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Britt Collins MS, OTR/L

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Disclaimer

This is not a feeding certification course and is an introduction of ideas for therapists who either already do some feeding therapy or have a lot of sensory background training. If you are interested in becoming a feeding specialist, look into the SOS Feeding Course by Dr. Kay Toomey or another all day Feeding course that gives you more background to work with children with feeding challenges.

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Sensory Processing Disorder

∗ Sensory Processing Disorder (SPD) is a complex disorder of the brain that affects children and adults. People with SPD misinterpret everyday sensory information, such as touch, sound, and movement. They may feel bombarded by information, they may seek out intense sensory experiences, or they may be unaware of sensations that others feel. They may also have sensory-motor symptoms such as a weak body, clumsiness, awkwardness or delayed motor skills.

Dr. Lucy Jane Miller 2007

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How Does Sensory affect EatingWe have 8 sensory systems

Tactile

Auditory

Visual

Taste

Olfactory

Vestibular

Proprioceptive

Interoception

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SPD Subtypes

SENSORY PROCESSING DISORDER (SPD)

Sensory Modulation Disorder (SMD)

Sensory - Based MotorDisorder (SBMD)

SOR SUR SC Postural Disorders Dyspraxia

Sensory DiscriminationDisorder (SDD)

SOR = Sensory Over-responsivitySUR= Sensory Under-responsivitySC= Sensory Craving

Visual

AuditoryTactileTaste/SmellPosition//Movmt

Interoception

L.J. Miller 2007

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SMD- Sensory Modulation Disorders

• 3 subtypes◦ SOR◦ SUR◦ SC – may have heard this called Sensory

Seeking

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Sensory Over-Responsive

• SOR- these kids have responses that are too quick, too big or last too long than typical kids

• It is hypothesized that their threshold is too low and the therapist is working to raise that threshold◦ Examples: clinging to you when you try to toss your child

into the air◦ Tactile defensive to barefoot in grass or touching sticky

and gooey◦ She covers her ears when something seems too loud

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Sensory Under-Responsive

• SUR: this kid feels things too late and too little. He is low and slow almost lethargic.

• It is hypothesized that these kids have a high threshold and therapists want to lower this◦ Examples: he doesn’t hear his name being called◦ She falls down and doesn’t cry or notice she hurt herself◦ Hard to motivate to move◦ Your child may not be able to tell whether the water is too hot or too

cold

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Sensory Cravers

• SC –Even if a child seems to be seeking deep pressure or input, we don’t want to give them too much as this will disorganize them.◦ Examples: always on the go, constantly moving◦ Crashing, giving hard high fives◦ Spins a lot, jumps a lot◦ Over stuffs their mouth with food

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SMBD- Sensory Based Motor Disorders

• Dyspraxia – difficulties with ideation, sequencing, motor planning and/or execution

• Postural Disorder – difficulties with overall tone, trunk strength

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Dyspraxia/Motor Planning

• Individuals with Dyspraxia have trouble processing sensory information properly, resulting in problems planning and carrying out new motor actions.

• These individuals are clumsy, awkward, and accident prone. They may break toys, have poor skill in ball activities or other sports, or have trouble with fine motor activities.

• They may prefer sedentary activities or try to hide their motor planning problem with verbalization or with fantasy play.

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Motor Planning/Praxis

• Praxis is the ability to self-organize◦ Starting with an idea (ideation)◦ Sequencing how to carry out the idea (organization)◦ Making your body complete the activity (execution)

• Examples –◦ Crawling across the room◦ Making a craft project (cutting, writing etc)◦ Getting dressed◦ Eating, chewing, feeding yourself

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Postural Disorder• Individuals with postural disorder have difficulty

stabilizing his/her body during movement or at rest in order to meet the demands of the environment or of a motor task, e.g. poor “core strength”.

• When postural control is good, the person can reach, push, pull, etc. and has good resistance against force.

• Individuals with poor postural control often do not have the body control to maintain a good standing or sitting position, especially when attempting functional tasks.

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Discrimination

∗ Tactile∗ Visual∗ Auditory∗ Taste/Smell∗ Vestibular (position)∗ Proprioception (movement)∗ Interoception

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∗ Identifying specific qualities of sensory stimuli and attributing meaning to them. They have problems determining the characteristics of sensory stimuli. The result is a poor ability to interpret or give meaning to the specific qualities of stimuli ∗ (Do I see a “p” or a “q”? Do I hear “cat” or “cap”? Do

I feel a quarter or a dime in my pocket? Am I falling to the side or backwards?). ∗ Those with SDD have difficulty detecting similarities

and differences among stimuli. They may appear awkward in both gross and fine motor abilities and/or inattentive to people and objects in their environment. They may take extra time to process the important aspects of sensory stimuli.

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Eating actually uses all 8 sensory systems at once which can be very difficult for children who have sensory challenges

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How to START?

Before ever even working on feeding with a child, you must

build trust with child and parent/caregiver

regulate their sensory systems

give them heavy work and movement activities

oral motor work

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How to help each sensory subtype regarding eating

What to do for SOR kiddo?

