A Speech & Language Pathologist’s job is anything but monotonous! There are endless ways that SLPs can contribute to society and help people across the lifespan. Some people might think, “I know what speech therapists do, they help people say their sounds correctly and fix stuttering, like in ‘A King’s Speech.'” Yes, that is only a smidgen of what is in an SLP’s wheelhouse.
One area that SLPs work on with clients is feeding therapy. Speech therapists as well as occupational therapists are qualified to target feeding therapy. I spent a semester at Emerson College working as a graduate clinician in a food school in the Boston area. I found the experience fascinating and wanted to share a handful of techniques and bits of wisdom that I learned while I was there.
Food Refusal
I can imagine that if your child is flat-out refusing food that mealtimes are stressful in your household. We have had our fair share of stressful mealtimes, coaxing and begging our children to eat what we serve them. In our home, we value eating healthy – and splurging, too – and it is important that we teach our children to have a healthy relationship with food.
There are many reasons that your child is refusing food at the table. Here are some common motives as to why your child is turning down nutrients:
- Hypersensitivity. A child who is hypersensitive might gag or vomit due to the size of the food, smell of the food, or texture of the food. This child is overly sensitive to foods.
- Hyposensitivity. A child who is hyposensitive does not always sense the presence of food in his mouth. He might end up pocketing food in his cheeks, not chew his food enough prior to swallowing, not clear food remnants from inside his mouth, or have spillage out the front of his mouth.
- Not liking the food. Sometimes a child doesn’t like the food that is presented to her. Not because of sensitivity issues, but because the food is non-preferred. This is okay to a degree, so long as your picky eater is still consuming a balanced diet.
- Dining behavior. We don’t often think about how and where our children consume food, but this piece of the puzzle is absolutely important.
- Control issues. When children are going through rough patches in life, they could take out their frustration on food. Why? Because a child cannot control much in his life, but he can control what he puts in his mouth.
Let’s Water the Sponge!
Let’s flesh out each of the issues above a little bit more and talk about ways to manage them. The suggestions I give might only scratch the surface for you and you may need to seek additional help still when it comes to helping your picky eater out, and that’s certainly okay!
Hypersensitivity
The blessing and the curse of being overly sensitive! I, myself, fit this category to some degree and our oldest son certainly fits into this category by a long-shot. I’ll give you some examples of what hypersensitivity means for myself and my child, just to give you an idea of whether or not your little one might be experiencing this as well.
Some of my non-preferred food items include mushrooms, olives, and pickles – all primarily for the texture. Furthermore, I have difficulty with fruit inside of yogurt, again because of texture. For my oldest, he threw up tiny pieces of squash (yellow and zucchini) for the longest time. He has difficulty with bite-size. Anything that is “too big” makes him gag or vomit. Potatoes can be tough on him as well because of the texture.
You can see the theme here for my family is texture in foods and to some extent, bite-size. However, the scent or the appearance of the food might send your kid overboard. Some hypersensitivity is normal, but for me, I realized that what our oldest experienced was not normal when he spent a lot of time throwing up his food. That’s when I decided to use some techniques I had learned in food school with him.
I have read from many sources that a person might need multiple exposures to a food before eating it. In therapy, we took it slow.
Depending on where your child is in terms of sensitivity, just being in the same room as the non-preferred food item might be enough for the day. Think in small steps: being in the same room as the food, smelling the food, touching the food, taking tasting bites of the food, and finally working up to real bites.
Everyone is different in terms of their response time. I remember working with a client for an entire semester. Her family was Italian and eating pasta was important to her mother. As such, her mom packed her a small Tupperware of pasta and red sauce for our therapy together. She began by licking pasta sauce off of the noodle, and would sometimes gag/vomit just from this. We worked up to having her eat 1/16th of a noodle in a bite without throwing up. By the end of the semester, my client was able to eat 1/3 to 1/2 of a noodle on a bite without vomiting.
If you’re committed to taking it slow with your child each and every day, expect slow progress. My oldest can now eat small bites of squash and not vomit. It took me about a year of consistently offering the food to him. Now, we are working on getting him to eat broccoli, haha.
