As a follow up to me blog entry yesterday, I wanted to comment from an SLP perspective on feeding issues. First let me throw in the disclaimer. I am a currently licensed Speech Language Pathologist, but this blog is meant to be informative not diagnostic. If your child has feeding issues please talk to your pediatrician or a therapist who is currently seeing your child.
Feeding problems are common, and to some degree normal, in young children. Babies eat what we give them. Toddlers do too for the most part. Around the second birthday children start to realize that they are not an extension of their parent and can make independent decisions based on their wants and needs–hence, the terrible twos. Most kids move through this stage with no problems, some do not.
There are many reasons a child can display or develop a feeding issue. There are oral motor issues; the muscles in the mouth are not strong and/or coordinated enough to chew or safely move or control the food once it is in the mouth. Foods like corn or rice “fall apart” in the mouth is there is poor bolus (that’s what the wad of food is called) control. Some children may pocket food in their cheeks because they can’t use their tongue to clear the food. Weak jaw muscles can lead to fatigue and poor chewing. Weak lips can cause problems with sippy cups, straws and being able to clear food from a spoon.
There are sensory issues; smell, taste, texture and consistency of foods can be offensive. Children with Sensory Processing Disorder (SPD) are “categorized” as either over responsive to stimuli or under responsive, and to make it even more interesting, can be both depending on which system you are talking about (sight, taste, touch, smell, sound, vestibular, or proprioceptive). Children who are under responsive may need to stuff their mouth to get enough flavor or proprioceptive input. They may need to eat harder crunchier foods so they can feel the texture or like salty, savory or strong flavors. Have you ever eaten an over ripe banana, tapioca pudding or some other food, and almost gagged at the way it felt in your mouth? Many foods typically seen as “normal” textures or consistencies can have that affect on a child with SPD who is over responsive. What is a seemingly mild smell to you or I may be as strong and offensive as the smell of vomit to this child.
Some children can be strong willed and simply want what they want. Think about the toddler or preschooler who has a fit when you serve spaghetti because they wanted pizza or the child who refuses to eat ice cream because they wanted a cookie. While this can still become problematic, it is of much less concern than other feeding issues.
If the feeding preferences of children are not figured out it can turn into a behavioral issue. I have seen infants with severe Gastro-esophageal reflux refuse to feed because they have figured out that feeding causes them pain. Even very young children are smart and quickly figure out if foods are not safe or uncomfortable for them to eat. For example, if motor skills are interfering with a child being able to chew a chicken nugget they may not chew and break it down enough. It may hurt to swallow the food and/or take extra effort. The food may even temporarily lodge in the child’s esophagus. Children instinctually know this is dangerous and may refuse to eat some or most foods.
Some children with Autism Spectrum Disorders (ASD) also have a need for sameness, or a resistance to change. These are often the kiddos who will only eat one brand of chicken nuggets, will eat fast food fries but not crinkle cut or will eat yogurt from a cup but not a yogurt tube.
Sometimes these various difficulties co-exist. Many children with ASD have motor, sensory and “sameness” issues and that can make for some big meal time challenges. The good news is there is hope. Through speech or occupational therapy children can overcome motor and sensory difficulties and eat most food items. Applied Behavior Analysis (ABA) or behavior therapy can help overcome some of the need for sameness and open children up to trying new foods. There are even feeding therapy centers that specialize in treating any and all of the difficulties.
I read a book by Ellyn Satter titled “How To Get Your Child To Eat…But Not Too Much” she shares that parents are responsible for what food is presented and how it is presented. Children are responsible for how much and if they eat. As the mom of a child with ASD I know it is hard to watch your child not eat enough or not eat a healthy variety, but do not make it a battle. Your job is to offer safe, preferred foods to your child. Let the therapist introduce new foods.