Feeding Therapy

Wow! So I posted on Facebook that our son’s feeding therapy is actually helping – baby steps right now. I recieved the biggest response! People asking what we do, people private messaging me to see if I could give them ideas or links on the internet. I had at least 15 responses.

I decided it might be easiest to write in a blog and post that.

The thing is, when your child doesn’t eat “properly” it really makes you feel inadequate. Other parents try to tell you what to do for him. Most of the time you have already tried those things and they didn’t work. Which makes you feel even more inadequate. The doctor tells you what to try. It doesn’t work. You get parenting magazines with articles that have titles like “How To Get Even The Most Picky Eater to Eat Healthy.” You open to that page and find suggestions on how to make Quinoa more appetizing or how to make smiley face whole wheat pizza rolls. Your child won’t go near one food in this article and you close the magazine with a sigh, feeling even more defeated. Pretty soon you have given up and just feed your child what he wants, because then at least he is eating. But inside you feel alone and scared and like you are the worst mom ever.

Some children have trouble swallowing or chewing. Some have troubles with the concept of eating.

My son has sensory processing disorder. He has a very hard time with eating. Certain tastes, smells, and textures bother him a lot. He gags at a lot of smells and has thrown up with some mushy textures like oatmeal. He was a normal eater as a baby and early toddler when we first introduced table foods. Then he slowly narrowed down what he would eat. He now eats 3 main dishes and a handful of side dish type things – as well as some fruits and cucumbers. He also has geographical tounge – which I am told contributes heavily to his ability to taste even small differences in foods (he knows if something isn’t the right brand by taste).

We started going to feeding therapy because he just isn’t getting enough nutrition. Thankfully he gets enough calories and is growing normally. We know a family who’s son has had to be put on a feeding tube because they can’t even get enough calories in him. He is 4 but is the size of a 2 year old.

Let me state I am not an occupational therapist. That is who we see, and she is great. But I will share the things we are doing at home to help and maybe that can help y’all.

First: the rules.

1. The family eats together, food is served family style at the table. (many parents in our situation get so frustrated with meal times that they just stop having them – and let the child eat when he wants, often in front of the TV or at least where he eats the best).

2. The adults choose what goes on the plate, the child chooses what to eat. (make a meal, then serve it with some of the child’s preferred foods. Some of everything goes on the plate, but the child chooses what he eats. Divided plates may be necessary to avoid melt downs, or a “trainer” plate – a salad plate on the side where he can put the non-prefered foods. Most of these kids are afraid of “cross contamination”.)

3. The child helps pass the food around the table – don’t dish up at the stove, put it in bowls, etc ON the table and pass it around like you did when you were a kid at home. This way the child sees and smells the food.

4. If the child touches or plays with the food, let him. That is part of learning about food. I know – it’s gross and you don’t want him playing with his food. He needs it.

6. Don’t be negative. It’s hard not to. Don’t turn your nose up when he plays with his food, don’t get frustrated when he spits out a bite after trying something new. That is allowed. He needs to feel safe. Always say “you can try it and spit it out if you don’t like it”. Don’t lecture about the child not eating. I recently gave him a huge high five and a hug after he tasted a piece of pizza and spit it right next to some grandma’s feet.

7. The child sits at the table until allowed to leave.

8. Don’t force feed.

9. No tv, movies, games, etc during meal time.

10. No grazing – the child eats at specific times every day – 3 meals and 2 snacks if you can. You don’t have to be too rigid – if snack is at 10 and he says he’s hungry at 9:45, it’s ok to bend the time a little. Older children should be able to wait a few minutes for snack or meal. (“It’s almost meal time, have some water and I’ll let you know when it’s done.”)

11. Take things out of the package. Some kids, like my son, are very visual. If he sees the “frigo man” on his cheese stick instead of the “kraft” logo, he won’t even touch it. Taking things out of the package should help desensitize that.

12. Let them help prepare food and clean it up. My son will cook for everyone else, but doesn’t want to eat it – that’s ok, he is smelling and touching it and that is important.

Second: dialogue.

