Many readers will know that I have faced an ongoing struggle with getting one of my twins – Ruby, to eat well.She has sensory processing disorder (SPD)and this unfortunately places her in another category entirely from the usual picky and fussy eating toddler stage! I now know I am not alone though as I have had many emails from concerned parents and early childhood professionals also experiencing similar challenges with their children.
It can be very easy for people to say that a child will eat if they are hungryand not to pander to a fussy eater but in my experience that is not at all helpful and frankly disrespectful to both adult and child.
We need to remember that children are individuals just like adults – they have different needs and feelings about what is comfortable for their own body. The next time someone gives this piece of ‘helpful' advice I urge you to follow your own instincts and dig a little deeper for the sake of the child involved!
Although I am by no means a professional in this area or an expert I thought it might help to share some of what has been working for us so far on this journey with food. If you'd like to read more about our journey with SPD and developmental delays you might like to read THIS POST.
Sensory Processing & Oral Aversion
Ruby was hesitant to start solids… unlike her twin who couldn't get enough and demanded more after a taste at 4 months! When she began eating purees she really loved them though…and then I began to introduce lumps and textures. Ruby began to gag and vomit frequently at meal times…she could fill her whole highchair tray with what seemed like 24 hrs worth of food and milk in an instant.I felt so helpless just watching her. I could see she was becoming too scared of food to eat it.
Many people told me she just needed to get used to her gag reflex but the Mummy and early childhood educator instinct in me knew there was something more to it. She seemed scared to touch food and when she did she often lifted it to her chin or cheeks to feel and smell before touching it to her lips.I had an awful time trying to get her to pick up finger food and she seemed to be getting fixated on certain foods she would eat…..one of which was a jar of pureed baby food I had once offered on a day outing. I soon realised she was only eating the food she hadn't gagged and vomited back up in the last few months. Her diet became very limited and it was very frustrating trying to find something different that she might eat other than rice crackers, cruskits and pureed food .
As a Mum and educator I was becoming more and more concerned…and frustrated. Her twin was now eating lumpy foods and even trying some cubed meat and other finger foods. Little did I know it then but our journey with food and SPD sensitivities had begun!
Slowly I began to realise that this wasn't just fussy eating….she often seemed to experience real terror when offered some foods. There was a lot of staring at foods on the plate but not much touching or eating. Around this time we were finally referred to an occupational therapist and a dietitian. The dietitian wanted Ruby to begin taking a supplement formula everyday but I had to inform her that she would not drink anything she wasn't used to…she would know instantly it was different and probably gag and vomit. She did…so we moved onto a supposedly odour and taste free version…it was rejected too. It was at this moment that I began to realise I needed to do some research of my own and work with Ruby here at home in the hope that maybe one day she would be able to enjoy a meal as much as her sister…..and I wouldn't have to create something different for her every day with the hope it would be tasted (let alone eaten!).
The occupational therapist we have been seeing every few months has been lovely but as we see her through the public system the help and support she can offer is limited. I decided to be proactive and support Ruby as much as I could even though it has often felt as though we aren't making any progress!
It wasn't until our last visit with the OT when she reminded me of where we had started and what Ruby is eating now that I began to see that we really have made some fantastic progress (see end of this post for a progress update at 6 years old!).I am so proud of how far she has come and how brave she is in facing her sensory fears.
These are some of the things that have so far worked for us….some I researched, some I worked on with the OT, some I just tried of my own accord….I really hope if you are also travelling this roadwith your child as a parent or as an educator working with children and families thatthese tipscan be of some help.
Eating Strategies for children with Sensory Processing Challenges
1. USE A ROUTINE TO ADVANTAGEWe worked on developing a washing hands and face routine before mealtimes….we use a facewasher with quite a firm touch..especially around the mouth and face…this prepares Ruby for the stimulus of the meal ahead. It is now her favourite part of mealtime. It is also a signal to her that mealtime is about to start so she has a little time to prepare her thoughts and feelings.2. BE AWARE OF BALANCE, POSTURE AND SUPPORT
We looked at Ruby's posture when eating. She wasn't yet able to touch the footstep part of the highchair so we tied a rolled towel around the bottom that she was able to rest her feet on. This had a marked improvement on the amount of time she would spend sitting in the chair without wriggling and growing distracted. I really think this tip helped her enormously and she felt more secure and ‘balanced'. We also used a few old phonebooks on the floor under the girls child sized table and chairs so she could rest her feet on them and maintain good posture and balance.I have since used this technique with children in my family day care service as well and noticed that all children ate better when their feet were well grounded – even the babies and younger toddlers in highchairs – make sure you find ways to help their feet connect with a hard surface. It really helps with the wriggling and fussing while eating – try it!
