1. Sensory based feeding issues
Stacy Thompson, Ph.D.

2. What is a sensory based issue?
Some children cannot compensate for their environment.
Because of this limitation they interact/react differently within their environment
Four types of sensory processing described in sensory integration theory (Dunn, 1997, 2001, 2007)

3. Dunn’s Model of Sensory Processing (1997)
Threshold/
Reactivity
Responding/Self-
Passive
Regulation strategies
Active
High
Low Registration
Sensory Seeking
Low
Sensory Sensitivity
Sensory Avoiding

4. High Threshold Low Threshold Requires a great deal of input to respond
Notice sensory input easily and more in environment

5. Low Registration High neurological threshold
Passive behavioral response
Needs a great deal of stimulation in order to respond
Responds minimally to foods unless highly textured or flavored
Trouble reacting to low intensity or rapidly occurring stimuli

6. Strategies for Children with Low Registration
Provide opportunities to notice & respond to sensory cues
Finger paint with textured paint
Play with food
Rub lotion
Add strong smells to activities
Add scent or sand to play dough
Add vanilla/cinnamon to foods (pancakes, yougurt)

7. Sensitivity to Stimuli
Low neurological threshold
Passive behavioral response
Easily distractible by things around them like movements, sounds, smells
Notice food textures, temperatures, & spices more rapidly
High level of awareness

8. Strategies for Children with Sensitivity to Stimuli
To focus on feeding, requires a feeding environment that is:
quiet,
low light,
free of distractions for feeding environment
Give ample warning when change is coming or changes in schedule

9. Sensory Avoiding Low sensory threshold Active behavioral response
Expends a great deal of energy to avoid stimulation
Find ways to limit sensory input
Leave room if others are moving or talking
Create rituals for daily routines which may be strategy for predictable sensory patterns

10. Strategies for Children with Sensory Avoiding
Provide support to keep engaged in activities
provide picture schedule and/or transition object for mealtime,
Work on strategies when faced with new sensory challenges
Introduce new foods / drinks slowly, one at a time with time to accommodate

11. Sensory Seeking High neurological threshold Active behavioral response
Seeks out stimulation to meet neurological needs
Very active, continuously engaging
Excitable
Motivated to move, by a desire to touch, taste, smell, see and hear everything around them

12. Strategies for Children with Sensory Seeking
Physical activity before eating
Keep fidget toy nearby,
Add texture to preferred foods such as berries to yogurt/pancakes
Burn scented candles
Have music playing

13. Sensory-based feeding issues continued
Examples of food items to address sensory needs
Oatmeal with raisins
Pancakes with toppings
Saltines / Flavored crackers
Vegetables with dipping sauces
Bite size chunks of fruits

14. Sensory input to cheeks and jaw prior to meal or snack
Try varied positions
in chair, standing at counter, on a beanbag during meals or snacks
Sensory input to cheeks and jaw prior to meal or snack
Varying temperature of foods and liquids
Weighted utensils
Straw for drinking
Heavy lifting prior to having to sit for meals
(see Thompson, Bruns & Rains, 2009 for additional ideas)

15. Case study
Marcee is the two-year-old daughter of Tom and Tina. She enjoys playing with blocks and looking at books. Her favorite activities are playing outside and spending time with her mom while she cleans the house. Marcee attends a child care center, Kreative Kids, for approximately five hours a day while Tina is at her part-time job. Marcee is always excited to see her friends and teacher, Jenna.
Jenna and the other child care staff are concerned about the disruptions that Marcee was causing at snack and mealtimes. She approached Tina with concerns about Marcee’s eating habits right after her second birthday. Jenna reported that Marcee would not remain at the table with the other children at snack time and refused to eat anything at the child care center. Marcee would throw food items and push cups and utensils to the floor. The other children began to imitate her behaviors and mealtimes were becoming difficult for the children and the staff. Jenna recommended that Tom and Tina take Marcee for a feeding evaluation at the community hospital.

16. Tina and Tom report that Marcee is a picky eater and only eats brown foods, such as oatmeal, wheat crackers, chicken strips, bread, tater tots, French fries, and, sometimes, Cheerios®. If those foods are not available, Marcee refuses to eat. Marcee does drink milk from a cup but will not drink any type of juice. Tina first introduced a cup with a spout when Marcee was ten months old. She refused to use it. She preferred her older brother’s wide mouth cup but spilled at least half of the liquid each time she used it. This continues to occur with at least two to three spills every day.
According to Tina, the only way she can get Marcee to eat is to leave preferred foods on a child-sized table and let Marcee eat throughout the day. Both Tom and Tina follow Marcee around the house trying to get her to eat. She will not sit in her booster seat at the table. Marcee’s mother and father take turns sitting at the dinner table with Marcee’s siblings during mealtime. Marcee’s older brothers do not exhibit any feeding problems. Tina is concerned about Marcee’s nutrition and the toll her eating habits have taken on the family. Tina feels that Marcee’s eating has taken over her time and focus.

17. Selected Resources
Dunn, W. (1997). The impact of sensory processing abilities on the daily lives of young children and their families: A conceptual model. Infants and Young Children, 9(4),
Dunn, W. (2001). The sensations of everyday life: Empirical, theoretical, and pragmatic considerations. American Journal of Occupational Therapy, 55(6),
Kranowitz, C. S. (2006). The Out-of-Sync Child: Recognizing and Coping with Sensory Processing Disorder. New York: Perigee Trade.
Miller, L. J. (2006). Sensational Kids: Hope and Help for Children with Sensory Processing Disorder. Putnam Adult.