oral phase dysphagia: sensory-based feeding disorders

Question 1

sensory-based feeding disorders

Answer 1

An abnormal response to sensory stimulation from food –> refusal or restriction of certain foods; child does not eat a healthy, balanced variety of foods;
AKA: food or feeding refusal, food or feeding aversion, severe food selectivity, oral aversion, sensory-based feeding disorder
**child has difficulty integrating sensory input they receive and often interpret that input as noxious

Question 2

picky eater (restricts)

Answer 2

picky eater: some limiting behaviors but eats variety of textures/flavors; often restricts less desirable food groups; often age related: when starts self-feeding (10 mos), toddler years; not abnormal; treated by parents

Question 3

feeding aversion (excludes)

Answer 3

excludes: variety of textures, flavors, foods, food groups; extreme limiting of foods; only eats age-inappropriate foods
- Abnormal and potentially detrimental to child’s overall health and growth/development
- treated by SLP/OT

Question 4

potential causes of feeding aversion

Answer 4

• Delayed or limited oral feedings (for any reason)
• Dysphagia
• Negative oral experiences
• GI issues (previous or currently)
• Food allergies
• Respiratory problems
• Abnormal hunger/satiation sensations (ex: extreme low hunger drive, Prader-Willi Syndrome, etc.)
• Commonly associated with -Autism Spectrum Disorder
• Psychosocial factors (ex: force-feeding, negative eating associations, family eating/mealtime routines, dysfunctional family issues)….create a negative cycle of feeding refusal and family response

Question 5

red flag for feeding aversion

Answer 5

fact that can’t be dirty (hands)- palms/mouth have more sensory inputs that all of body
hands = first gateway to mouth; getting hands dirty = GOOD

Question 6

presentation of feeding aversion

Answer 6

Possibility of some, all, or a layered effect of the following:

• Gagging and/or vomiting with certain foods
• Retching with certain foods
• Verbal refusal, Head turn and/or pushing away, & “Escaping” behaviors
• Need for Extreme distractions during meals (Parent feels need to put on a “circus” show to get child to eat)
• Long meals…>20-30 min. (Parent may complain of “feeding all day”)
• Only accepting a narrow range of food choices
• Extreme preference for certain brands of food
• Inability to eat any foods, including foods regularly chosen within the home, when not at home
• Avoiding food, often for an entire day
• Prolonged mealtimes
• ****DO NOT judge by the child’s weight. The child does NOT typically present as underweight.

Question 7

hypersensitivity

Answer 7

receive too much sensory information; your system overwhelmed & reacts; sensory info too much –> –> overloads
-body has reaction to say stop; don’t want anything in mouth for every little thing;
oral sensitivity- anything that comes into mouth= assault to body

Question 8

hypersensitive- oral

Answer 8

reduced mouthing, refuses oral touch/stim/care

Question 9

hypersensitive: body

Answer 9

resists touch of varying types; bothered by wipe of hands; does not do well w/ body positioning, resistive to extreme changes in sensory stimuli- sounds, lights, smell, etc.

Question 10

hypersensitive: general

Answer 10

emotional response to stim; sensory stim= threat

Question 11

hypersensitive: feeding skills

Answer 11

limit chew, bolus lateralization, or oral manipulation time as way to avoid food making contact in mouth

Question 12

hypersensitivity:food preferences

Answer 12

seeks bland, plain food; smooth/softer, limited to no texture; avoids mixed consistencies; no extreme flavors; prefer veggies over fruits; resistive to try new foods

Question 13

hyposensitivity

Answer 13

seek oral stimulation: mouthing, biting, slobbering, eating, drinking, talking

Question 14

hypo: oral stim

Answer 14

typically very “mouthy” of hands, fingers, toys, etc. (even past typical oral exploration age)

Question 15

hypo: body stim

Answer 15

seek out heavy input to senses, deep pressure, vibration, spinning, stomping, fidgety, typically described as “rough and tumble” kids…..Possible need for OT referral for add’l sensory integration training/Tx

Question 16

hypo: general

Answer 16

needs frequent stimulation to maintain levels of alertness….not to be confused or misdiagnosed for ADHD

Question 17

hypo: feeding skills

Answer 17

typically poor sucking and chewing skills 2° to impaired oral discrimination skills

Question 18

hypo: food preferences

Answer 18

like foods that are high flavor, sharp, possibly bitter, almost spicy flavors, extremely sweet, high texture, crunchy, foods with a “kick”, often prefer fruits over veggies

Question 19

eval/hx of feeding aversions

Answer 19

1) list food types eaten, tried, tolerated, refused, etc.; food log from parent
2) break foods into categories to look for patterns
3) determine if hypo or hyper; assess responses (oral, whole body, feeding) to diff stimuli
4) rule out motor-based feeding disorder- can be in conjunction w/ sensory disorder
5) consider family mealtime habits, customs, and routines
6. ) BEST QUESTION TO ASK: “Does your child eat what the family eats (within reason) or do you have to make a special meal for him/her each time?”