Occupational Therapists, Physiotherapists and Speech and Langauge Therapists practicing Ayres SI are frequently asked about eating difficulties; this is a common feature of sensory integration difficulties for many young babies and children.
Sensory and motor based eating issues require a whole child approach, starting with how a child moves and sits. Adequate and stable postural control facilitates a good head position and frees the hands up to help with eating.
Try this little exercise – sit on a low stool or chair, slump forward, with your chin almost on your chest and then try to sip a glass of water and chew and swallow a piece of soft fruit? How easy was it to do?
So how do we know if eating difficulties are more about sensory hyper or hypo-reactivity or poor oral sensory discrimination affecting the child’s motor skills? We have a range of tools in our toolbox. For older children, the SIPT Assessment provides excellent information about oral praxis, tactile reactivity and tactile discrimination, vestibular processing and proprioception. The Sensory Processing Measure can provide information for school-aged children, but also younger toddlers from 2.
Clinical Observations and parent report, as well as hypothesis testing through early intervention allows a therapist to test and confirm an early hypothesis through play with toys and games.
Therapy activities used might include a rice tub, play dough, messy paint play, kinetic sand, water play, shaving foam, play on balls, in tunnels, on swings and over foam rollers and with lots of textured surfaces. Careful observation will all help confirm why sensory differences may be contributing to tricky eating.
Then we also need to consider the child’s level of alertness, are they very tired, under-responsive and sleepy, or whizzing and fizzing – neither of these states is right for a task that needs focus and attention.
Do you feel like eating immediately after you wake up, or while trying to concentrate on a difficult task? Or while learning to walk a tight rope? Clear focus and attention is required for success at the table.
I really love this table from this amazing book, which provides an outline of questions to shape your parent interview and to use to inform your clinical reasoning during unstructured clinical observations.
from Arvedson, JC., Brodsky, L. (2002) – Pediatric Swallowing and Feeding: Assessment and Management
Addressing the underlying sensory or motor issues, whether this is an under -responsive vestibular system, over responsive tactile system, poor oral discrimination or poor proprioception and related motor muscle skills required for chewing does not have to be with food. And often it helps if initially, it is not about food. This is because when families first come for assessment and therapy food may already be an emotive subject. Helping our children to eat is key to helping them survive – and when for whatever reason they struggle with eating, Mum’s and Dad’s can feel sad, scared and even desperate. Growing and developing the postural, motor and sensory especially tactile discrimination skills needed for eating through play is fun and allows everyone to relax and new learning to occur without pressure.
Education about family mealtimes is also important, especially for younger children who may need to watch and observe, to model eating skills and see others trying new foods. For slightly older children, sometimes doing this with friends, at friends houses and even at school, cooking groups can allow a child to take risks, modelling peers. It is however essential that there is never pressure applied!
Other information and resources to support eating can be found here, and we will be posting again on eating and feeding difficulties.