Our Sensory Preferences & Mealtimes

An interview with co-authors of the newly released book “Sense-

ational Mealtimes” Denise Stapleton, PhD, Accredited Practicing Dietitian & Gillian Griffiths, Occupational Therapist.**

Mealtime should be enjoyable, yet some children struggle, and their families struggle.  Mealtimes for some families are fraught with ongoing grimacing, gagging, distress, anxiety, worry, frustration and anger. Do these phrases sound familiar?  “He won’t try new foods”. “She won’t try new textures”. “He spits food out of his mouth”.  

Mealtime problems can be a common toddler trait. However, they might be more common in children with FPIES due to negative, even traumatic, past experiences with food. It makes us wonder: how do you know when it’s more than just a fussy phase and is it going to get worse if you don’t do something about it?

What causes mealtime difficulties?

There is a long list of things that can trigger eating to be tricky.  For example; premature or complicated birth, early hospitalization, medical or developmental conditions, pain, trauma, excessive stress, reflux, vomiting, ear, throat or chest infections, allergies, intolerance's, and constipation are some of the conditions that can contribute to complex mealtimes. FPIES can interrupt and delay the process of introducing solids to an infant and can complicate a toddler’s progress with textures. Post-natal depression, anxiety and stress can also make mealtimes tricky for some families.

What can we do about mealtime difficulties?

After attending to medical needs, one of the key areas to explore in order to create enjoyable mealtimes is your own and your child’s sensory preferences.  Our sensory preferences influence what we notice, tolerate, seek, avoid and are distracted or distressed by.  Understanding preferred sensory properties of food and mealtimes might be a key.

What are sensory preferences?

Sensory preferences are the sights, sounds, and types of touch, smells, tastes, temperatures, textures and types of movement we prefer in our day.  

Sensory preferences are unique to each individual as they are based on: sensory thresholds in the brain; genetics; the surrounding environment; feelings; interactions and experiences during each day and across a lifetime (ie memories). On top of this, pain, stress, trauma, fatigue, reflux, vomiting, infections, allergies, intolerance's and constipation may make a parent or a child more or less sensitive.  

Discovering sensory preferences takes time as we may have a different threshold for each sense and the amount of sensory information we avoid, tolerate or seek more of can change during the day.  At times, parents can also project their own sensory preferences onto to their children.

How do sensory preferences affect mealtime behavior?

During mealtimes we use EVERY sense to help us notice, interact, socialize; and to eat, to use utensils and to be seated (or not).  We continually use our senses to gather sensory information from our surroundings and our body in order to ensure our mealtimes are emotionally safe, successful and enjoyable.

Our sensory preferences directly influence our thoughts, feelings, memories, interactions with others and our behavior.  If our brain detects or remembers an experience that feels unsafe, worrisome or dangerous, our body might experience a Danger Center Response (fight, flight, freeze or fright).  These strong feelings might be associated with the sensory properties of certain foods, the surroundings or interactions and can have a very large impact on mealtime behavior.

Exercise: Can you remember eating a food that caused you to feel unwell or vomit?  Can you tolerate the smell, sight, taste or texture of that food now?  How does it make you feel?  What would you do if you were forced to eat even just a little bit? How would you behave?

What we and our children experience can affect our thoughts and how we feel, and these can affect our behavior. Similarly, our behavior affects how we feel and our feelings can make us more or less sensitive to certain stimuli. As we explore in the book, it is so helpful for parents to always tune in and wonder what might have caused a child’s behavior. Ask yourself, how were they feeling, how were you feeling, what might have affected those feelings? This wondering can help us identify and do something about the potential triggers to alleviate or prevent the undesirable behavior.

How can I help my child feel safe at snack and mealtimes?

You can support your child’s ability to stay calm by taking time to "SENSE-itively" tune in to his or her cues. When you tune in to your child’s sensory preferences, you can create a ‘just right’ experience that will feel emotionally safe for everyone and hopefully bring pleasure.  Ongoing pleasurable mealtimes can positively shape a child’s mealtime behavior and the types or range of food he will eat.  

The authors acknowledge typical strategies may not have been successful for many families with ongoing mealtime difficulties. The book reinforces:

1. That each child is incredibly unique,
2. Parents are the experts in relation to their child; and
3. With the new understandings that the book brings, parents are enabled to develop unique ‘just right’ strategies for their child, with the help of a supportive clinician if needed.

The authors are at the forefront of applying all the evidence in sensory processing across a lifetime. This enhances our understandings of mealtime difficulties. SENSE-ational Mealtimes is the first to enhance caregivers’ capacity for reflective functioning through the understandings about sensory preferences. The following article provides preliminary research results that strongly support the need for further research in this area. Families found the understandings in the book are a crucial missing piece of the jigsaw puzzle about mealtime difficulties: “Development and evaluation of SENSE-ational Mealtimes: a book for families with mealtime difficulties” (2013) by Denise Stapleton, Gillian Griffiths and Jill Sherriff. International Journal of Health Promotion and Education.

If your child is displaying sensory preferences and needs help, discuss this with your child’s Pediatrician, Dietitian or Therapists.   This article highlights one resource for navigating feeding issues related to sensory preferences. If you are looking to learn even more, here are some additional resources:

1. Living Sensationally (2008) by Winnie Dunn (occupational therapist) which explains what it means to have sensation everywhere given that people are sensory beings and the world is a sensory place
2. Just Take a Bite by Lori Ernsberger & Tania Stegen-Hanson
3. Feeding Challenges in Young Children: Strategies and Specialized Interventions for Success Paperback by Deborah Bruns Ph.D., Stacy Thompson Ph.D. 
4. Baby Sense (2007) by Megan Faure (occupational therapist) and Ann Richardson (nurse and midwife) helps parents understand their infant’s sensory experiences.

