Sometimes picky eaters are going through a phase, one day they hate hot dogs then the next that’s all they want. But, sometimes it can be a little more extreme, gagging, pocketing food, overstuffing their mouth, and actually throwing up. When this is the case it’s typically one of two things happening. The child may not have the oral motor skills required for the food being presented to them or its sensory. Let’s walk through the differences and how to address some of the issues!
The body is smart! If the oral motor skills required to safely eat food are not present sometimes the body’s natural reaction is to reject the food. For most eating is second nature/automatic but when broken down into skills it’s actually very involved. The jaw needs to move in a rotary motion (develops between 16-36 months of age) while the tongue moves laterally (develops 3-7 months of age) and up/down to move the food around and assist with breakdown. If developmental skills are delayed or missed feeding issues will most likely occur resulting in pocketing, gagging, coughing, or spitting food out as the body’s natural reaction to feeding not being safe.
Building oral motor skills:
Y chewies are a great way to encourage safe chewing to help build jaw strength and develop the ability to rotary chew. Make sure when chewing they use both sides of their mouth, typically they will favor one side.
When assisting with feeding in an older child or when feeding a baby change up where you present the food. Don’t always place the spoon in the center of the mouth. Presenting the food to the left and right side of the tongue you will challenge it to bring the food where it needs to be. This will encourage tongue lateralization.
The sensory spectrum is a little more complex but typically they will present in one of two ways.
Hyper-sensitive: This is too much oral awareness and can result in gagging, vomiting, turning of the head away from food, spitting food out, or even kicking and screaming to resist eating.
Hypo-sensitive: Little to no oral awareness. When there is not enough oral awareness you may see mouth stuffing (pocketing), leftover food in the mouth after eating- if the child can’t feel them in the mouth, they won’t know to retrieve and swallow them. Drooling is also common, if they can’t feel the saliva in their mouth they wont know to swallow.
If you would like more information on sensory please refer back to this blog post, 5 Sensory Activities for Sensory Impairment.
A gum massager is beneficial for both hyper and hypo sensitive stimulation. It awakens the senses in hypo-sensitive children and desensitizes hyper-sensitive tendencies. Results are typically seen after routine use in a sensory diet. Meaning it is done daily at the same time for the same amount of time.
food aversions involving sensory issues
Working with food aversions involving sensory issues requires a lot of patience. While you want to break any defensiveness towards food and textures you need to do it slowly. If a child is defensive towards eating certain textures they will most likely present that somewhere else as well, not wanting to touch certain things is a big red flag. This is a GREAT place to start!
Have them play with their food!
Do what we were always told not to do, squishing peas, removing objects from a rice sensory bin, finger painting with cool whip, macaroni necklaces, playing with cooked spaghetti noodles, these are all great activities for getting the hands acclimated to different textures and slowly introducing them to the body as a whole. Its a more holistic way of desensitizing the body and you will be less likely to have resistance.
Once they are more comfortable with their hands and the different textures you can work towards tasting and eventually eating. While painting in pudding or cool whip at some point curiosity will set in and they will bring their finger to their mouth. It’s done on their terms instead of being forced at them with a spoon. It’s going to take time and persistence but it can improve and it will get better!
humans naturally have preferences
It’s also important to remember that while some cases are indeed oral motor or sensory-related, it’s also crucial to remember humans naturally have preferences. For example, I worked with a kid who ate solely burnt bacon and burnt toast with apple jelly, and when I say burnt I mean to a crisp! As a therapist I looked at this two different ways, it was sensory (he preferred the crunch and did not like softer foods) but it could also be a preference, we all eat our toast a certain way and some people prefer crispy bacon over chewy and there no need to change that, so you try to meet in the middle.
Slowly burn the toast and bacon less until he is tolerating softer textures then introduce some different foods altogether that fall into the same texture category that he is tolerating yet offer some different nutritional values. You can improve tolerance and increase motor skills while also keeping the individual an individual. I prefer my coffee black, some have to have creamer, and some hate it all together…there’s no right way.
When treating picky eaters, treat the presenting issues while remembering the child is a person, there’s no absolute right way to prefer your food.
activity related items to use at home:
