Sensory Issues and Feeding Simplified

Does your child have sensory issues?

I always ask this question as part of my intake questionnaire when conducting a feeding assessment. Immediately after saying it, I try to provide parents with an explanation, because in my opinion it’s a very confusing question.

What are sensory issues?

Sensory Processing Disorder (SPD) is a complex neurological disorder that affects the way sensations are experienced and processed. SPD exists when sensory signals don’t get organized into appropriate responses and, as a result, a child’s daily routine and activities are disrupted (Miller 2006).

Here’s the way I explain it to parents…

We use our senses to take-in information about the world around us. This includes our well-known five senses: sight, sound, smell, taste, and touch. Did you know there are also three other “hidden” senses, that most of us aren’t familiar with: proprioception (receptors in our joints, muscles, and bones that give us information about body awareness and movement), vestibular (our sense of movement and balance), and interoception (a sense that helps you feel and interpret what's happening inside your body).

These 8 senses provide an awareness of the world around us. When children have sensory issues (or differences), they may over or under interpret sensory information. They become confused, disorganized, overwhelmed and may overreact or underreact to sensory input. Noises may seem louder, touch may feel painful, and lights may feel blinding. Tastes and textures in the mouth can either feel reduced (hyposensitivity) or enhanced (hypersensitivity). We all interpret sensory information differently and there are different types of SPD. I encourage you to visit Sensory Mom’s website (link in references) to learn more about the different types of SPD.

This is personal to me, beyond my work as a Feeding Therapist. My son Thomas has SPD. Here is a description of his unique sensory profile:

Thomas: The Over Responder

• Clothing tags: I had to cut all of the tags out of his clothing because he couldn’t bear the scratching on his skin.
• Loud Noises: When he was younger, he had to wear ear coverings and cover his eyes at firework displays because he couldn’t cope with the loud noises and bright lights.
• Seams in his socks: Thomas would constantly tear his socks off because the seams “hurt” and made him cry.
• Toothbrushing: Thomas would gag to the point of vomiting.
• Clothing: He would gag when wearing a scarf or turtleneck because he was overwhelmed with the sensation of touch on his neck and throat. Thomas was unable to wear pants that make “crinkly” noise (e.g., jogging pants) or jeans (as he could feel the seams on his legs).
• He would gag when getting his ears cleaned (even to the point of vomiting)
• Tactile (touch) defensiveness on hands: As a baby couldn’t stand mess or wet foods on his hands
• Tactile defensiveness on body: We had to change his shirt immediately if there was a drop of anything wet on it...it was as though it was physically painful for him.
• Tactile defensiveness on feet: Thomas was unable to walk barefoot on grass.
• Tactile defensiveness on head/face: Hair brushing always “hurt” his head and face washing was intolerable for Thomas.

Thomas: The Sensory Seeker

• Mouthing and Chewing: Absolutely everything!!! This provided sensory input in his mouth. He would chew the ends of his sleeves and necks of his shirts until they had holes in them, chew the zippers off his coats, and chew-up pencils, erasers, and toys.
• Thomas sought deep sensory input: He would ask to be squeezed and squished “goush me” very hard over and over again.
• Thomas sought small, tight places to hide…baskets, boxes, under blankets and tables.
• Weighted clothing: He able to focus in school when wearing weighted clothing or do his homework more effectively when I pushed down on his shoulders.
• Pressure: Thomas was able to focus in school when pressing his legs into a kick-band wrapped around his chair.
• Reduced sensory awareness in his mouth: He preferred strong food flavours and things that crunch. As a baby/toddler, Thomas ate parmesan or extra old cheese, green olives, spicy foods and soya sauce.
• Thomas was constantly in motion and loved crashing, banging, bumping, and jumping.
• He had significant difficulty with self-regulating, sitting still, and attending.

Thomas is now 17-years old and has outgrown many of his sensory differences; however, he continues to find sensory input overwhelming at times. To some degree we all have sensory issues or differences. My adult brother feels like gagging when just looking at a banana, my husband is startled and upset by loud noises, my 19-year-old daughter gags when she encounters a piece of fruit in her yogurt, my Mum can’t cope with the sound of wind in her ears and avoids going outside on windy days….and me? I get very overwhelmed in loud, bright, busy places. Did someone say Costco? Gah!!!

