and stress that parents feel around feeding is understandable. Understanding where your child's fussiness is stemming from can often help eliminate this stress and set you on the right path to improving your child's intake.
When we look at feeding, the actual intake of food is just the 'Tip of the Iceberg'. We need to establish what is happening internally with a child. A child who is experiencing any type of gastrointestinal discomfort, pain in any anatomical region associated with eating, sensory difficulties or motor difficulties will more than likely have some type of food refusal or feeding difficulty.
Children who I see with feeding issues often fall into one of two groups (or a combination of the two). These are sensory and/or oral motor related difficulties. When assessing a child it is essential that all of these aspects of their feeding and development are considered. Also all medical problems need to be addressed, as if a child is in pain or discomfort, there is no way that they will eat.
When we look at the sensory aspects of feeding, we see a range of behaviours that can indicate how a child's system is functioning.
We see children that are described as being hypersensitive or in some cases sensory avoiders. These children are often described as having a lower sensory threshold, meaning they require a reduced input to get a sensory response. These children often prefer bland tasting foods with small smells. They will often choose white types of foods that are softer in texture and require minimal amounts of chewing, hence minimal amounts of sensory input. They also often prefer foods at room temperature avoiding things like ice creams, foods straight from a fridge and warmed bottles. For these children certain foods cause visual discomfort for them. They also may gag, vomit or run away from foods.
With these children we work on normalising their sensory systems by using a sensory diet, sensory play and systematic desensitization. If a child feels stressed or uncomfortable around eating their intake will be restricted or reduced.
Some children may be described as being hyposensitive or having higher sensory thresholds and require larger sensory inputs to obtain a response. These are the children that love big flavours and smells, like curries and chilli. They also tend to go for crunchier types of foods the provide more sensory input when chewed. Temperatures are often in the extremes, freezing or hot, room temperature provides no input for them. they also tend to over stuff their mouthes as this provides more sensory input. They also may drool or have pieces of food scattered in their mouthes or on their lips due to decreased input and awareness.
When assessing a child's feeding its essential that you therapist establishes where your child is on the sensory continuum as this will help develop a appropriate therapy plan.
When we look at feeding and eating, in the first few weeks of life feeding is instinctive, it then becomes reflexive and once a baby starts solids they start leaning how to eat. In most cases, a babies oral skills develop as the baby develops. There are however critical periods for the development of oral skills for eating. If a baby isn't exposed to the appropriate textures during these periods, their skills can be delayed or they may need to be taught how to chew and swallow efficiently.
Oral motor delays and difficulties are often the major cause of feeding aversions, fussy eating and feeding difficulties. Babies and children will refuse or reject foods and textures due to an inability to chew and swallow them.
Before embarking on a feeding therapy program it is essential that your baby or child's oral motor skills are assessed by a speech pathologist to ensure that they don't have an oral motor delay. If you are only working on the sensory aspect of feeding, their oral skills will not improve. Once a child presents with an oral motor delay, they need to be taught how to chew and swallow. If they are delayed they will not just develop along the normal continuum.
Its also important to understand that sometimes sensory difficulties mask oral motor difficulties. So its essential to look at both systems and to ensure the most effective treatment, both systems should be worked on together.
About the author: Mandy-Lee Adno is a SPA registered speech pathologist who specialises in and is passionate about paediatric feeding. She has written numerous articles and regularly presents to parents, collegues and associates on normal feeding development and it's difficulties. She consults at The Children's Clinic in Bondi Junction. www.sydneyfeedingspecialist.com