3. START WITH WHAT THEY DO EAT….AND BUILD FROM THERE
We began starting the girls meals with a hard ‘munchable' as Ruby seemed most comfortable with crunchy, hard food items. It also ‘warmed up' her mouth for chewing. She took a particular liking to little round rice crackers and rusks….and still enjoys these at 2 yrs. Instead of trying to fight this I learnt that she needs these ‘safe' foods on her plate and I used them to begin adding some scrapes of different spreads and textures…sometimes it works…sometimes not!
Ruby likes round, crunchy crackers…I'm not sure why but I have used this to advantage over the past year by introducing other crunchy, round shaped foods! I have been mashing and grating up vegies and adding rice (which she won't eat on its own), grated cheese (which she won't touch if by itself) and more recently some beef and chicken mince as well as lentils.
It seems if they are rolled into little patties, coated in panko crumbs and fried with a dash of salt…she loves them. I have been so excited to finally see her eating some meat, cheese and vegies. The texture has obviously been key for her but I do try to make each type of patty slightly different in shape so she knows she is actually trying something different and doesn't get stuck on wanting that same food each night.
To see some of the recipes that have been working for us recently you might like tovisit these otherposts….
4. USE FORKS AS A TOOL TOWARDS TOUCH
We introduced forks and began loading them with different foods that previously she would not touch. We started with foods she liked so she could enjoy the new experience of the fork and then we began introducing foods that weren't as favoured. To my absolute surprise this one began to work really well! She wasn't eating the food but she would at least pick it up using the fork and touch it to her mouth…a small victory.
I decided to add a few little bento type forks to introduce a novelty factor and these worked wonderfully!I broughtthese onesfrom Ebay but I have seen similar types all over the net! They are an inexpensive tool and I highly recommend them for those children that won't pick up certain foods.
I have also usedcraft/ice-cream sticks as a tool for trying new foods. These frozen banana sticks were a hit and yet she would normally not eat banana as the texture is to slimy.
5. USE THE ‘DIP DIP' TECHNIQUE
We encourage Ruby to mix some of the textures she does enjoy with some she is unsure of. For example we modelled dipping her favourite rice crackers into a slightly lumpy puree. This has been quite successful for getting her to try some new foods that she won't take a spoonful of. We use this technique so often that she regularly uses the phrase ‘dip, dip' before trying something with lots of encouragement. I was over the moon when this first worked with a runny boiled egg and some toast fingers…she loves them now…as long as she can ‘dip, dip' with her toast and not touch the actual egg. So basically we use her favourite crunchy foods to dip into less favoured or new foods…I really have been surprised at how successful this has been!
6. EAT TOGETHER AS A FAMILY AND MODEL EATING
I try to eat with the girls as often as possible as she really does like to watch and then try similar things on her plate. This isn't always feasible as the girl's have dinner at 5.30pm and the family isn't always ready for dinner then but we make a special effort on weekends to all come together and make mealtimes a family event. They also eat with their big sister most nights and Ruby will often try foods that Miss Teen eats for afternoon tea after school. Amazing what a little modelling can do!
7. TRY TO OFFER LOTS OF MESSY FUN AND PLAY
I think it has been really crucial to do as much messy, sensory play with Ruby as possible so I have made sure to include a little each day…it doesn't have to be a huge activity with lots of preparation…just something she can experience different textures, colours and smells…as well as having lots of fun along the way.
The messy play allows her to get more comfortable with mess on her hands and to become more comfortable with the different textures of slimy, soft, rough, bumpy and hard …all the textures of food! You can find some of my favourite messy play activities in this post….
8. USE FOOD AS PLAY
As well as messy activities I have provided activities using food as play…the aim is for Ruby to see food as ‘fun' not scary, and experience different textures and tastes while playing. We have done some painting with pureed apple, yoghurt, mashed banana and jelly. Sometimes I also add their favourite little farm animals and people and we ‘feed' the animals whatever it is we are playing with…and if someis eaten by Ruby too…thenall the better!!!
I know many early childhood educators are not comfortable with the idea of using food in play but sometimes you have to challenge your own perspective and go with what is best for the child at the time and for Ruby and many other sensory sensitive children I have worked with in my capacity as educator it has been a lifesaver – a real stepping stone to actually being able to pick up a food and eat it because they are already comfortable and familiar. The sensory fear has been removed because they have already had fun playing with it.