**Denise Stapleton is an Accredited Practicing Dietitian with many years experience in Pediatric nutrition and research. She passionately supports families with varying mealtime difficulties and therapeutic dietary needs as a private practitioner, senior community Dietitian, researcher, author and mentor. Gillian Griffiths an Occupational Therapist with extensive training in Sensory Processing and is co-director of Engaging Your Senses, providers of professional development. Denise and Gillian recently published the go-to parent guide book SENSE-ationalMealtimes and Facebook page.

The FPIES Foundation provides suggested links to other Web sites as a convenience to you. The Foundation encourages you to evaluate websites yourself and discuss the information you find with your health care provider(s).  Use of our Web site constitutes acknowledgment and understanding by the user that within our Website there may be links to other Web sites that are operated by parties or individuals that are not affiliated with The FPIES Foundation. Read more on our link policy.

FPIES: Avoiding and Addressing Oral Texture Aversion

Avoiding and Addressing Oral Texture Aversion

Written by: Annette Mestern, OTR/L

I am the mother to a two year old with Food Protein Induced Enterocolitis Syndrome (FPIES). I am also a Pediatric Occupational Therapist (OT). When my daughter was 10 months old her allergist recommended a period of time without any food and just Neocate formula to heal her system following several FPIES reactions. After just one month without food I noticed that my daughter was no longer mouthing her toys and was avoiding oral exploration with toys. Having had several hours of “feeding therapy” type education due to my career I knew that this likely would lead to texture and food intolerance when it was time for her to eat again. From working with several children with oral intolerance I knew I must spring into action and fast. Luckily due to my education I knew just what to do.

I realize that a parent without the education I have likely does not know what to do in this same situation and then has to deal with the heartache of finally being able to feed his/her child only to find that the child gags/spits out food, or will only tolerate purees and no textures. This is highly preventable. I would like to share some ways to prevent this or if it is happening address this issue. The following is a list of what I did for my daughter:

* I always supervised my daughter closely when she was using these materials *

1.     I provided her with continued opportunities to chew and mouth textured materials. Because she already started to become aversive to this I started by having her accept the materials on her lips and in the front of her mouth, then moved to the inside of her cheeks and tongue. This takes time and patience and acceptance of the materials in the mouth does not generally happen overnight.

The following materials can be ordered online and are great for this purpose; Chewy Tube, and Ark Grabber. Besides increasing oral tolerance for texture these materials when chewed strengthen the jaw and prepare it for later chewing of food. A nuk brush can be used – roll along the inside of each cheek and along the tongue. Helps to sing “row your boat” while you are doing it. A nuk brush can generally be found at Babies R Us or similar baby store in the toothbrush section. I recently purchased one in a set with an

Infa-Dent Brush, and first toothbrush. An Infa-Dent Brush fits over an adult’s finger and can be used to massage an infant’s gums.

2.     I provided her with vibration to the inside of her mouth. Vibration desensitizes the mouth if sensitive and also can increase awareness inside the mouth for those kiddos who stuff food. Vibration is great because it can serve either purpose.

The following materials work for this purpose; The Z-Vibe with Probe Tip. It is recommended that this tool be used with supervision of an occupational or speech therapist. It is a good idea to call your local Early Intervention to see if your child would qualify for help from a therapist. Oral Jigglers can be used for this purpose as well.

*I only used the items with long handles such as the Z-Vibe  and Nuk Brush with my daughter when she was strapped in her high chair. I knew she should not be crawling or walking around with those items as she could fall and they could be jammed into her throat. I kept them away and out of her reach when I was not using them with her.*

A great item that my daughter eventually enjoyed and could use daily on her own was the Infantino Vibrating Teether. I just bought this at my local store. I have bought these for my daughter and the children I work with at the grocery store, Baby Depot and Babies R Us. I find they are cheaper at the stores than online. I had to ultimately buy a second one for my daughter as the vibration does not last very long. However, this was a great tool as I could keep it out for my daughter all the time with her other toys so she could grab it whenever she was playing. There is a The First Years Massaging Action Teether that can be used as well.

3.     I had my daughter sit with myself or the family in her high chair for meals. This is usually when I gave her, her Z-Vibe so she could somehow orally participate in meals. I also had her eat frozen Neocate by spoon or fed her ice chips to work on her spoon skills and oral acceptance of a spoon. I will admit a lot of the time it was just so sad for her to sit there and not to eat, but I realized that she enjoyed being with her family at meals. It was good for her to see food, see people eating and experience the social interactions that come with meal times. As hard as this was for her family members, it worked to her great benefit when it was time for her to eat again.

4.     I provided my daughter with these materials daily. It may feel like a lot to do this daily, but if you are doing it at mealtimes when you would normally be feeding your infant/toddler, than it works.

When my daughter was 14 months old and allowed to eat again, she was happy to do so and she had no oral aversions. Every food we gave her she would at least try and was a happy eater. She also within a few weeks of eating began using her spoon independently.

My hope is that the information I provided will help you to help your child to become a happy eater and enjoy meal time. Our little ones, at least my little one, had so much negativity and suffering when it came to food, that I am thankful I had the education to help her so that she can now enjoy her food or the several that she can eat.

Listed are the techniques I used with my daughter, but should not replace any guidelines specific to your child provided by his/her pediatrician or therapist.

Annette Mestern is an OTR/L and the mom to a sweet two year old with FPIES

Copyright© 2011, The FPIES Foundation