SUR?

SC?

Posture?

Motor Planning?

Discrimination?

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Picky eaters vs. Problem Feeders

According to Dr. Kay Toomey, children should have a variety of 30 different foods.

10 sources of proteins (milk, cheese, yogurt, meats, nuts, nut butters etc)

10 sources of fruits and vegetables

10 sources of starch/carb other

Must eat these foods on a consistent basis

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What picky eating patterns do we see?

some children get into poor eating habits because parents are worried they are not getting enough calories early on

Food Jagging- we want to AVOID!!

If they had chicken nuggets today, they can’t eat it again for 2 more days. Change small things about their chicken nuggets to help prevent food jagging

what to do if you are starting off with a young infant or toddler to avoid this

what to do if the child is already into a strong negative eating habits

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Dinner Ideas!

◦ Family style dinner◦ Make Eating Fun!◦ Try different textures,

colors, smells◦ Always present a

protein source, fruit or vegetable and starch at every meal/snack and at least one preferred food

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How to present foods?

Always start with a preferred food

if working on introducing a new food, do one food at a time and then build from there

if presenting a family style meal have at least the 3 food types (protein, fruit or vegetable and starch/carb other and at least preferred, semi-preferred and non-preferred

if you want to learn more about food hierarchy there are many feeding courses taught to specifically train therapists on this. (see reference page)

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We always start with looking at the foods- the child cannot decide whether they like a food just by looking at it (VISUAL)

its round, brown, has holes in it (Ritz Cracker)

Then TOUCH

its bumpy, hard, soft, smooth etc. You can break it or pull it apart or crumble it

Then SMELL

It might be a big smell or a small smell

Then TASTE

licking, taking bites, kissing with lips, taking bite (then spitting it out) or chewing and swallowing

Praise for all engagement with the foods- “Good looking, Good tasting, Way to try” Pretend its a choo choo train, blow it away, if all you can get is them picking it up and throwing it away thats fine too. Its all progress

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Oral Motor Techniques

• Providing crunchy and or chewy snacks to help increase focus

• raw carrots, celery, large pretzel sticks, chewy fruit leather, dried fruit, beef jerky, twizzlers, etc

• Chewy tubes/chewelry bracelets

• Blowing bubbles, pinwheels, whistles, cotton balls

• Drinking through a straw (smoothie, applesauce, pudding) Drinking from water bottles that require good strong oral motor muscles

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Problem Feeders/Medical needs

For children who are being fed through feeding tubes, or have significant oral defensiveness or other medical issues.

Always rule out aspiration before you EVER work on feeding. You need more specific training to work with this population of children

work with medical doctors regarding tube feeds and oral motor abilities. Working with their SLP and Nutritionist are beneficial

If they are not currently an oral feeder and you need to just start working on oral motor there are also more advanced courses that teach these strategies. Uses of Nuk brushes, vibrating tooth brushes, brushing protocol for tactile defensiveness, oral motor techniques (need to be demonstrated) and more

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Feeding TubesChildren who are fed through a G-Tube, or J-tube or any sort of feeding tube need to learn to associate the feeling of being full with oral stimulation, taste or actual eating.

Each time they are fed through the tube, its ideal to give them something by mouth. There are children who need to be fed overnight through a slow drip which is not ideal since we do not digest food while we are sleeping and you cannot stimulate their mouth at this time, but do what you can depending on the medical needs of the child.

If they are an aspiration risk and cannot have anything by mouth, then stimulate them orally with a nuk brush or toothette or stretches, tongues exercises etc.

If they can have little bits of flavor, then add flavor from foods onto those listed above or your finger

If they can have thicken liquids or foods that are not going to cause aspiration then provide them flavors and textures slowly to get them used to it while they are being fed through the tube. Then they associate the feeling of being full with oral feeds vs. a tube that connects to their tummy.

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Case StudyBeing a Sensory Detective

Sam (age 3) very delayed in cognitive skills, motor skills and oral motor skills. Medically Fragile. Just starting to eat baby level 2 foods, and trying to drink from sippy cup but very difficult - he still has a feeding tube

June (age 3) cognitively age appropriate, motor skills on target, did have some speech delays previously, Very picky eater, tactile defensive, eats soft foods like Ramen noodles but overstuffs and wont swallow unless is watching Mickey Mouse on iPad. Will eat preferred things like chips or candy which requires chewing and crunching.

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What to do for these Cases?

Sam? what questions to ask first? is he aspirating? is it a tactile issue or oral motor delay?

June? what questions to ask first? picky eater vs. problem feeder? how much do the parents enable her?

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Questions

Thank you for your time, please use the resource list for more information regarding feeding tips and trainings for children.

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Resources

www.spdstar.org

www.aota.org

www.occupationaltherapy.com

www.sensoryparenting.com

www.sensoryyogaforkids.com

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Sensory Yoga for Kids available on her

website, Amazon and Barnes and Noble

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