Fussy Eaters Information Sheet

Sensory/Behaviour Strategies for Mealtimes

Fussy Eaters Information Sheet

Sensory/Behaviour Strategies for Mealtimes

The term ‘fussy eater’ is often used but is not always a helpful description as it tends to ignore the very real challenges that some children can face when it comes to mealtimes.

If you are worried about your child’s dietary intake, it may be useful to keep a food diary. This way you can monitor how much of what they eat. It is useful to note:

• What they ate and the amount they ate
• What time of day they ate
• Where they ate and who was there

It may also be useful to note other factors e.g. distractions (was the TV on?), did they eat off their favourite plate, were they in a busy/noisy school dining hall. Although some children have a restricted diet, it can still be a healthy diet.

It is also very important to rule out if there is a medical reason for them not eating / taking a restricted diet e.g. do they have a sore throat/ tooth abscess? Do they have chewing / swallowing difficulties? If you are unsure, make an appointment with their G.P.

Sensory Information

If we’re thinking about processing sensory information and the difficulties a child may be facing when they eat, we need to consider the senses they use when eating. 

 

Vision (Visual)   

Eating starts with our eyes. We need to be able to see where the food is, we also look at the shape, colour and presentation of our food.

Touch (Tactile) 

We touch the food with our hands, body and face so that we can move the food from the plate and into our mouths. We have to be able to feel the food as we put it into our mouths and chew it. It also tells us the shape and texture of the food and whether it is hot or cold.

Smell (Olfactory)

As we smell food as we bring it towards our mouths and explore how it smells.

Taste (Gustatory)

As the food goes into our mouths we taste it.

Hearing (Auditory) 

We listen to how the food sounds as we eat it, particularly if we eat something hard.

Body Awareness  (Proprioception)

We need to know how much force to use when biting and chewing different foods and when our mouths are full/empty.

Vestibular (Balance)  

We need to be able to keep ourselves and our head upright and in the correct position when eating.

Sensory Issues

We need to remember that none of the sensory systems work alone, they all work together, and you can have processing difficulties in one or more areas.

The other important thing to think about is that we all process sensory information differently. What smells good to one person can be unpleasant to others. What feels comfortably warm to some may be too hot for others. So telling your child ‘eat it, it tastes good’ or ‘don’t be silly it’s not too hot’ may not be the case for them.

If you are hyper (over) sensitive to touch, the ‘feel’ or touch of the food can often be an issue. The temperature or texture of foods can almost seem to be painful or unpleasant and needs to be ‘just right’. It is common for children to insist on all foods being at room temperature. This may mean that cold foods such as ice cream are not tolerated and that foods that are cooked need to be cooled to room temperature before children will eat them.

Foods with a crunchy texture may be loved, while any other textures are rejected. Some children will prefer soft pureed food, whilst others will prefer hard crunchy food.

Smell makes up a large part of our sense of taste. Some children may be under responsive to the tastes of foods, preferring either bland food or hot spicy food.

A child can have an extremely acute sense of smell, and the odour of food they don't like can be enough to make them lose their appetite, gag or feel sick. Some children are so sensitive to certain smells that they cannot sit in the same room with someone who is eating a food they dislike. In addition, if your child is expected to eat in the kitchen where other food stuff has been prepared, this combined smell may be too overpowering for them.

Ensure your child is exposed to smells one at a time, allowing for an opportunity to get used to the smell of different foods. If required open the window to expel strong food smells before your child comes in for their meal.

Sameness

Some children dislike a change in their routine, and this can affect their eating pattern e.g. food presented to them in a different way, at a different time of day or in a different place. In addition, some children will notice a difference in food packaging, and this may result in them refusing to eat a food they previously ate.

Investigation

The first step is to carry out some detective work to find out what, when, where and how your child will and won't eat certain foods. Be aware of sensory issues such as textures, heat, cold, smell and colour. You can usually see what kinds of foods, textures etc. your child likes/dislikes.
 