Here are some other ideas for you to try……
This was the first time Ruby touched and even tasted a little spaghetti…it took another month before she would eat it at mealtime but I believe playing with it first gave her the strength to actually eat it from a plate! As you can see there was lots of resting her face against it and just sniffing before any tasting!
A few basic ingredients mixed with water provided lots of textured messy play fun around the face area!
Such an easy activity with no fancy props…just lots of deep wonderful rice to explore with the senses!
The props allowed Ruby to feel comfortable exploring the flour…she didn't need to touch it straight away with her fingers but her curiosity was piqued!She used many different ‘handles' before she began to use her fingers to explore the flour.
Dry Pasta Play
This is one of our favourite activities….dry pasta, bowls and spoons in their little play kitchen. Ruby quite often takes a bite and has now begun tonibble atthe samepasta shapes cooked!
9. GRADUALLY INCREASE SIZE OF FOOD
Ruby used to be very wary of chunks in food so I continued to puree fruit to mix through her yoghurt and custard. We are slowly making progress in this area now by first coarsely grating some apple to stir through and then finely chopping. She is now eating chunks the size of a pea without spitting them back out! You can try this with any number of foods really….it's all a step in the right direction! You just have to remember to do things like this very gradually…even though it is so frustrating. If we try to hurry the process she might gag or vomit and then we are back to square one so quickly and she has formed a distrust for that food again!
10. USE DISTRACTION
I learnt very early on that Ruby eats better and sits in her chair for longer if she is distracted. I know this goes against many parenting principles but we eat with the TV on…usually one of Ruby's favourite shows or DVDs. It helps enormously to keep her eating. Sometimes a small favourite book or squeezable toy also helps. Whatever works for your child but distraction helps us immensely!
It also helps to keep most meals to the highchair but pulled up to the family table to enable inclusion…it is so hard to keep her still and eating if she just sits on a chair…we are working little by little to overcome this but not sure how successful we have been!
11. MAKE THE SAME FOOD A LITTLE DIFFERENT
Some months Ruby would only want to eat crackers and jar puree but the OT warned against offering them in the same way all the time or eventually she would become bored or tired of those foods and they would also be rejected. We had to find new ways of presenting the limited foods she liked so that her plate always looked different…yet safe and familiar to her in some way.
Sometimes we changed the colour of the food, sometimes I changed the taste by adding seasoning…salt is something that seems to make food more palatable for Ruby (only tiny amounts of course). I have also played around with the texture of the purees by adding things such as oats and lentils to thicken them slightly.
The idea is not to make the food look or taste so different that it becomes unfamiliar and therefore rejected….just make it a little bit different from last time.
I often use cookie cutters or sandwich cutters to make bread look more interesting as sandwiches are still something Ruby finds hard to eat.She will now chew the bread at least but usually spit it all back out. But i count her at least tasting and chewing bread instead of the usual toast as a win!
Theselittle cuttersalso put a little imprint of the shape/animal onto the bread which add to the novelty value and make something she likes to try seem different!
Again…I brought these from Ebay quite inexpensively! They were worth every cent too!!
12. UTILISE A MOULI, BLENDER AND FREEZER
Although Ruby still won't pick up cubes or slices of meat she will eat it pureed or moulied…sometimes! The little meat and vegie cakes have been my biggest success with meat so far but I also find thatblending some of a stew or meat dish and mixing it with some blended a little coarser can give some good results….if she gets that spoon to her mouth! She can chew and swallow lumps well now but it seems to be the actual texture of the lump that makes her spit it out….so as always we start gradually and slowly mix half and half until there is more lumpy than blended.
I use my freezer as a tool for lessening my stress levels at meal times. By freezing batches of patties and other homemade foods that I have had some success with I can just pull a few out each night and add them to a ‘new food' on the plate. This way I at least know she will eat something…and perhaps try the new food too. It gives me a little breathing space from that feeling of ‘i just cooked all afternoon and she didn't even eat it trauma!'
By freezing foods I make in batches I can also keep trying them regularly even if they weren't touched the first time around!
The reason I like using a Mouli is because I have 3 different sized hole plates that I can insert. We have now moved onto the largest hole plate and are having some success but it has been a slow process….nearly a year to get here! Hopefully just roughly fork mashed meat is next before finally getting to meat as a finger food!
