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Sensory Based Feeding Disorders

Image by Harry Grout

Feeding disorders may be caused by a variety of factors, including oral motor, medical, sensory, and behavioral factors. Feeding problems affect 25-35 percent of children who are otherwise developing normally and 40-70 percent of children who have developmental delays or chronic medical conditions. If your baby or child is picking foods or liquids based on texture or consistency and refuses to eat others, they may be experiencing sensory feeding difficulties.

Children learn to eat through sensory experiences with food, as foods that provide a positive sensory experience are preferred over those that provide a negative sensory experience. Sensory processing disorder causes you to overreact to stimuli in your environment. Any of your five senses, including taste, smell, touch, sight, and hearing, can be stimulated. 

Touching foods allows the child to gain an understanding of new foods without needing to put them to his or her face. The sense of smell is closely linked to successful eating because it allows you to smell the food and gradually bring it closer to your mouth. To raise awareness, the child is then required to begin tasting new foods. Finally, the child is asked to try new foods without becoming anxious or engaging in negative behavior.

According to when a child has sensory processing disorder (SPD), they may seem to have out-sized reactions to what you'd consider "normal" inputs to your five senses. A child suffering (SPD) may be hypersensitive, hyposensitive, or a combination of the two. Poor integration/processing of sensory information can have a negative impact on feeding and mealtimes. The hypersensitive child may perceive flavors, textures, temperatures, and smells to a greater extent than other people, causing what we perceive as outbursts or tantrums., Hypersensitive gag reflex and refusal of whole groups or textures of food are hallmark characteristics of sensory-based feeding aversion. In contrast, the hyposensitive child may seek out strong flavors and crunchy, hard textures. They may prefer spicy foods, sour flavors (such as lemon), and only crunchy foods, and they may find it difficult to progress to textured foods because they find them unpleasant.

Sensory processing deficits can also negatively affect a child’s posture, chewing, muscle tone, and attention to movement. Consequently, we may see the following behaviors associated with these deficits.

  • Avoiding or seeking movement

  • Strong liking or disliking of certain textures

  • Prefererance for plain foods or very strong flavors

  • Hyper or hypo-sensitivity to environmental noises

  • A child who struggles to tolerate activities of daily living without modifications or accommodations


Causes of sensory based feeding difficulties

  • The causes of sensory-based feeding difficulties are not completely understood. However, these difficulties may be the result of 

    • previous negative food experiences

    • Undiagnosed or prior medical complications, including digestive and GI issues as well as dietary sensitivities.

    • underlying conditions which impact a child’s sensory processing, such as autism spectrum disorder.

    • Sensory Processing Disorder affecting the child’s sensory system as a whole


Risk Factors of sensory based feeding difficulties


  • Premature birth

  • History of chronic illness, 

  • Underlying neurological conditions

  • Adverse oral-tactile interactions

  • Various and/or numerous medical procedures

  • Delays in or lack of exposure to age-appropriate oral feeding

  • Gastroesophageal complications (e.g., gastroesophageal reflux disease (GERD), eosinophilic esophagitis) 

  • When a child transitions from tube feeding to oral intake, sensory-based feeding difficulties may arise.


Symptoms of sensory based feeding difficulties

It is perfectly normal for most babies and children to refuse some food at some point. Sensory feeding difficulties can be a problem if they are constantly refusing new or solid foods. Sensory-based feeding difficulties manifest as the following symptoms:

  • Refusing weaning foods or dislikes trying new foods

  • Aversive to particular textures tastes ,brand or food groups

  • Will only eat certain types of food e.g. fast food, fried food

  • Refusal to eat vegetables or items from other food groups

  • Not growing or developing as fast as their peers and

  • Excessive meal times, or  taking longer than average time to eat their food

  • Tired and irritable due to lack of energy or nutrients

  • Weight loss, or failure to thrive

  • Excessive weight gain with suboptimal nutritional intake


Complications of sensory based feeding difficulties

It is critical that your baby or child consumes foods from all food groups. Short term effects of restricted diet include slowed or stunted development, decline in cognitive abilities or aptitude, inadequate weight gain or growth, mild malnourishment/dehydration, and other possible health complications. These complications may persist or worsen if nutritional deficiencies are left unresolved. In severe and chronic cases, hospitalization may be required. Organ failure, including loss or vision, are occasionally associated with long term, chronic nutritional deficiencies. In younger children, developmental delays or behavioral disturbances may present as a side effect of poor nutrition.


Diagnose of sensory feeding difficulties in children

Usually, sensory-based feeding disorders are discovered during a clinical swallow assessment. During the evaluation, the speech-language pathologist tries to replicate a normal meal time and observes the child-parent relationship as well as the child's response to preferred and non-preferred foods. Sensory based feeding difficulties occur when a child has a sensory aversion to certain foods, usually based on their texture, taste, smell, or appearance. 


Know your child and be their advocate

Sensory-based feeding disorders often go under identified or unidentified in the setting of adequate growth and weight gain. Well meaning doctors and physicians can easily miss diagnosing a sensory based feeding disorder if the child is gaining weight appropriately. Be sure to discuss concerns regarding restrictive eating and mealtime struggles with your pediatrician, and don’t settle for a growth chart as an indication of overall health. It is possible (and common!) for children with sensory-based feeding disorders to be average weight or over weight due to restricting their intake to processed, high carb and fat foods. It is important to look at a child’s overall nutrient intake rather than focusing only on weight and growth to ensure they are getting adequate intake of vital nutrients. When in doubt, schedule an appointment with a pediatric dietician or pediatric feeding therapist (SLP or OT).

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