When texture is a known issue, try to introduce new foods in a similar way at first. For example, a new vegetable can be turned into a puree if chunky textures aren't liked, or traditionally hot food can be served at room temperature.

Introduction and Exposure

When developing a plan for increasing the number and variety of foods your child will eat, it is important to be calm and not controlling. The most successful experiences are when children are given some control, or at least they think that they have some control. Struggles and battles over eating can often make matters worse.

Gradual exposure to new foods can be very important. Frequently, parents will offer a different selection of new foods each day hoping that their child might try something. They may think that by giving more choices, they will have more chance of success, which sounds like it makes sense, but not for all.

Gradually introducing a new food will help your child to become desensitised to the smell, look and possibly feel of an unfamiliar food. If a new food is chosen that has the sensory qualities (consistency, texture) that your child likes, you will have a better chance at success e.g. if your child will eat chicken nuggets, try them with baked chicken or if they will only eat a certain brand of pizza, try a different brand. Start with a food that has a good ‘sensory fit’. Offer the food on a daily basis by putting it where your child will be able to desensitise to it.

Think of how your child might best accept a new item in their space. Frequently a small separate bowl or plate put close to their seat will work. Try to increase your child’s exposure to new foods by starting with:

1.    Put the new food on the table
2.    Put the new food on their plate
3.    Encourage them touch it
4.    Encourage them to lick the food
5.    Encourage them to hold the food in their mouth
6.    Encourage them to swallow the food

Sometimes a child can tolerate the new item on their plate as long as they understand that the only expectation is that it will just stay on their plate. Repeatedly try offering the identical food item once or twice a day, at meals, with no expectations attached. Sometimes this technique, as well as other family members (particularly brothers and sisters) showing their enjoyment of eating this new item, can encourage your child to try tasting it. You may wish to try the same food item for two or three weeks.

Children do not want to be tricked. Tricks such as hiding ‘extra’ vegetables in spaghetti sauce and or supplements in a child’s favourite drink do sometimes work but can also backfire. Sometimes, after finding ‘additions’ to familiar favourites, children learns to be suspicious of all foods and will limit their diet even further. This strategy probably works best when the sensory characteristic the child is focusing on is the ‘look’ of the food. If a child is more sensitive to the smell, taste or texture of a food, it may be harder to make ‘additions’ because they are usually easier for the child to detect. Be cautious when using this strategy. Do let your child try sauces with their food, if this helps them to accept and tolerate new foods.

Eating and feeding problems can sometimes dominate family life. It is easy to be overwhelmed when eating problems are severe and are so closely tied to your child’s health and development. The fact that mealtime occurs at least three times a day, and families and children are not always able to eat at home, adds to the stress.

It is essential to rule out any possible underlying medical or behavioural problems which may be affecting your child’s eating patterns. After those areas are addressed, families’ can often tackle the environmental factors by calmly working to desensitise their child to new foods with structure and a non-controlling plan for trying a new food.

The expectation to sit and eat at the table can be structured in small steps and graded so your child is successful. Don’t expect miracles after 10 minutes, an hour, or even a week. Patience and consistency with this process is key to success, however this isn’t always easy, especially when you’ve had a long tiring day! 

Desensitisation

This can work well with introducing new foods. Its gradual introduction can help your child to become desensitised to the smell, look and texture of an unfamiliar food. First, try a food that has the best chance of suiting your child's tastes as previously detailed. It might just sit on a plate near theirs for several nights. For the next few meals, it could be placed on their plate but with no pressure for them to eat it. Next, family members can try the new food and show their enjoyment. With a gradual introduction, and no negative effects this may allow your child to eventually try the new food.

Play a taste game. If your child does not have a strong negative reaction to refined sugar (becomes very “hyper” or sleepy), get an assortment of flavored jellybeans. Eat one at a time, and have them guess which flavor it is. If you want to avoid sugar or artificial colour and flavour, you can play this game with slices of fruit, or other healthier snacks.

