Helpful Tips for Children with Food Sensory Challenges

Children from hard places can have struggles with eating and their food selection, either due to sensory issues or food deprivation. As foster and adoptive parents, we want to be sensitive to these and help provide a road to healing. Thanks to a community resource, the following is a program that is adapted from the book “Just Take a Bite” by Lori Ernsperger and Tania Stegen-Hanson to provide a safe space for healing.

Feeding Home Program (Adapted from “Just Take a Bite” by Lori Ernsperger and Tania Stegen-Hanson)

General goals:

-     Create a safe, positive, nurturing mealtime environment
-     Increase child’s participation in preparing, eating, and cleaning up at mealtimes
-     Provide exposure to new food using multi-sensory approach
-     Respect the child’s response to eating
-     Expand the types of food the child eats and create a balanced diet

Environment and Mealtime Expectations:

1. Set a Schedule

  • Create a consistent mealtime/snack schedule. Write it down and post it in the home. Use pictures, if that is more appropriate for your child.

  • Use timers to indicate when the next meal/snack will begin as well as a timer during meal time/snacks (approximately 20-30 minutes for meals, approximately 5-10 minutes for snacks). This will help establish a routine and set clear expectations

  • Provide at least one preferred food item at every meal and snack.

  • Provide only water between mealtimes and snacks. If the child seems to be consistently hungry at certain times of the day, alter the feeding schedule to build in more snack times.

    2. Create an Appropriate Setting

  • Select a specific place in the home where all eating/drinking will take place. Again, this helps establish a predictable routine and set clear expectations.

  • Reduce environmental distractions (TV, iPad, etc) so that the focus can be on eating and socializing.

  • Eat as a family instead of having the child eat alone. This provides appropriate models for feeding and opportunities to talk about what and how others are eating their food. Describe the tastes, textures, smells as you are eating. Also describe where you are chewing certain foods or how long you need to chew before swallowing. Other topics should be discussed as well (upcoming events, things that happened during the day, etc.) to reduce the anxiety related to eating.

3. Establish Mealtime/Snack Procedures & Expectations

  • Providing a movement activity prior to mealtimes may promote self-regulation during feeding tasks. Examples include: animal walks, tug-o-war, scooter board activities, wall pushups, etc. Making a checklist of duties (i.e. wash hands, choose plate, carry one food item to the table, etc.) may also help the child transition to mealtimes.

  • Establish mealtime rules and post them near the designated feeding place. (Examples: keep food on your plate, remain in your seat, use utensils, tell an adult when you are “finished”)

  • One rule/expectation should be that the child remain at the dinner table/designated feeding area. It may take some time to get used to this new expectation, but later it will help provide the structure needed for resistant eaters. Trial alternate seating – “move-n-sit” cushion, exercise ball, etc. – to provide movement opportunities while staying in the designated area if that your child seeks out movement input.

  • Avoid coercion or punishment at mealtimes/snack times. Also avoid speaking negatively of the child’s eating habits. Never force food into the child’s mouth without permission. (Listing this as an expectation may help reduce anxiety related to feeding tasks.) Keep the conversation and interaction positive to create a stress-free and supportive eating environment.

  • Let the child participate in mealtime responsibilities – setting the table, serving food onto plates, passing food items around the table. This will help the child feel successful and build confidence in at least one aspect of feeding.

4. Food Selection

  • Use age-appropriate size plates and utensils. A plate that’s too large can be overwhelming. Incorporate the child’s likes/preferences (i.e. a favorite superhero or cartoon) into mealtime utensils or objects to make the experience more inviting and motivating.

  • Serve smaller portion sizes. Again, this reduces feelings of being overwhelmed and allows the child to feel a sense of accomplishment when he/she sees the food “disappear”. (See “Serving Sizes for Children” for reasonable portion sizes.)

  • Plan for one menu for the entire family that incorporates food from a variety of food groups. (Avoid buying/preparing separate meals for resistant eaters.) This menu should include foods that are familiar to your child as well as some new foods. Consider foods that are child-friendly and try to avoid foods that may be difficult due to texture, color, or smell.

  • Build choices into the mealtime experience. This gives the child a sense of control over the situation.

Food Exploration:

  • “Learning About New Foods” should occur at a separate scheduled time, not during mealtimes/snacks. Since this time is separate from eating activities with a different purpose, it should also occur in a location that is different from where the child engages in mealtimes/snacks.

  • The focus of this time is increasing exposure to new foods and creating a foundation to explore and accept new foods. So activities should be fun, engaging, and non-threatening.

  • Acquiring a taste for new food may take several months. It may take up to 10-15 exposures to a new food before moving to the next stage.

  • Stages:

    • Acceptance - Child tolerates looking at new food, talking about food characteristics, touching food with utensils, assisting in cooking activities

      • Tips: Make a food diary of all the food items your child eats leaving blank pages to add more as new foods are incorporated into his/her diet; discuss the food pyramid and which groups the child currently eats from/doesn’t eat from; have your child look through grocery store coupon papers and pick out interesting foods to add to the grocery list; print out a coloring sheet of the mouth and let your child color in different teeth while discussing the role teeth play in chewing and eating; read books or sing songs about food and nutrition; provide opportunities to engage with plastic food in pretend play.

    • Smell – Child tolerates new smells in the room and/or nearby

      • Tips: Introduce calming smells first (apple, vanilla, cinnamon), waft odor to child or let them bring nose to new food (do not forcefully place under child’s nose as that would elicit a fight-or-flight response), only introduce 1-3 new scents at a time

    • Touch – Child tolerates touching new foods with different body parts (fingertip, hand, elbow, cheek, lip)

      • Tips: Use small portions and day-old food as the food will not be eaten; allow touching the new food with another food (i.e. pretzel stick, carrot stick) until the child can transition to touching with fingers; do painting activities with food (i.e. sauces, pudding, yogurt, celery sticks or broccoli as the paint brush, etc.); sort foods by color or size; have child close eyes and try to guess what food it is just by touch

    • Taste – Child tastes the food (*In all previous stages there has been no pressure to taste or eat the new food item. In this stage, the expectation changes and the child is required to taste the food at some level. See “Steps to Eating” Chart for reasonable expectations.)

      • Tips: Always provide a “spit bucket”… set the expectation/rule to try the food (i.e. lick, hold a small bite in mouth, chew 2 times, etc.) but then allow child to spit it out; select foods that are similar in taste, texture, or temperature to food items the child already eats; have water available to rinse the mouth after tasting a new food; turn it into a game (bobbin’ for food, making “bite art” by biting into new foods and comparing the bite marks, etc.); let the child make choices regarding what to taste or how to make changes to a preferred food

    • Eating – Child incorporates the new food into his/her regular diet

      • Reminders: This is a long process that will continue throughout childhood. The overall goals are for the child to enjoy a meal, eat from different food groups, and stay calm when presented with new foods. However, understand that your child will not like every food presented to him/her. Continue to respect your child’s response to food; remain positive and encouraging.

For further assistance implementing a feeding intervention program at home, consider pursuing services at a private clinic or home health agency.

References:

Ernsperger, Lori PhD. & Stegen-Hanson, Tania OTR/L. (2004). Just Take a Bite: Easy, Effective Answers to Food Aversions and Eating Challenges! Arlington, TX: Future Horizons Inc.

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