“Adam is a picky eater; he will never accept eating fruits and vegetables.”  “Sama will only eat bread, crackers, and chips. She throws a tantrum if I try feeding her anything that is not hard and crunchy.”  “Going out with Hashem to the restaurant is almost impossible. He constantly runs around in the restaurant, touches people, stuffs his mouth with food and creates a big mess around him.” Are you a parent who happens to say such statements often? Do you often dread when it is mealtime and you have to feed your child knowing that the coming half hour will be a battle? If your answer is yes, then maybe you need to ask yourself why is your child not developing proper feeding and eating habits.

If you believe that your child is having feeding and eating difficulties, do not worry, because there is always something you can do to have a more positive mealtime.

In some cases, feeding and eating difficulties result from a certain medical condition and this can be further untangled with the help of a physician or a nutritionist.  However, what we will be looking at, are feeding issues that result from sensory-motor difficulties. Before looking at what you can do, let us think for a moment, what do feeding and eating involve?

• As infants, babies start by involving their sense of touch when breastfeeding and they start developing motor skills for sucking.
• Later on, children gradually start learning how to bite, chew and swallow semi-solid food and then solid food using their lips, teeth, and tongue.
• Throughout this process, children will involve their four senses (touch, smell, taste and, sight) when they get introduced to new meals by exploring its texture, smell, colors, presentation and the different tastes.
• When children are more capable motorically, then mealtime will mean that they have to remain seated for a given amount of time. They will need to maintain an upright posture to eat and will need to have proper coordination to be able to use different utensils (spoon, fork, and knife). They will also need to show body awareness in order not to create a mess around them or on their face and clothing.

As you can see, even though we usually take feeding and eating for granted it does actually involve complex sensory motor functions that are important to our development of other skills later on. So, what do we mean when we say sensory motor based feeding difficulties? There is a common concept spoken of these days known as sensory integration. What do we mean by sensory integration? This is a concept that describes the process of receiving and organizing sensory information from our bodies and the environment. We all know about our five senses: touch, smell, sight, hearing, and taste. There are additional senses that contribute to our ability to interact with the world.  These include:

• The vestibular sense, which helps us maintain an upright posture, keep our balance and coordinate our head with eye movements, as well as, coordinate moving our left and right side.
• The proprioceptive sense, which provides information about our body awareness, rate and time of our movement and helps us know the amount of force we exert on items.

Based on that, we can see that feeding requires a lot of sensory integration. We need to see our food, smell it, feel it, taste it; and we will also need to have the ability to sit upright, coordinate our hand movements and control our tools. Sensory motor based feeding difficulties can present itself in two different ways:

1. The over sensitive child; the child who is extremely sensitive to touch, smell, sight, or taste. These children may complain if their food looks different, gag or vomit when given certain food textures or run away from the room when smelling or seeing certain foods.

2. The child with poor sensory perception; the child who could find difficulty managing their food and drink in their mouth, might drool a lot, bite their cheek while chewing, or swallow their food before chewing it properly. They may also constantly move around and find it difficult to sit still on a table or have difficulty using a spoon and fork.

Who can help you? Identify an occupational therapist or speech-language pathologist who can conduct a feeding assessment for your child. Through observations and questionnaires, the therapist will be able to point out the sensory-motor reason behind your child’s feeding difficulties. What will the intervention entail? The therapist will mainly be working with the child and his/her family directly using different sensory motor strategies to help develop more positive feeding habits. This happens through exposing the child to sensory motor experiences in a safe environment, then through close monitoring of the child’s development and emotional responses, the therapist will gradually challenge the child and promote a positive mealtime experience across different environments. In addition, the therapy can include exercises to improve oral motor skills. Can you help at home? Of course, you can! You can help by trying some of the following tips:

• Make eating a pleasurable experience for you and the child, regardless of what he is eating!
• Be aware of the different sights, sounds, and smells in the environment.
• Let the child explore with food at home and play with it when it is not a regular mealtime.
• Start by having the child feed others with his/her non-preferred food before asking him/her to try it.
• Start with asking the child to lick, then bite, then bite and swallow. Never force the child to eat if he refuses!
• Practice related movement patterns such as scooping and pouring during play activities.
• Have the child fully supported when seated at the table to eat.

Take a deep breath and remember it might be difficult now, but surely it will get better, so celebrate your small successes!