For children who refuse to put food in their mouths, encourage them to explore their favourite toys orally (ensure first there are no small parts that could come off and be swallowed). Dip their toys into flavoured water, pureed foods etc. Encourage them to become more comfortable having their hands, toys and food near and around their mouths. 

Involvement with Meal Preparation

Encourage your child to help you with meal preparation. Children are more likely to taste something if they help make it. They could go to the shops with you, then select and buy ingredients, if they are comfortable with this.

If they do not like to go shopping, you can plan a meal at home; look up a recipe and shop on-line.

If you have a garden, let your child help you grow fruit, vegetables, and herbs.

Give children a sense of control: let your child choose between chicken or fish, beans or peas, potato or rice. Try to stick to two choices, any more and your child can become overwhelmed. If age appropriate, let them help with cooking, mixing, chopping. Let your child put the meat etc in the pan and help you to arrange food on each plate so it looks nice. If they have a chance to help prepare food they are more likely to touch and smell it.

When choosing foods, encourage your child to make up a weekly menu, and use pictures to illustrate what each meal will be.

A Positive Attitude

This is important for parents who are introducing new foods. The focus should be on patience and to let your child feel in control of what will and won't be eaten. Undue pressure and arguments usually only make children more resistant to new foods than ever and it’s a battle you are unlikely to win, as it is one area that your child can control.

Make sure meal times are fun and not confrontational, if your child struggles with the social ‘chit chat’ of mealtimes, try putting on some music / an audio book.

Remember, try and keep the pressure off.  The goal isn’t eating when you are exploring new foods, just play, and if your child happens to eat it — bonus!

Structure

Have set times for meals, and sit down as a family to enjoy a meal together. Don’t ever pressure your child to eat new / different foods.

It is very important to let your child get hungry, in order to motivate them to eat. Stick to 5 opportunities to eat within a 24 hour period e.g. 3 meal times and 2 snack times. You want to discourage ‘grazing’ and encourage routine.

Use a timer to indicate how long meal time will last (around 20-30 minutes), after this time remove the food.

Expectations

Let your child play with their food. Outline what behaviours are unacceptable, such as throwing the whole plate of food on the floor, but what they can do is, feel the texture of his food with their fingers. This process helps your child explore the food with their tactile/touch sense before they use their sense of taste.

Presentation

Be creative. A so-called ‘picky eater’ may be more willing to eat “rocks and trees” than meatballs and broccoli. Fun arrangements such as some vegetable sticks and grapes / tomatoes placed in a smiley face pattern on a plate may encourage your child to taste something new. Let them play with their food as much as possible.  Make food fun! 

To Conclude

Look at your child’s eating environment, do they need a distraction such as music? Does your child need a puppet / favourite character to help them model eating?  Would it help to place a mirror in front of them to see where their mouth is?  Is the seating comfortable and positioning appropriate so that they do not slip out of the chair?

Make eating times regular, routine and make it fun!

During eating, do not present all foods at once. Instead, present them one at a time. 

After eating, praise your child for whatever success they had.  If there was none, always be positive and say, “Nice trying!”

Use rewards e.g. if your child tries a new food, reward them with their favourite food, use reward charts so they can see their success.

‘Social Stories’ can be useful to explain to your child, why we need different types of foods to stay healthy and fit.

These strategies aren’t just for new foods. Sometimes ‘picky eaters’ will often stop eating something they previously loved, never to touch it again. Hopefully you will find some that work for you and your child. Remember some new foods need to be tried around 20 times before a liking for it can be developed.

Content

  • Sensory Information
  • Sensory Issues
  • Sameness
  • Investigation
  • Introduction and Exposure
  • Desensitisation
  • Involvement with Meal Preparation
  • A Positive Attitude
  • Structure
  • Expectations
  • Presentation
  • Conclusion