Hyposensitivity
The opposite of being too sensitive is, of course, not being sensitive enough. Being hyposensitive poses a problem when food is not being consumed safely or when your child has decaying food in his mouth because he doesn’t know that it’s there.
For your hyposensitive child, be sure to offer lots of verbal cues. You can simply say something such as, “Chew, chew, chew, swallow.” Sometimes with our youngest, I sing a song, “This is the Way We Chew Our Food,” and he dances and chews while I sing. He isn’t quite hyposensitive, per se, but he has difficulty with over stuffing and sometimes does not chew his food enough.
Point out when there is food in your child’s mouth that he hasn’t swallowed yet. In addition to using verbal cues, try tactile cues as well. Rub his cheek gently as a reminder to chew, or gently rub his throat as a reminder to swallow.
Once feeding time is over, double-check that your child’s mouth is empty. Even after having your child say “Ahhh” so that you can look in his mouth, use a toothbrush to rub the inside of his mouth, particularly in areas where food can be pocketed – between the teeth/gums and cheeks. This will help remind him to use his muscles in his mouth and will also clean out his mouth so that there won’t be any decay.
Finally, something that you can do on a daily basis with your child is oral-motor exercises. These will help stimulate muscle movements in the mouth and increase awareness and sensitivity. Check out this awesome list of 34 oral motor exercises put together by an OT! Also, here is a list of easy oral motor exercises that an SLP wrote.
Not Liking Food
What if your child is refusing to eat because he doesn’t like the food? Try turning mealtime into a fun bonding experience! If you’re able to, take your child to the grocery store (well, maybe an online grocery store given the pandemic), and talk about the different foods that are available. Tell your child about healthy versus unhealthy foods.
Once you have selected some quality ingredients, have your child participate in the meal prep with you! When you think your child is old enough, you can have him carefully cut with you using hand-over-hand technique. Explain what you are doing as you do it and tell him what you are making.
Now, your child still might not like the dish that you made, especially if non-preferred food items are in it, but the odds are higher that he will give it at least a tasting bite. If not, you can always coax him by reminding him how hard he worked on it and that he has earned at least a few bites of the meal.
Remember that multiple exposures to a new food are often needed before a child will start engaging with and eating the new food. Don’t give up after the first try and be prepared to interact with foods in different ways! You can do art projects with foods or sensory projects with foods – you aren’t limited to just preparing and eating foods.
Dining Behavior
This may or may not have even crossed your mind, but how and where does your child eat?
If your child is running around or not eating at the kitchen table, then the chances are slim that he is getting the nutrition that he needs out of the meal that you are serving.
Getting your child to sit at the table and not leave the table teaches him that there is a purpose behind eating. It gives your child structure and boundaries, two things from which children thrive.
Needless to say, if your child is not consistently sitting, this is the place you need to start. Insist on getting your child to sit in a chair at the table for every mealtime, no exceptions.
In therapy, we would strap the children in and let them scream. This sounds harsh, and believe me, as a soft-hearted person, this felt harsh. But! After the child screamed and learned the rules and boundariees of therapy, he eventually calmed down and we could proceed with eating.
The point is that you won’t be able to target any other feeding issues until the dining behavior issues are targeted first. If you’re in the market for some highchairs or booster chairs, I recommend the following:
Control Issues
Oftentimes when something big is happening in the external environment, children take out their issues on food. Why? Because it is the only thing that a child has true control over.
If you’re able to identify a life-changing event in the child’s life, then work with your little one and help label the emotions that he could be feeling. Explain the change as much as possible and how, even though some negative things might be happening, put an honest silver-lining on it.
If your child is still upset and unable to process what is going on, then don’t be afraid to solicit help from a child psychologist. A psychologist will probably have additional insight about ways that you can work with your child to feel like he has better grounding in his life.
Hopefully some of these tips and tricks will prove to be useful with your little one(s) at home! Feel free to share a story or drop a comment below and share on social media!
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