If only parents could log frequent flyer miles when navigating “airplane” spoons loaded with healthy food toward wary children. Every parent, whether they want to admit it or not, has done the mealtime drill, regardless of the transit system they choose. When a child refuses to eat, there’s often plenty of blame served up for dessert. Either parents are deemed too soft or the children are considered too stubborn, but there’s a whole other chapter to this age-old mealtime story.
Feeding struggles can be rooted in oral motor skill, medical and sensory issues, according to Sarah Biers, director of operations and occupational therapist with Family Speech and Therapy Services in Edina, which provides family-centered therapy for individuals with communication disorders and motor delays, including feeding issues.
Parents are often in tune with children’s fine and gross motor skill development, but some might not realize that fine motor skills also include oral skills, including jaw, cheek, lip and tongue movement. “Think about all the little movements your tongue makes making a word,” Biers says. Now consider how many movements it takes to move food around, especially peanut butter or meat. If a child does a “hard swallow,” it could mean that they don’t have the oral motor skills to handle the food they’re eating.
Obstacles to feeding can also be caused by underlying medical issues, including reflux, when swallowed food comes back up from the stomach into the esophagus or mouth. “A child may develop negative associations with feeding due to pain caused by reflux,” Biers explains. Other roadblocks include constipation and dehydration. Food allergies and celiac disease might also come into play.
When a child says, “I don’t like the way that apple feels in my mouth,” chances are, they are likely having a hard time with the food texture, which can be due to difficulty processing sensory information. Boiling it down to a behavioral issue is too simplistic, Biers says. “There’s usually a reason.” Children (and adults) can experience sensory processing disorder (SPD), which limits a body’s ability to process, interpret and respond to sensory input from the environment. This can include tactile, olfactory, oral, auditory, visual, vestibular (inner ear/balance) and proprioceptive (perception of body position) elements, Biers explains.
“They can’t handle unpredictability,” Biers says of those with SPD. This is why some children stick to a limited menu. Consider why some children always eat the same kind of crackers, for example, which are always the same shape and taste. Oranges, however, can be sweet or sour, dry or juicy, fibrous or nonfibrous. “My belief is that kids will do well if they can,” Biers says, adding when children are rigid in their food choices they are sending a message: “ ‘I can’t handle that. That won’t work in my body,’ ” she says.
Most, if not all, of these situations can lead to food jagging, which is the practice of repeatedly eating the same item. While the food product might satisfy the child for a time, there comes the crash and burn, when the child will no longer eat the food item—peanut butter sandwiches, as an example. “You might have just lost a good protein source,” Biers says. “That’s one of the things we really worry about because that is how your diet gets smaller and smaller.”
When patients come to the clinic, they are examined by a speech/language pathologist and an occupational therapist. If it’s appropriate for Family Speech to address the issue, treatment can include a pediatric feeding program, which is a play-based approach. “They’re usually laughing and giggling,” Biers says of the sessions. There’s also a focus on family involvement and parent and family education.
The bottom line is that Biers reiterates it’s crucial for parents to remember that children most likely aren’t being obstinate at the meal table. “They are just trying to protect their little bodies from something that doesn’t work for them,” she says.