13. TRY NEW PRESENTATIONS OF FOOD
I decided to get a little bit more creative with the presentation of food on the plate and in the girls little lunchboxes. Although I have seen some wonderful Bento type lunches across the web (and been very inspired) I just don't have the time when feeding twins to go to that amount of effort!
When I saw a post on snack boxes for kids from the wonderful Learn with Play at Home I knew I wanted to give something similar a try!
My idea was to give Ruby a few different choices at each mealtime rather than overwhelm her with big serves of something she probably wasn't going to touch. I wanted to have some small sections on her plate or in a lunchbox that might entice her to try a little something different. I always include a few of the foods I know she will eat but I also include something new and something she has touched before but not actually chewed and swallowed!
Instead of the lunchbox compartments like Deb uses in her post I decided to collect some inexpensive silicone patty cake liners as well as a few novelty ones from ebay. Here are a few examples of recent lunchboxes….
14. LET GO OF HIGH EXPECTATIONS
I was one of those Mum's that loved making baby purees and all sorts of homemade food bursting with goodness…the trouble was that it often wasn't eaten by Ruby once we moved past the puree stage!
After talking with the OT and dietitian I learnt that it was ok to let go a little and just focus on what Ruby liked and would eat rather than the fact that she wouldn't eat my homemade chicken nuggets but would actually try a shop brought one straight away!
I learnt that a little salt makes things a lot more palatable for Ruby and this is ok. I learnt to let go of the feeling that I was a bad mother because she wouldn't eat my homemade food! She is actually coming back to it now but it has been a journey of discovery and letting go of preconceived notions!
The most important thing at this stage is that she eats….she tries, she sniffs, she feels safe….then we move onto the foods I want her to eat.
15. PRAISE AND ENCOURAGE FOR ANY INTERACTION WITH FOOD
Always remember that interacting with, smelling and touching foods are important steps towards eating. It's so important that we always praise and encourage our sensory kids for interacting with food even if it doesn't make the mouth each time. I know it's hard to do at times…especially when you are despairing of them ever eating a ‘proper' meal which hasn't taken hours of agonising over on your part beforehand…but it's important to both child and parent to acknowledge, praise and move forward!
I am still trying new strategies with Ruby everyday but when I step back and look at the bigger picture now that she is 2 I can see the progress we have made. There are still big hurdles to overcome but I think the hard work is paying off…yesterday I watched her eat a handful of spaghetti with some bolognaise sauce mixed through…a lump left in here and there. I know that might not seem like much to many parents but to me it was a huge achievement and I wiped a few tears away as I watched her enjoying food that I had made and that everyone else was eating.
For more inspiration and articles on toddler food and SPD you might like to visit my Pinterest Boards..
Feeding/Eating/Oral Dificulties
I also find the blog Your Kid's Table a wonderful resource. Alisha is a pediatric occupational therapistwho specialises in feeding therapy and sensory processing and she has some wonderful articles and ideas for parents!
It can be a long and lonely road trying to get a child who has SPD issues to eat a balanced diet…or even a diet of any kind to be honest. They aren't just fussy and they won't just snap out of it….so we will just keep taking steps forward and hope we get to the top soon…see you there xx
If you are an early childhood educator reading this I encourage you to keep an open mind when it comes to children being labelled as just ‘fussy eaters'. Don't be afraid to dig a little deeper under the surface, take meaningful observations and open a line of communication with the parent or carer. Provide information and referral support if required and above all listen to and respect the child's voice and individual needs.
Progress Update
When I first wrote this article I was feeling very alone and like no one really understood what I was going through as a parent – the only advice I was receiving was from people talking about ‘fussy eaters' and ‘just leave her, she will eat if hungry' (no she didn't!). Since then I have received many, many emails and also comments below letting me know that this article has helped others going through very similar issues with their own children.
I'm always asked how Ruby has progressed and I understand that because when you are in the middle of this process it can be so very overwhelming and you want someone to tell you it's going to get better.
Well I want to let you know that in our case the hard work did pay off – we kept up with all the strategies above and continue to do lots of sensory play (including with food). Ruby (now 6 years old) eats better than her twin sister ironically and is mostly happy to try foods with new textures and smells. At times she is still cautious and there are things she will not touch but we are many, many steps away from those earlier years.
The changes have been huge but it didn't happen at once – we had to stay consistent and my patience was often tested I admit but we got there…and I know you will too. Every child is different so just keep travelling that path at your own pace and keep trying. Seek support from an occupational therapist who understands sensory processing (I had no luck with dietitians understanding her needs but that doesn't mean you won't!)
You will get through this – hang in there!
