Heightened anxiety and Sensory based feeding aversions

Many of the children I see for feeding therapy have increased anxiety surrounding new foods and many will "shut down" so to speak at the very sight or mention of a new or undesired food. When working with families I ask them to list their child's favorite foods and then I examine the various properties and help plan which foods to introduce based on the similarities. Pairing desired foods with new or undesired foods has been helpful with many children...you do not want to be 'sneaky', but rather discuss the similarities and provide opportunities for exposure and for your child to build trust and familiarity with the new foods.

It is not uncommon to see a child with a limited diet Love foods that are crunchy, sweet, salty, even spicy. What is the common factor in those type of foods? They all have an increased sensory value and give more feedback! A child who loves barbeque chips for example, may love the idea of having chicken tenderloins coated and baked in her favorite bbq chips. This is a way you can expand on a food. Children who prefer these types of foods often Overstuff foods, usually the foods that are a little softer. Here is a great article by Suzanne Evans Morris regarding overstuffing: Mouth Stuffing.

Yesterday I discovered a great blog written by the co-authors of Food Chaining. I did not realize that the treatment approach I use with many children is similar to the concepts and plan in Food Chaining. Please check out the site, it is a great resource and lists many others! I plan to order the book and incorporate some of the examples in my own therapies! I spoke with a very sweet, very concerned mother of a 5 year old son who has a diet limited to 4-5 'staple' foods. Her story is like many others--she knows her sons anxiety and panic surrounding new foods is not typical of other children his age but she is having trouble seeking treatment. A speech-language pathologist or occupational therapist specializing in pediatric feeding disorders is sometimes difficult to come by but we are out there! I hope to continue adding to this site and eventually have a list of treatment centers and speech and occupational therapists working in the field of pediatric dysphagia; so if you happen to be reading this and are a professional in the field or have a recommendation for other families, please leave a comment below! Most Children's hospitals have a feeding/swallowing program and will offer outpatient treatment. You can also check with any company that offers speech or occupational therapist and ask if there is a therapist/therapists who works in the area of feeding.

Below is an example of introducing a new food, discussing its properties, presenting it in a new form (puree for dipping) and pairing it with a like colored desired foods.

ARFID, selective eating and PFD—where to start?

If you suspect ARFID and you are researching and starting there I also suggest you seek out a therapist specializing and treating pediatric feeding disorders. Your child or teen or yourself may likely need a psychologist or psychiatrist and a cognitive behavioral therapy plan in conjunction with other therapy, but I can personally attest to what I know as an SLP working primarily with feeding since 2003 and that there is rarely a one factor root to very selective eating.

Maybe I shouldn’t mention ARFID at all but rather the fact that there are certain criterion that send a red flag for noticing a difference in what could be typical vs atypical or just a difference that is affecting lives in a way that is less than ideal or optimum. Whether struggles in the arena of eating and mealtime began due to this or that there WILL often be accompanying oral motor feeding patterns, sensory disturbances and associations that have been created likely without the person or their caregivers absolutely knowing that those inefficient patterns or differences in anatomy were present. 

It can be as “simple” as a history of early feeding difficulty, a slew of “wait and see” mindset determined by yourself or a medical professional, etc, but the bottom line is that a thorough evaluation can at least look into background history and help identify patterns and along with that comes the feedback from someone with experience of knowing what other patterns including oral motor function and sensory and a whole body mindset to further investigate all possible influences and where a starting point should be At the TIME of assessment.

There is no need to fixate on why “this was overlooked” or “why didn’t I or they identify this or that” aside from having a newfound perspective or new information. This may be opinion but I also feel it is helpful in making strides in the present. What do you know now, today, that could lead to a direction of a plan and progress? Stay there and know that if you haven’t considered or haven’t been aware of the possibilities, that now you are and you can get started right away on seeming solutions and implementing a plan. Sometimes the “plan” is simply letting all of the new information soak in and allowing empathy to root in the ways that you will certainly find are necessary. We are an interconnected web of information and if you start somewhere that can lead you to the next step then you are already making progress in the journey to increased awareness and action. There’s a lot to be said for that! I am opening this up to hopefully allow connections to be made in whatever location you are, there are numerous resources available and sometimes it is just a matter of logistics and experience and people connecting with each other so that the journey can begin for you.

I encourage you to check out the Feeding Matters resources provided in this link! https://www.feedingmatters.org/pfd_and_arfid/