Eating as social, sensory and developmental activity

I get lots of emails from families to help them with issues that arise with their children. This recently came in:

“…..  I am wondering if I should be concerned or not about my daughter’s  eating. She is 17 months old and still prefers pureed foods.  She picks up and eats plenty of foods on her own, but they are mostly cracker-type foods. Never meats, vegetables, or fruits (with the exception of apple slices). I am sure that I am mostly to blame, but just curious if this is an issue at this age, if he needs help, or if there is simply something that I need to do differently at home. She is growing very well and is usually in the 50th-75th percentile at least…”

Alarm bells went off—the answer a resounding YES!! Be concerned!  And address it now before the child becomes so resistive to foods that you are looking at a future eating disorder.  It is important to note that “eating disorders”  do not all fall within the anorexia/bulimia category.  Eating disorders can include obesity, food aversions, and more.

I advise parents to ease out of the “preferred foods”. Mix the baby puree with the lumpier toddler foods and slowly make the transition to the more “chewable, age-appropriate foods.  I also advise that it is easier to do this now when the parent is 100% in charge of what the child is served than later on when these behaviors and preferences are habituated.

The fact that the child will eat crackers says to me that the child is not rejecting textures, and so there might be a swallowing issue to investigate.  If the youngster is eating the cracker until it becomes very mushy then that is a significant suggestion of  possible swallowing concerns.  Occupational and some speech therapists specialize in this and a proper referral should be made so that this can be ruled out (or in).

One cannot ignore that eating is sensory. It smells (think holiday cooking odors and how that makes you hungry), it feels (think ice cream in your mouth, it tastes (salty, sugary, sweet, etc.), it has temperature (hot/cold) and it is visual (that is why cookbooks have pictures!).

If it is a sensory issue then there are protocols that the OT can create so that the sensitiveness to specific foods can diminish and eating become less of a struggle and more typical.

Keep in mind that the right foods choices are no longer in the aged-old pyramid; it is now a pie chart of balanced options.   

Fruits and vegetables should make up 50% of your daily diet; dairy products and calcium rich foods should be 34%, proteins from meats and beans, etc. 8% and whole grains 8%.  It used to be that carbohydrates were king but they have definitely been “dethroned”.

An article in the New York Times by William Neuman (May 27, 2011), stated that the switch from the pyramid to the plate will be beneficial in many ways and not missed by either professionals or consumers.  The article in part states that “….Few nutritionists will mourn the passing of the pyramid, which, while instantly recognized by millions of American school kids, parents and consumers, was derided by nutritionists as too confusing and deeply flawed because it did not distinguish clearly between healthy foods like whole grains and fish and less healthy choices like white bread and bacon. A version of the pyramid currently appearing on cereal boxes, frozen dinners and other foods has been so streamlined and stripped of information that many people have no idea what it represents…”  The article says that by looking at a plate the consumer can relate to how it should be filled with healthy foods.

Parents and professionals can easily access various versions of this food plate chart on the Internet.

So if the issue is merely “attitude” encourage parents to be strong and to tough out the toddler tempers and better foods are added.  If however the issue is sensory and/or physiological then create a protocol that encompasses the issues and provides easy access solutions.

A sample chart can look like this: Age range toddler

Problem	Manifested by	Physiological concerns	Social emotional concerns	Interventions
Scenario #1
Refuses to eat table foods beyond the appropriate age for eating more typical foods	Pushes it away Cries Temper tantrums	Had swallow reflexes checked Had oral sensitivities evaluated—no issues noted	Difficult to go out to restaurants as a family—child has meltdowns when family goes out	Slowly introduce textures at home Keep plates small for “one-bite” samples Let the child “cook” with you Make foods fun: i.e. heart shaped chicken pieces using a cookie cutter, etc.
Scenario #2
Cannot tolerate any crunchy foods in mouth Does not like to brush teeth	Severe rejection of both food and non food items in mouth and at times does not like hair combed either	Swallow reflexes appear to be within normal limits Generalizes sensory hyper-reactions t touch and habituates wearing same type or same clothing Stereotypical behaviors especially noted at meal times	Child refuses to eat with non-family members has a difficult time with snacks at friends homes and/or at pre-school	Get oral toys such as cars that go by blowing up a balloon, vibratory toys that can be put in mouth Blow paints Smoothies with raspberries –it has mini seeds and therefore ads texture while being sweet. Special Gum massagers maybe ones the child can “decorate” and make special just for them

Occupational Therapist are by nature problem-solvers and when picky eaters are presented to you remember that it is the whole family that is having this problem, not just the child.

Susan N. Schriber Orloff, OTR/L  FAOTA is the author of the book. “Learning RE-Enabled” a guide for parents, teachers and therapists,(a National Education Association featured book) as well as the WIN™ Write Incredibly Now™ Program (available through YourTherapy’Source.com).  She is also the CEO/Exec. Director of Children’s Special Services, LLC an occupational therapy service for children with developmental and learning delays in Atlanta, GA.  She can be reached through her website at www.childrens-services.com or at susanorloff@childrens-services.com.