Monthly Archives: September 2017

My Kid is a Picky Eater and I Need Help!

By: Laura Van Zandt, OTR/L

peblog2Around 2 years of age, children enter the age of autonomy where they become aware of their individuality and become increasingly independent. This is also the age where they become increasing comfortable testing limits. Around this age, kids are most likely to start becoming “picky eaters.” By the time children enter preschool, many have begun to move past this phase and start to expand their food preferences; however, some children don’t move out of the picky eating stage and continue to refuse foods. Foods once liked may become dropped and not added back into their diet. The big difference between typical picky eating and avoidant /restrictive food intake disorder (AFRID) is that typical picky eating fades away in conjunction with repeated food exposure and a positive mealtime environment.

Children with ARFID may also have other health issues or conditions such as attention deficit hyperactivity disorder, autism, sensory processing, food allergies, constipation, and/or anxiety. Some children who were born prematurely may have required breathing and feeding tubes during hospitalization which can increase oral sensitivity. A child who had a choking episode in the past, was forced to eat, or who had multiple respiratory infections at a time when she was learning to eat may have developed negative associations with eating. Some children may have a sensory system which is offended by the texture, smell, odor, or appearance of food. These sensitivities may alter how kids experience food and result in their refusing to eat many foods. Anxiety can stem from the food itself, especially if it’s unfamiliar or disliked, or it can result from other factors such as pressure to eat at mealtime or a negative memory of eating. Older kids may experience social anxiety around their peers.

Parents often have good intuition and know when something is not right with their child’s eating patterns. Some signs of AFRID include refusing food due to its smell, texture or flavor, or a generalized lack of interest in eating. Children may have poor eating or feeding abilities, such as preferring pureed foods or a refusal to self-feed. They may be underweight or demonstrate slowed growth due to inadequate or poor nutrition. They may also show signs of anxiety or fear of eating. If you feel like your child’s eating patterns is moving beyond typical picky eating, please schedule an appointment with a pediatric occupational or speech therapist that specializes in feeding.

What can be done:

  1. Schedule a comprehensive evaluation with an occupational or speech therapist can assist you in helping rule in/out other medical conditions which may also be influencing your child’s eating behaviors and patterns. A therapist may also be able to make recommendations to further evaluate nutrition or evaluation for gastrointestinal issues causing discomfort or pain influencing feeding. They will help develop a comprehensive treatment plan that addresses all different angles of feeding.
  2. Read occupational therapists Maureen Karwowski’s blog regarding playing with your food. Research suggests that when too much negative pressure is placed on the child for eating, the child’s appetite may also decrease and could spur an emotional response leaving the child to dread mealtimes. Vice versa, additional research also suggests that when children are allowed to mess with their food and are given permission to touch, handle, and even squash foods they are actually more likely eat them. Allowing your child to handle food without the expectation to eat the food allows them to gradually desensitize their body to the sights, smells, and feeling of a variety of food. Allowing your child to play with food helps to build new brain pathways that help to reshape prior negative experiences with food.
  3. peblog1Recruit your child’s help. If you do not already meal plan, start meal planning and involving your child as much as possible in the process. When at the grocery store, ask your child to pick out food on the grocery list (even if it is not food your child regularly eats). At home, encourage your child to help rinse fruits and vegetables, stir batter, use scissors to cut herbs, or set the table. During mealtimes, serve dishes family style where everyone passes the different food bowls.
  4. Be patient and start very small. Your child might need repeated exposure to try a new food. You may also need to start by presenting a single bite of a vegetable or a fruit versus presenting a lot of the food immediately off the bat. Sometimes, even reading books about different foods, might be the place to start with your child.
  5. feast for 10.pngThink of fun and creative ways to present the same food. For example, if you child is learning how to like pizza, you can try serving pizza on a tortilla shell or on an English muffin. The following are a few books on food that are good to read with children:
  • Eating the Alphabet: Fruits and Vegetables from A to Z by Lois Ehlert
  • Cloudy with a Chance of Meatballs by Judi Barrett
  • I Will Not Ever Eat a Tomato by Lauren Child
  • The Seven Silly Eaters by Mary Ann Hoberman
  • Growing Vegetable Soup by Lois Ehlert
  • Feast for 10 by Cathryn Falwell
  1. Enroll your child in a food group. Easter Seals has routinely been offering an occupational therapy and speech therapy group called “Fun with Food” that helps children learn how to explore foods using all their senses, including touch, smell, sight, and taste. Each session will utilize sensory “warm up” games prior to heading to the kitchen for our snacks. Parents are encouraged to continue with food exploration at home based on weekly recommendations following each session.

