The Root of Picky Eater: Sensory-Based Pediatric Feeding Therapy Strategies For SLPs and OTs

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Before delving into the challenges many therapists and parents face when it comes to sensory based feeding approaches, we want to highlight that our team at Ambiki is made up of therapists who are passionate about the pediatric population and providing the best platform to assist you in helping your clients. While this blog post provides some insights into helpful sensory based feeding strategies, be sure to also check out the abundance of resources and our new electronic medical record system that can help tailor your practice to your specialty. 

 

The Root of Picky Eater 

There is a difference between picky eating and true problem feeding. Picky eaters tend to have between 10-20 foods that they will eat. While concerning, there is usually enough variety that if the child decides to eliminate 1-2 foods, there are plenty remaining that can provide nutritional value. The problem eater on the other hand, usually has less than 10 foods they will eat. Each item, even if the same, is counted as one (for example: a child may eat two types of cheerios yet these would count as two of their ten foods).  

True problem feeders will:  

    • Eliminate foods faster than they gain new ones due to redundancy yet do not eat new foods to replace them.  
    • Would (and will if untreated) starve rather than eat something they do not like.  
    • Need quick intervention to address these challenges.  

Begin with an Accurate Evaluation and Collection of History:  

Evaluate Medical and Feeding History:  

    • Rule out medical diagnoses such as chronic or acute ear infections, tonsilitis, GERD, strep throat, reflux etc before moving on to a feeding program. 
    • Recognize that eating is a series of cause-and-effect events and if a child has had a poor experience with food and is unsure which food(s) have caused this, they often tend to eliminate multiple foods at once.  

Collect Enivronmental History  

    • Understanding where a child eats and what their eating patterns are in daily life can provide insight into environmental challenges.
    • Asking questions to caregivers such as “where does your child eat? What are they sitting in? Are other family members sitting with them? Are they usually eating a few bites and getting up to move around?” can provide useful insight into the sensory environment the child experiences during mealtimes.  
    • The ideal framework for good eating is for a child to sit at the table in a proper highchair/booster seat while under the age of five, preferably with others.  

Gather Social and Behavioral History:  

    • Collection of social history regarding what foods have been available to this child or how caregivers have responded to mealtimes is crucial (has the child been neglected? Forced to eat? Is the parent feeling particularly anxious or nervous having exhausted all efforts?) 
    • Are caregivers ready to participate in a feeding program? 
    • What are the child’s behaviors around mealtime like?  

Determine Feeding Approaches:  

Breaking down what is happening within the child can be helpful in navigating the right plan for the client. Evaluating oral motor function and sensory challenges can allow you as the therapist to begin at the right place. Some popular approaches are as follows:  

SOS (Sequential Oral Sensory) Approach:  

    • This approach integrates oral motor, sensory, and medical models. The SOS approach highlights quality over quantity when it comes to feeding. Finding an occupational therapist or speech language pathologist who has specialized training in this area to learn from (or taking continuing education) can be incredibly useful if you are looking to build up this area of your practice.  

Oral Motor:  

    • While this overview is geared more towards the sensory approaches to feeding, it is crucial to watch for oral motor issues. These can appear as gagging, choking, unable to chew, poor lip closer etc. Any oral motor issues should be addressed first prior to navigating any secondary challenges such as behavioral or sensory problems, as sometimes addressing the oral motor challenges can reduce or eliminate other factors. 

Sensory: 

Address any sensory issues, particularly aversions, which can play a large factor and can often be addressed if detected. 

    • Tactile Aversions: de-sensitize by allowing a child to play a bit with their food, use a multisensory approach and provide a variety texture for the child to explore. 
    • Visual Aversions: provide ways for a child to engage with food without having to eat the food itself. Playing with plastic/toy food, looking at pictures of food or watching others eat are all great ways to do this. 
    • Smell Aversions: using scratch-off stickers or playing around with different smells can assist with de-sensitization of the olfactory sense. 

Good foundations for Developing a General Feeding Program:  

    • Programs should be child led/directed. 
    • Cultivating good caregiver reactions around feeding will guide the program and promote carryover. 
    • Food chaining can be a useful tool. Begin with a provided list of liked foods to determine what next foods may be best to offer next (for example, if a child is only eating white or orange foods, food chaining will help you determine what may be a next step to take to offer a new food).  
    • Have a parent provide 2-3 favored foods and 2-3 non favored foods. 
    • Make sessions enjoyable, playful, and age appropriate. 
    • Allowing a child to have a sense of agency during these sessions can be particularly helpful. For example, having a ‘no thank you’ bowl allows the child to place unwanted food in a specific place to revisit later. 
    • Avoid sensory challenges of food touching one another by presenting food on trays/plates that look like mazes, divided plates, muffin trays, etc that allow for small portions that do not touch.  

Utilizing Ambiki to assist these clients:  

    • Ambiki’s EMR system allows you as a therapist to categorize your overall caseload into subcategories, making it easy to manage a caseload of just feeding or sensory clients.  
    • Ambiki’s assessment feature allows you to input scores and easily track progress toward goals. 
    • Ambiki’s goal bank offers you access to a public and private goal bank, making the creation of goals for these clients quick and easy.  
      Image of Ambiki's Goal Builder
      Visit our goal bank and builder FAQ page to learn more about how to use these tools to create comprehensive goals around feeding (geared to sensory, oral motor, caregiver carryover, etc) 
    • Ambiki Teletherapy provides interactive features tailored to pediatric clients which allows you to work on many feeding or sensory challenges even remotely when there is good caregiver support. 

Still need more help?

As a small team made up of therapists and developers looking to provide the best tools for your therapy needs, we encourage you to reach out to us and provide any feedback on ways we can help you simplify the way you practice. Our mission is to support you in the purposeful yet demanding work you as a therapist to do to provide value in the lives of those you treat.