This has been an eye opener for me. Before when my son would say “it tastes different” I would just get him something else. Now we are talking about food. All the time – not just at the table. This causes some anxiety some days – just the talking. Try to be positive and help their inner monologue about food change. Some of the things we have learned: If he says it tastes different, talk about whether it’s a big difference or a little difference in taste. At first he will say “big” about everything. But we just keep trying to help him change that inner talk by saying “really? I think it’s a really small difference”. Talk about what will happen if he tries something he doesn’t like. Will he explode? Is it going to eat his nose off? Is it going to make the house fly away? Silly things that cut the anxiety and make him realize that even if it’s uncomfortable, it won’t really do any damage. Also talk about the food itself – what texture is it? What color? Does it smell like something similar that we like? For example, does he know that pizza tastes kind of like spaghetti? Talk about similarities and differences. They may be obvious to you, but they are not to your child. I never let him say he doesn’t like something he hasn’t tried until we talk about it. Always stress that we are still LEARNING about the new food. Stop letting people talk about what a bad eater your child is. I say “We are learning about foods right now. One day maybe he will like them all.” And then I may have to ask them later to stop saying negative things in front of my child. Most of my husband’s friends and family do this – talk about what a bad eater he is right in front of him. If someone says you are a bad athlete every day you will get it in your head that you might as well give up on athletics… same with negative talk about food.

Examples: “You don’t have to do anything you don’t want to do” “Is it a big difference or a little difference?” When he says he doesn’t like something new but hasn’t tried: “No, we are still LEARNING about this food. Our tongue doesn’t know if it likes something or not until we try it 10 times.” “Did that surprise your tongue?” “What makes you worried about this food? We are just going to learn about it.” “this food is a lot like ______. What can you see that makes it alike?” Say “you can” instead of “can you” because if it’s a question the answer is going to be no. I say “You can spear those with your sword.” or “You can try that cucumber with the apple.” We have even recently been talking about how “brave” he has to be to try new things – like some of his favorite super heroes or the girl in the movie “Brave”.

Activities we are trying at home:

The order of desensitization usually goes like this: sight, smell, touch, touch part of the face, taste. So we started out by just putting some new thing in front of him. We started with “veggie sticks” at feeding therapy – they are 3 different colors, look different than most foods we eat, and have little taste. In fact, they kind of taste like potato chips. This is the one he will eat now. The good thing about these is they can be used in a lot of ways. She had to start by just letting him leave the sticks in front of him on a plate, not pushing them away. We talked about how they looked. The colors, the shapes, etc. Then they crunched them up into “puppy dog food”. They used their hands at first, but after about 4 lessons she let him start using a chopper for things we have already explored with our hands. Then he smelled it. Then she did the impossible. She got him to put the sticks to his mouth. First he just kissed it and freaked out that there was salty stuff on his lips. Eventually she got him to put it in his lips to make “rockets” out of them and he spit the rockets into a bowl. Since he is a boy he liked that. But it gets the taste into his mouth and the smell and helps to desensitize him. Eventually he licked them and even licked the crunched up part, now he will eat them. THEN she used them to branch into new things – crunching up some very small part of something else (dried fruit or pretzels) into the “puppy dog food” and then licking it again. Talking about if we could taste the new thing, or if it tasted different.

Back to the at home stuff we do (wanted to give you a background).

~ We start with something he already eats. Say graham crackers. He will eat the regular graham squares, but won’t touch teddy grahams. I bought some teddy grahams and some graham crackers shaped like spiderman. I put them all on his plate at once and that was what we had for snack that day. He crunched them, stacked them, and did a taste test with them. He still didn’t like them, but didn’t freak out and tried them. We also shot rockets with the teddies.

Applesauce – we got different flavors of applesauce to taste test. He now eats those.

Cereal – he likes honey cheerios – I will try another flavor next.

All of these things have to be repeated over and over again. We ate graham crackers for 2 weeks for one snack.

~ We tap our lips or our nose or our ears with a food – a cracker for example – and sing a silly song, “tap tap tap, I can tap my nose… tap tap tap, I can tap my teeth…”

~ Use something he likes to try another food. For example, if your child likes pretzels, use the pretzel to scoop up applesauce instead of a spoon.  Use bread sticks to color with pudding. I saw on pinterest today an idea to cut sticks of celery, put peanut butter on the end, and use it like a “fishing pole” to pick up goldfish crackers.

