In my time as a pediatric occupational therapist, I’ve come to learn that fun is everything. My success rate in getting therapeutic benefit out of an activity is directly correlated to how fun I make it. If I am a kid- will I sit still and complete 10 reps with an arm weight? No. Will I complete a challenge on the rock wall to climb to the top? Absolutely. It’s our job every day to make therapeutic activity the most fun thing on earth, and when it comes to feeding therapy, it’s no different.
Each of us has a very unique sensory system with different thresholds of what our body considers a “safe” amount of input. It’s biologically advantageous for us to go into protective mode in response to a toxic smell (we leave the area), a loud noise in the house late at night (our heart beats fast ready for “fight or flight”), or a taste of spoiled milk (we gag and spit it out instantly). However, input not normally offensive for the average person can be very insulting to someone with a low sensory threshold. This is where our picky eaters come in.
Feeding is one of the only activities in which we use all of our senses at once. If I’m a child with an oversensitive sensory system, food has the potential to look, sound, smell, feel, or taste offensive. Imagine- if the touch of different textures, or the smell, or even the sight of it enters my overresponsive sensory system- my body might respond to a chicken nugget like yours would spoiled milk; Gagging, spitting out, refusing to interact with it. Even if I was willing to put it in my mouth, coordinating all of my motor actions to sit up, feed myself, and manipulate the food is a lot to handle. Not to mention if I had reflux after every meal, I would be even less excited about dinner time. The behavioral responses you may see are responses such as refusal, crying, or running away. But if you were a child and you had a medical issue, sensory issue, or difficulty with motor coordination every time you were presented with foods, wouldn’t you have high anxiety surrounding food and resist it too?
So how do we help our picky eaters? Eating is not an instinctive behavior beyond the very early weeks of our lives. Learning to eat takes many, many steps. We have to teach our children to eat. But before we do that, we have to make food fun. We have to PLAY. Herein lies the most important part of feeding therapy, the best piece of advice I have to offer; if you want to teach your picky eater to eat, we must decrease the anxiety around food and mealtimes first.
I put the chicken nugget on my head. Uh oh, it’s about to fall, here it goes! Ahhhhhh! Crashhh! Instantly, according to this two year old I am the most fun person in the world with the source of the joke being the food they won’t eat. But they’ll play with it. They’ll put the chicken nugget on my head, touching it, feeling it, getting crumbs on their fingers, smelling it, waiting for it to fall. They’ll squish it to see what it’s going to do in their mouth; they’ll learn all about it. But more importantly, they will laugh, play, and enjoy themselves. And suddenly, this food isn’t so scary. Feeding therapy is a slow progression but it absolutely has to revolve around play. We need to explore, play, get messy, and learn about our food before we can ever eat it. Only when we are comfortable and our body has gotten desensitized to the novelty or to the threatening texture will we ever gain any ground in starting to expand our diet.
So, that is why as an OT, I have had a chicken nugget: in a ball tower; in the bed of a toy truck; in a toy dinosaur’s mouth; on a fire truck’s ladder; in a dog’s food bowl; in a racecar; on top of a block tower; and- on my head. And I wouldn’t have it any other way.
Jayson DeLeaumount, DPT