Hi! I’m Janice Goodfellow, a pediatric occupational therapist and mom of 4 grown-up kids, and also an avid swimmer, lover of the choral arts!. I love the field of OT, which combines a knowledge of the human body, the capacity to analyze the abilities necessary to carry out an activity, as well as using creativity and know-how to figure out how an individual can develop the abilities to carry out the activities which are significant to them, when this is a challenge.
I love working with children and their families and helping them to overcome obstacles related to their daily activities such as self care, play, and participating at school, in sports or cultural activities – whether these challenges be motor, sensory, cognitive or emotional. Each child is unique and fascinating! Having brought up 4 very different children and having experienced parenting a premature baby, going through 4 C-sections, parenting children with various issues such as attention deficit hyperactivity disorder, generalized anxiety disorder, sensory processing differences and sleep issues has given me invaluable experience which helps me understand each child and family better.
Through a series of short articles, I will present some of the most common scenarios which I encounter in my work, tell you how to know if your child needs help and also share what is the role of OT in helping any particular challenge your child may be having!
Adventures in Feeding!
We have all heard of picky eaters (we may have one in our home!) and the reactions of parents vary, from thinking the child is spoiled and is being manipulative, to worrying they are not getting enough nutrition, to cooking only their favourite foods or all of these at once! And of course, friends and relatives all have an opinion too, which can be stressful.
First of all, rest assured that it is normal that children have preferences – likes and dislikes. I’m sure we can all name things we don’t like to eat. Personally, I really don’t like mushrooms. Their taste is already not very appealing to me but then add that rubbery texture when being chewed and I shudder at the thought. However, for most of us our likes and dislikes don’t interfere with our meals or keep us from eating a balanced diet!
For children, it is normal that they like a more restricted range of foods than adults do. Children like predictability and is it common to present a new food 20 times before a child will try it. Their sense of taste is different from an adult’s sense of taste and many children perceive certain vegetables, like broccoli and spinach, as bitter which changes as they grow older. Around the age of 2 years toddlers show a diminished interest in food as their growth dramatically slows compared to the first two years of life. They are just not as hungry! They are also more interested in their environment than they were before, and some tiny tots consider every moment sitting at the table is time keeping them from exploring and playing! Add to that the fact that flus, colds and teething can reduce appetite, and it’s no wonder that our small ones don’t always eat with gusto! However, unless a child likes fewer than 30 types of foods, it is considered normal if they like fewer foods than adults. If your child is eating from a variety of food groups and is growing to the satisfaction of their pediatrician, then you can take a deep breath and relax!
One main reason why children are picky eaters is due to a sensitivity to the textures, taste, smell. Often this goes along with sensitivity in other spheres as well (more on this in a future blog). Is your child sensitive to tactile stimuli (the textures of his/her clothes, doesn’t like to have their hair brushed), auditory stimuli (more sensitive to noise than average), or visual stimuli (finds light is too bright) ? Is your child more irritable than others his age or harder to calm? Often these children also have oral hypersensitivity or a heightened sensitivity to taste and smell. During a meal, they will choose certain textures and avoid others, prefer certain tastes to others. Some children may be under reactive to sensory stimuli and not be as interested in their food, prefer very spicy or sweet food, or they may also stuff their mouths to increase sensory input.
What are signs of oral hypersensitivity?
- A child who is selective with respect to eating, refusing foods due to their texture, taste, temperature, or odor.
- A child who accepts new foods with difficulty.
- A child who won’t eat foods which are mixed together (casseroles or stews).
- A child who has a frequent gag reflex while eating.
- A child who refuses to have his/her teeth brushed, doesn’t want his/her mouth to be touched, or who doesn’t want to have his/her face washed.
What are signs of oral hyposensitivity?
- A child who prefers foods which are intense with respect to taste (very sweet, spicy or salty), temperature (very cold) or texture (prefers crunchy).
- A child who takes big bites or who stuffs their mouth.
- A child who eats a lot, eats quickly and who may not notice when they are full
- A child who mouths objects beyond the age of 18 months.
Another reason for difficulty in feeding in children, and usually apparent from a younger age, is a difficulty with oral-motor coordination, that is, coordination of swallowing, breathing and movements of the tongue and lips and jaws. These difficulties are often noticed earlier and are usually more severe, resulting in earlier intervention and earlier answers. However, sometimes difficulties are milder and may be associated with some difficulty in oral coordination related to speech. A child who has difficulty moving food around in their mouths due to poor mobility of the tongue, lips and cheeks may prefer easier to handle textures (liquids, purees, easier to chew foods and easier to swallow foods). Drinking from a cup and using a straw may be difficult for these children.
Signs of difficulty with oral-motor coordination when feeding :
- A child who has difficulty with nursing.
- A child who becomes more tired than average when feeding or who becomes too tired before finishing.
- A child who has more difficulty with transitions from nursing to bottle feeding to purees or to solids than other children.
- A child who pushes out food with their tongue.
- A child who has a hard time chewing.
- A child who drools excessively, or past the age of 3 years
- A child who chokes often or whose voice sounds different after eating.
There are also other reasons a child may struggle with meals, for example gastro-esophageal reflux, phobias related to eating, food allergies or an underlying medical condition.
How do we know when to seek help?
If you have concerns, you can start with your child’s pediatrician or your family doctor who can assess if your child is getting the nutrition he/she needs and can assess your need for information and reassurance, as well as a need for a referral to occupational therapy for a feeding assessment You can also seek the advice of an occupational therapist in the private sector without a referral. If you are concerned that your child is not eating enough quantity or variety of food to stay at a healthy weight, or if mealtimes are a time of distress for your child or of stress for the rest of the family, a consultation with a pediatric occupational therapist is a good idea. It is a good place to ask your questions regarding feeding,and to get advice and information. Your child can also be fully assessed for feeding difficulties and an individualized treatment plan will be put into place for your child, if needed.
What does assessment/ treatment look like?
During the assessment various factors are taken into account, such as the child’s environment, feeding history, oral-motor coordination, sensory profile, and behavioural issues.
Different approaches can be used to help with issues which are environmental (seating, where meals take place) and behavioural (structure, timing of meals, reinforcement).
For sensory issues, therapeutic approaches to increase or decrease oral sensitivity as well as taste or olfactory senses are available. For issues pertaining to oral-motor control, techniques to improve motor control can be of great help to improve or resolve feeding difficulties. A home program can be given to parents who are motivated and able to work on these techniques between OT sessions, which leads to quicker results!