By Julie Stefanski MEd, RDN, CSSD, LDN CDE

When the dietitian reviewed the referral, it seemed pretty cut and dry.  A ten year old boy with a high BMI, elevated LDL cholesterol, and mild anxiety.  As the family dynamics were investigated at the nutrition appointment though, it was discovered that Adam can’t sit with the family at mealtimes.  The smell of other family members food causes him to gag, he hasn’t eaten a vegetable since 11 months of age, and he tends to gravitate towards only crunchy foods.

Whether you work in weight management or a cardiology clinic, you may occasionally encounter clients whose reaction to sensory input interferes with their ability to consume a wide variety of healthy foods.

Not only is April Autism Awareness Month, it’s also Occupational Therapy Month and addressing feeding issues falls in the overlapping realm of Occupational Therapists, Speech Language Pathologists and Dietitians.  To share some tips on identifying sensory issues which may impact picky eating behaviors in your clients I turned to my colleagues Gabby Spangler OTD, OTR/L and Leah Tingley MOT, OTR/L of Leg Up Farm in Mt. Wolf, PA along with Jaime Smetana MS, OTR/L and Katie Hein-Schultz, MS, CCC-SLP of WellSpan Health in York, PA.

We explore food with all of our senses, especially new foods. Fear of new foods or their sensory characteristics is sometimes referred to as food neophobia.  It’s not always the case, but in interviewing parents of children with autism many pinpoint the age of approximately 15 – 18 months as a time when food variety significantly dropped. Hein-Schultz explained, “There is a great deal of gross motor and fine motor development that occurs between 10-18 months of age. Children with autism can struggle in these areas from language to sensory regulation. As their brain develops and learns, sensory triggers can become more overwhelming.  Feeding is a skill that requires all five senses to work together simultaneously and can be quite challenging when one is unable to regulate the constantly changing system during tasks such as eating.”

For children with sensory issues, the advice to simply make them eat a non-preferred food or to offer it when they’re extremely hungry simply won’t work.  Food selectivity can lead to significant food jags in which less than 5 to 10 foods total are consumed. A child may avoid all choices from the fruit or vegetable group or consume only one item from an entire food group.  Caregivers whose children have severe negative reactions to the sensory characteristics of food sometimes give up hope of ever introducing new foods.   Some adults and teens on the autism spectrum have never had these sensory issues with food fully addressed and finally the issue rears its head when high cholesterol or excessive weight gain must be addressed.

Along with significant food selectivity, other signs of sensory integration issues can include problems with loud noises, bright lights, bathing and grooming tasks, particular preferences with clothing such as issues with tags or socks, and many other triggers.  For individuals not on the autism spectrum, oversensitivity to sensory input can still impact food choices.

Here are a few things to look for to identify possible sensory issues with food and the need for a referral to a feeding specialist-

Sight

How a food looks including the color, appearance of wetness, or lack of a perfect or expected appearance can be a cause for refusal or a complete meltdown.  Children may closely examine new foods and gag at even the sight of non-preferred foods.  Choosing only one brand of food is also very common.  Children can often identify certain brands by the sight, taste, or texture.

Smell

Identifying and overreacting to smells that sometimes seem very minor or gagging at the smell of non-preferred foods and other people’s food can be an issue.  Children may run out of the room when someone is cooking or eating.

Touch

Children may avoid touching new foods or wet foods with their bare hands.  In our feeding clinic you would commonly see children quickly wipe their hands on their shirt or pants after finally touching a non-preferred food.  And let’s face it-  If a child is unwilling to touch a food with their hands, they’re not going to put it in their mouth.

Hearing

Yes, even sound can play a role in food selectivity.  A food when chewed such as hard pretzels may cause a lot of internal noise.  While some children may crave that sensory input, other children will be totally turned off by the sound and the feeling of crunching down on a hard food item.

Taste

There can still be negative overreactions even when a person decides to put a new food in their mouth.  Spangler suggests examining whether there are certain characteristics that a child avoids completely, “Look for a pattern in all sensory aspects of preferred foods such as a preference for bland or strong/spicy, a certain color, shape or texture.  Consider the original texture but also as it is chewed (ex – apples may be crunchy to bite into but then creates a lot of juice as chewed).”

When a caregiver finally gets connected with a provider who understands the challenges of sensory issues, it can bring significant relief and hope to the family.  Smetana agreed, “Obtaining help provides families with a sense of someone who is aware of what they are going through, that their child is, in fact, picky and not just a behavior problem.  Families can obtain a support system, someone who is listening and providing assistance as a starting point to increase the child’s desire to sit at the table, begin to engage with new foods, and eventually begin to consume new foods.”

To find a feeding specialist in your area who may be able to help with sensory issues, check out: https://www.feedingmatters.org/providers

Julie Stefanski is the Food, Nutrition, & Dietetics Editor for Nutrition Dimension, a division of OnCourse Learning and a blogging coordinator for the #EatrightPA blog.  As a specialist in pediatric nutrition, Julie worked closely with the interdisciplinary feeding program at Leg Up Farm and WellSpan Health.  She is the author of a twelve-credit continuing education course for registered dietitians on clinical pediatric nutrition and can be found on social media @foodhelp123.