Interventions for "fussy eater"

Question 1

Three subtypes of sensory processing disorder

Answer 1

1. Sensory modulation disorder
2. Sensory-based motor disorder
3. Sensory discrimination disorder

Question 2

Sensory modulation Disorder

Answer 2

• over responsive to sensory stimulation
• under responsive to sensory stimulation
• sensory seeking

Examples with feeding:
- oral defensiveness (oversensitive to sensations in mouth)
- Oversensitivity to the smells of food
- Sensory seeking (may seek very crunchy food or highly flavored food)

Question 3

Sensory-Based motor disorder

Answer 3

• poor postural control
• poor bilateral integration skills (bilateral coordination)
• Poor motor planning skills (dyspraxia)

Examples with feeding:
- child may struggle to coordinate use of spoon or knife and fork and may avoid food that takes too much effort to eat
- The hypotonic child may have difficulty with chewing and swallowing, and may prefer food which doesn’t need to be chewed.

Question 4

Sensory Discrimination Disorder

Answer 4

• difficulty processing and understanding what the child sees, hears, and feels.
• difficulty determining the characteristics of sensory stimuli

Question 5

Red flags with picky eaters

Answer 5

• poor weight gain
• frequent choking, gagging, or coughing during meals
• Avoiding all foods of a specific texture
• eating less than 20 foods
• mealtimes consistently a battle
• children who have difficult transitioning to purees by ten months, are not accepting foods by 12 months, still only eating baby food after 16 months, or haven’t transitioned to drinking something out of a cup by 16 months

Question 6

Recommended progression of OT intervention

Answer 6

Phase 1: Whole body
- address whole body sensory and motor needs based on traditional sensory integration treatment strategies

Phase 2: Oral sensory
- decrease sensitivity of and/or improve sensory discrimination of oral structures

Phase 3: Oral motor skill
- strengthen and promote increased control and use of oral structures, which effects the child’s ability to manipulate food in the mouth

Phase 4: Food exploration- non-oral
- increase tolerance of smells, tastes, textures of a variety of foods before consuming them for nutrition

Phase 5: Food exploration- oral and consumption
- increase tolerance for a wider repertoire of foods for increased consumption (food-based play)

Phase 6: Eating in functional environments
- promote eating meals in the community and at home (emphasis on functional carryover and transfer of skills developed in previous phases)

Question 7

Feeding programs

Answer 7

• SOS approach (sequential oral sensory): assesses and addresses feeding issues
• Beckman oral motor protocol: addresses oral motor skills
• Mealtime notions with Marsha Dunn Klein: targeting mealtime challenges
• Applied Behavior Analysis (ABA): Aims to change a child’s behavior through identifying antecedent, behaviors, and consequences
• ## FOCUS program: addressed foundational sensory processing and motor skills.