Going through OT with my son, Xander, has been an eye-opening experience. I understand him so much more now and what’s even more important I understand his needs. Now I’m able to help him much more effectively. One area he has struggled tremendously with has been eating.
Did you know that there are actually many tiny steps involved with learning the skill of eating? Contrary to what many of us think, eating isn’t an instinctive thing. Babies learn to suck, swallow, chew and move bits of food around in their mouths. Eating is also one of the most sensory involved activities we practice. And when a child has developmental and senesory issues that impede on their ability to learn these skills, eating can be a challenge.
For Xander, he never seemed to move past the mushy food stage. He stuffs food in his mouth to ‘feel’ it, he has difficulty chewing foods with any chewy, crunchy or lumpy textures that require more grinding like chewing (as when eating meat), he has a high gag reflex and he isn’t always able to tell when his mouth is empty.
In order to get kids, like Xander, learning to eat-and enjoy it-we need to work him through all the baby steps from tolerating, interacting with, smelling, touching, tasting and, finally, eating food. Here’s a breakdown of the steps:
• Being in the same room as the food is being prepared/cooked;
• Being at the opposite side of the table as the food;
• Being at the table with the food ½ across from her;
• Being at the table with the food right in front of her;
• Looking at the food in front of her.
INTERACTING WITH THE FOOD:
• Helping to prepare/cook the food;
• Using utencils/container to stir or pour food/drink;
• Using utencils to serve food.
• Tolerating the aroma of the food in the same room;
• Tolerating the aroma at the table;
• Tolerating the aroma of the food in front of him;
• Leaning down/picking up the food to smell it.
TOUCHING THE FOOD:
• Using fingertips;
• Using whole hand;
• Tolerating food on chest/shoulder
• Tolerating food on the top of the head;
• Tolerating food on chin/cheek;
• Tolerating food on/underneath nose;
• Tolerating food on lips;
• Tolerating food on teeth;
• Tolerating food on the tip of the tongue/full tongue.
• Child licks lips, uses tongue to lick food;
• Bites off piece and spits it out;
• Bites pieces, holding in the mouth for xx seconds then spit out;
• Bites, chews xx times then spits out;
• Chews then partially swallows;
• Chews then swallows independently.
OTs work with children through these steps using fun activities and games. For example, Misty, Xander’s OT, took a food Xander loved (apple sauce) and started with having him touch so he’ll learn to tolerate the tactile side of eating-a strategy that will teach Xander to tolerate different textures of food. At the beginning, he wanted nothing to do with food on his hand, face or other body parts. But Misty would put some on her own arm or face, calling it a ‘tattoo’ and after a few sessions, Xander was willing to try too. By the end of his first round of OT, Xander was beginning to tolerate different minced fruits in his apple sauce as well as mildly flavored cream cheese! It sounds like such a minor thing but these tiny steps are helping Xander be more tolerant to having new things on his plate and encouraging him to expand his food palate.
For children, like Xander, who have poor oral-motor skills, highly sensitive sensory defensiveness, poor proprioception or other issues eating can not only be a huge challenge but extremely frustrating. Until we knew the severity of Xander’s issues, there were many tears and meltdowns at the dinner table. Now that we understand all the steps involved with eating, as well as Xander’s specific eating issues and needs, we are working together to making the food experience more enjoyable for him.
Eating truly is a skill that many children struggle with. But with the help of a knowledgeable OT and/or nutritionist, caregivers can learn how to incorporate the above steps into meal times and get their child crunching, munching, chewing and loving food! The key is taking baby steps, having lots of patience and giving tons of praise for each and every attempt.