~ Toothpicks. So he doesn’t want to touch the mac and cheese. Who can blame him? It’s on his plate with something else he likes, so why not use that opportunity? Have him stab the mac n cheese with a toothpick. My son especially likes the sword shaped ones. See how many he can stack on it. See if he can make the toothpick stand up in the food… get creative here people.

~ Play with food. I know, your mom said to never play with food. And honestly, I have a hard time letting my anti messiness go with this one. But he has to touch and smell things to get used to them. So we take those little square cheese sticks and make boats out of them (toothpick for a mast and put little foods like fruits on it as the people). Paint with pudding or applesauce or jello. Make cereal necklaces.. There is a ton of stuff you can do, just let your imagination take over. We make cheese sticks into an octopus or a tree. Etc.

~ Make foods look different. I started using sandwich or cookie cutters on waffles. I have been cutting up fruit and cucumbers into different shapes. I am going to get some mini cutters to make it easier. Trying something that is a different color (green eggs) or different brand then they are used to. Changing the way the child thinks food “should be” helps a lot. Cut strawberries and bananas up in the same bowl…

My son now has experimented on his own with no suggestion from me. He made cucumber and saltine sandwiches, he tried some cucumber in the same bite as his macaroni the other day. He even tried a different brand of pizza at a party yesterday. He didn’t like it and didn’t eat it, but he tried it and didn’t freak out.

THE BIGGEST THING is to keep it up. These kids need lots of exposure. Perhaps you will have to play with teddy grahams for weeks before he thinks he likes them. That’s ok. The more he learns that he can change his ideas about foods, the more his ideas about foods open up and the more you can try. Keep at it, it’s frustrating, it’s tedious, it’s boring. But you must keep pushing with the home activities. Every single day, mix it up, change it up, change what your child is doing.

I will add some links I have found helpful here, but if you google “sensory food issues” or “feeding therapy ideas” you can probably find plenty more. OH – and look up “food chaining” – it’s the idea of going from what he will already eat to something just a tiny step away from that – to another step… Like waffles to pancakes to french toast to toast to sandwiches.

http://www.sensory-processing-disorder.com/picky-eaters.html

http://www.speechlanguagefeeding.com/category/feeding-and-picky-eating/tips-for-parents/

http://www.earlyinterventionsupport.com/parentingtips/feeding/problem-feeder.aspx

http://arktherapeutic.wordpress.com/

How to make food look fun:

http://www.circleofmoms.com/article/smiley-face-quesadillas-04722

http://kitchenfunwithmy3sons.blogspot.com/

http://www.sixsistersstuff.com/2012/01/fresh-food-friday-25-kid-friendly.html

http://www.kids-cooking-activities.com/

http://www.kids-meal-ideas.com/

Last but not least: If you think your child has sensory processing disorder, or even sensory issues (things are too loud, things are too scratchy, things are too wet, dry, mushy, bright etc ALL the time) – a general sensory diet is supposed to also help with feeding issues – you can google sensory diet and find tons of stuff, but I will also make a point of doing a post dedicated to that this week. I have had my son sucking on straws and chewing on chewy tubes, chewing on bubble gum, and filling his mouth with water as full as he can get it, then spitting it out as far as he can (outside, of course), and a vibrating toothbrush. He likes to stuff his mouth full of food and chews on his shirts or fingers, so I know he needs oral stimulation. This has seemed to help with his feeding issues some, and I am going to get a vibe stick soon – it’s a contraption that vibrates your mouth with tips of different textures…

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2 thoughts on “Feeding Therapy

  1. Thank you for sharing this! My son is 10 and we have struggled with this for years. We have discovered some of these things on our own, but you have given me a fresh outlook to renew his “exploring”. He likes to freeze things these days and see how it makes it different and has tried banana, apple slices and watermelon because of his “experiments”. All the best!

    • Oh! The freezing is a great idea – my son loves “science”. Just yesterday we went to the store and I made him get some cheese sticks that “look” different. They are the same brand and same cheese, but for back to school they have crayons printed on the wrapper. I thought he would have apoplexy. He did eat one though. Please feel free to share any other ideas you have, or ask any questions. Honestly, the OT has been great, giving me ideas of simple things to do that can help – like the cookie cutters, etc.

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