Learn more about our occupational therapy services at http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html. 

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My Child Needs Deep Pressure! What Do I Do?

By: Laura Bueche, MOT OTR/L

Sensory Processing

Our bodies are constantly receiving and processing sensory information around us. Our senses give us the information we need to function in the world. We receive information from stimuli both outside and inside our bodies. Our sensory systems include auditory (hearing), vision, olfactory (smell), vestibular (movement), tactile (touch), gustatory (taste), and proprioceptive (body awareness). Sensory processing is the neurological process that organizes and interprets all the sensations we receive so we can function effectively within the environment.

What is Deep Pressure?

CatherineDeep touch pressure is a combination of a tactile and proprioceptive input which is often provided by firm holding, firm stroking, cuddling, hugging, and squeezing.

The proprioceptive sense refers to the sensory input and feedback that tells us about movement and body position. Proprioceptive receptors are located within our muscles, joints, ligaments, tendons, and connective tissues. It is one of the “deep senses” and could be considered the “position sense” (as Carol Stock Kranowitz refers to it in her book entitled  The Out-of-Sync Child.

If a child is having difficulty processing proprioceptive input, they’re brain isn’t receiving proper messages regarding whether muscles are being stretched, whether joints are bending or straightening, and how much of each of these is happening, children may seek out more intense forms of proprioceptive or deep pressure input. Kids with tactile and/or proprioceptive sensory processing dysfunction may seek out deep pressure input to send a stronger message to their nervous system. Deep pressure may help them “dampen” averse tactile sensations or may give them a greater sense of where their body is in a space.

 

Indicators of Deep Pressure Seeking

  • Tensing/squeezing muscles of the body
  • Crashing into furniture
  • Enjoys climbing into small spaces
  • Head banging
  • Grinding teeth
  • Pushing on chin
  • Stomping feet
  • Mouthing non-food items
  • Toe walking
  • Leaning into people

brushingDeep Pressure Input Activities

Deep Pressure Input Benefits

Deep pressure touch has been found to have beneficial effects in a variety of clinical settings (Barnard and Brazelton 1990, Gunzenhauser 1990). In anecdotal reports, deep touch pressure has been described to produce a calming effect in children with psychiatric disorders. Deep pressure stimulation, such as rolling up in a gym mat, has been used to calm children with autistic disorder and ADHD (Ayres 1979, King 1989). Lorna King (personal communication, 1990) reports that children with sleeping problems appear to sleep better inside of a mummy sleeping bag, which adapts to fit the body snuggly. It also has been used to reduce tactile defensiveness in children who cannot tolerate being touched. McClure and Holtz-Yotz (1991) found that deep pressure applied by foam-padded splints on the arms reduced self-injurious behavior and self-stimulation in an autistic child. (Ayers, 1992)

Deep touch stimulation is beneficial to typically developing babies (Barnard and Brazelton 1990, Gunzenhauser 1990). Institutionalized babies who received supplemental tactile stimulation, mainly deep touch pressure, developed more typically (Provence and Lipton 1962). Premature babies who receive stroking and tightly bound swaddling also are reported to show definite benefits (Anderson 1986, Field et al. 1986, Lieb et al. 1980). (Ayers, 1992)

If you think you child is seeking deep pressure input or has a sensory processing disorder, schedule an occupational therapy evaluation before trying to implement a sensory program at home. For more information on our occupational therapy program visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html.