“Everyone has a unique sensory profile. The difference in children with SPD is that their specific sensitivities interfere with their daily functioning.” – SensoryMom.com

Sensory Issues and Feeding

Feeding is the most sensory experience of all….sitting right at the top of the sensory hierarchy. We use ALL of our senses to eat. We SEE the food (colour, shape, size), SMELL it, HEAR the sounds it makes in our mouth and when we poke it with a fork, FEEL the texture and temperature with our hands and mouth, and TASTE the various flavours. To add more layers, we use proprioception and vestibular senses to engage our body awareness, balance, and movements.

For kids (and adults) with sensory processing issues, feeding can be an overwhelming experience. Mealtimes are compounded by communication demands from parents like, “Why aren’t you eating your beans?” and “Did you pick up your toys?” Vestibular challenges like unsupportive seating and dangling feet can make mealtimes even more difficult for kids faced with sensory differences. This is even more challenging for children with additional special needs like cognitive and gross/fine motor delays. The mealtime presents layers and layers of challenges that incorporate of all of a child’s senses...and it happens at least 3 times per day!

With all of this sensory input, kids often feel so overstimulated at mealtimes that they limit what they will eat in order to feel under control. If a child only eats chicken nuggets, there won’t be any sensory surprises…. the chicken nuggets always look the same, feel the same, smell and taste the same…so the child feels safe and refuses other foods that might be overwhelming. Cooked carrots might be crunchy one day, but soggy the next. They could be cut into circles at one meal, but long sticks the next. Carrots might be sweet at one sitting, but a little bitter at another. Children with sensory issues often avoid foods that might change from meal-to-meal. They feel safer with foods that are predictable from a sensory perspective.

Children that have reduced oral sensitivity (mouth awareness) may gravitate toward crunchy and highly flavoured foods that offer a lot of information and sensory feedback in their mouth. They may pocket bland/mushy foods in their cheek, as they lose awareness of the food’s presence in their mouth. These same children may demonstrate mouth-stuffing by putting way too much food in their mouth. Packing their mouth full of food allows them to feel the food better and provides more information (feedback) inside their mouth. It also reduces the feeling of food floating around and getting lost in the mouth.

I encourage you to visit Your Kids Table or Sensory Mom’s Checklist (link in references) to assess for red flags of Sensory Processing Disorder. These websites offer a wide range of resources to help parents of children with sensory issues. Carol Stock Kranowitz has dedicated her career to working with children with SPD and authored the book “The Out-Of-Sync Child.” Her website also offers excellent resources to help navigate SPD (link in references).

If you feel that your child has sensory issues, I recommend finding an Occupational Therapist (OT) who is “SI Certified (Sensory Integration)” for proper diagnosis and treatment of sensory processing challenges. Research has shown that SPD has a strong comorbidity (two diagnoses in one person) with the following disorders: ADHD, Autism, Misophonia, Anxiety Disorder, OCD, Developmental Delay, and Learning Disabilities. Unfortunately, many children with SPD are either misdiagnosed or completely overlooked, so it’s important to work with an OT who is SI Certified to develop an appropriate treatment plan for your child. There is a great deal of crossover between OT and SLP roles when treating sensory-based feeding disorders. We often work jointly to develop collaborative feeding and sensory goals to help kids with their feeding and sensory development.

Hopefully this week’s blog offers some answers to the question, “Does your child have sensory issues?” and how these differences can impact kids and their feeding development. Next week, in Part 2 of this blog series, I will offer play-based, oral-motor, and feeding tips to help kids with sensory-based feeding issues. See you on the blog next week.

References:

Miller, L. (2006): Perspectives on Sensory Processing Disorder: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759332/

Sensory Mom: www.sensorymom.com

Sensory Mom Symptom Checklist: https://www.sensorymom.com/spd-symptom-checklist/

Your Kids Table Sensory Resources: https://yourkidstable.com/category/sensory-diet/

Star Institute: https://www.spdstar.org/basic/understanding-sensory-processing-disorder

Carol Stock Kranowitz – The Out-Of-Sync-Child: https://out-of-sync-child.com/