Food Therapy

While most children go through a “picky eating” stage, a few are problem feeders who could benefit from the help of occupational therapy

Many children go through the “fussy eater” stage, and it’s a completely normal part of childhood. It may be that they’ve looked at a food and assessed that it is simply not for them without so much as trying it, or they may be averse to a certain texture or smell. Each of us likely went through this very same thing, and came out of it exactly the same way we went in. For some children, however, limits on their diet can become problematic and worrisome for parents, as they may be concerned that they’re not getting all of the vitamins and nutrients they need to help them grow. Children who live with autism, for example, may only eat a very small number of foods due to issues with texture, or exclude entire categories of food. This is where occupational therapy finds its place at the proverbial table, and the intervention of an occupational therapist can help young people on limited diets to gently reduce them. What is important, however, is that the difference between a fussy eater and a child whose limited diet has become problematic. Per the SOS approach to feeding - the sequential oral sensory approach, a popular intervention employed by OTs that was developed by paediatric psychologist Dr Kay A. Toomey - the difference can be categorised as “picky eaters vs problem feeders”. While a picky eater will be experiencing a little road bump in their journey of developing their own tastes, problem eaters will likely require the intervention of a professional to assist and support them. As stated above, OTs primarily employ the sequential oral sensory (SOS) approach when a client presents the signs of eating difficulties. Per Magnificent Munchers, a food therapy service based in Hertfordshire, led by OT Jacqueline Parkinson, these signs can include: a diet that is limited to fewer than 20 different foods, the refusal to eat entire categories or textures of food, an excessive emotional reaction upon being presented with new foods, gagging or vomiting when around new food, excessive reaction to food on or around the face, and children who may present issues when in a situation that requires social eating. The SOS approach examines the underlying cause of feeding difficulties, usually as a multidisciplinary approach including paediatricians, OTs, dieticians, and speech therapists. It examines the “whole child,” assessing organ systems, muscles (including oral motor), sensory processing, learning behaviour and cognition, development, nutrition and environment. The approach aims to increase a child’s comfort level around food by offering them a safe environment to interact with and explore the food before eating even comes into play. The child will be given the space to tolerate being around the food, before going on to the smell, how it feels, and then finally, tasting it. This could mean looking at the food, followed by the child allowing it to touch their skin, then smelling it, and touching it with a part of their body. Finally, after that, the child may feel comfortable tasting it: that doesn’t mean eating it, it may simply touch their tongue, or the child might put the food in their mouth, chew and spit it out. Using this evidence-based approach, OTs as part of a multi-disciplinary team can help children who may have a limited diet expand and develop a healthy, safe understanding of the joys of food, all within a safe and reassuring space.