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Occupational Therapy

Mealtime Support

Some children struggle with the sensory aspects of certain food types and will avoid the food they find overwhelming.

Sensory triggers can involve appearance (colour or shape), texture, smell and taste. Selective eating is not always a problem. Everyone has preferences, your child may exclude specific food but still have a balanced diet!

Eating is an experience which involves all our senses. It is important to understand 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 feel too hot for others.

Children who refuse foods or have a very restricted diet are dealing with a lot of information. However, for some children, there appears not to be a sensory element restricting their diet, and it is their dislike of change and preference for sameness that can contributes to issues around food.

Dive Deeper

Increase Exposure

If the range of food your child will tolerate is very limited, slowly aim to build up what they will tolerate over time. Studies show that children need to see or try a food at least 10 times before they are able to accept it.

  • You can do this in a positive way. Have the food present on the table or their tray but have no expectation that they will eat it. Don't overload their plate with non-preferred food and always try to serve alongside ‘safe’ food that you know your child will eat.
  • Try and eat together as a family so your child is able to watch others eating and trying foods. Seeing others eat the non-preferred food can make it look more appealing!
  • If your child doesn't want to put food on their plate it can be put on the ‘learning plate’ - a small separate plate on the side.

Explore Food

Eating is the last step when interacting with food. Start by helping your child explore food, using all their senses.

  • Compare smells, explore textures with hands and describe the appearance of different foods
  • Set up play activities using food. Jelly could be a pond with play animals in or they could use diggers or trucks in a bowl of cereal or oats
  • Involve your child in food preparation. Make it clear that no eating is expected of them. 

The following 7 steps can help adults to consider the lead-up to accepting new food. Sometimes it might be helpful to relax typical mealtime etiquette to encourage exploration.

  1. Accept new food nearby
  2. Explore food without touching (spoon/ fork)
  3. Smell or describe visual elements of food
  4. Explore food with hands
  5. Lick food without putting in the mouth
  6. Bite and spit out food
  7. Swallow food.

Using Utensils

For lots of children, mealtimes can be a frustrating and messy experience. Many find it particularly difficult to co-ordinate the use of a knife and fork. This can impact on their confidence.

Good positioning at the table is important. Ensure they sit tucked into the table, with feet supported (use a footrest if necessary), and back against the chair.

Sitting at The Table

It is important to consider where your child sits to eat. Sitting well supports their stability and balance, which allows them to use their hands effectively. If your child isn't comfortable or supported, they put a lot of effort into sitting and this can distract (even subconsciously) from eating.

For many busy families, mealtimes can be a great time to catch up on everyone’s news; it is a good way to help your child learn the social skills of sharing and listening to others.

Backward Chaining

When teaching a new skill we often start at the beginning. This can be challenging for children sometimes as they get frustrated. You can give your child a sense of achievement by using the backward chaining technique. Backward chaining is particularly useful when learning self-care skills like dressing or feeding yourself.

What is Backward Chaining?

You start by breaking the task down into small steps. You teach your child the last step first, working backwards from the goal.

You complete all the steps except the last one. You get your child to practice the final step. They will enjoy the success that comes from completing a task. Once your child can do the last step you complete all the steps except for the last two. You teach your child the second from last step and they then complete the last step themselves. Even more success! Keep going until you are teaching them they whole sequence.

This is a particularly useful technique to use when teaching a child how to use cutlery.

Calmer Eating Strategies

Many young people with sensory sensitivities have eating and drinking difficulties. Difficulties can be chewing or can present as behavioural issues such as biting or grinding teeth. Difficulties can range from the very restricted or limited diet (due to taste or dislike of how it feels/habit) to mouthing objects (food and non-food). Some food or drinks make us feel calm, others make us more awake. Everybody is different but you and your child will know what is relevant to you.

Use this information to plan a calmer mealtime. Introducing some of the activities prior to mealtimes may help your child accept new foods or experiences. Using activities that stimulate the mouth can have an organising effect on your child’s behaviour, as deep pressure through biting can help calm their senses. Using these ideas at the right time can help decrease biting and help your child ‘feel’ where their mouth is, so activities such as feeding, or drinking are easier.

Deep Pressure Touch – Mouth

Heavy pressure across the roof of the mouth is usually calming.

  • Food (particularly chewy food)
  • Support your child to use a baby toothbrush to provide deep touch pressure to the roof of their mouth. Toothbrushes with a mouth guard, which prevent insertion are available from many shops. Electric or vibrating toothbrushes can be a good way to reduce sensitivity in the mouth, but make sure use is on your child's terms and never forced.
  • Food textures that encourage biting and crunching are also sometimes helpful and worth trying.

Experiencing Taste & Textures

Food can be an easy way to give sensory and tactile experiences to the mouth. Cold food can be useful to ‘wake up’ your mouth before you eat something else.

Cold (to wake up)

  • Ice lollies or drinks
  • Fruit juice frozen in ice cubes
  • Frozen fruit or vegetables - grapes, bananas, peas or carrots.

Chewy (to organise and calm)

  • Hard cheese or string cheese
  • Cereal bars
  • Dried fruit
  • Chewy sweets e.g. gummy bears, toffee bars.

Crunchy food (to alert)

  • Raw fruit and vegetables
  • Breadsticks, crisps or dry cereal
  • Nuts, crackers or popcorn.

Spicy food (to alert)

  • Hot salsa
  • Curries, chilli or Mexican food.

Sucking & Blowing

Sucking and blowing during play can help ‘work out’ the muscles in the mouth and can give positive experiences that are not connected to eating.

Sucking

  • Using longer, curly, thinner straws or bundles of straws
  • Use a straw to drink yoghurt, fruit puree or smoothies
  • Sucking frozen fruit or ice cubes
  • Lollipops or hard sweets
  • Water bottles with ‘sports tops’.

Blowing

  • Blowing bubbles using a straw in a cup or bowl
  • Blowing bubbles in drinks
  • Musical instruments.

Tugging, Biting, Pulling or Teeth Grinding

  • Liquorice
  • Straws
  • Chewy toys designed to improve jaw strength (chewy tubes)
  • Toffee bars
  • Water bottles with ‘sports tops’.

Information Sheets to Download

Using a Cup

Download

Using a Fork

Download

Using a Knife & Fork

Download

Using a Knife

Download

Using a Spoon

Download

Crockery Equipment

Download

Cup Equipment

Download

Cutlery Equipment

Download

High Chair Information

Download

Protective Clothing For Feeding

Download

Fussy Eaters

Download

Who Can Help?

Children's Occupational Therapists work with children from birth to 18 (or 19 if attending Complex Need schools). If your child or young person is under the Occupational Therapy teams, you can speak to them about any questions you may have.

If you think your child requires specialist support, please speak to their GP.

If you have any questions about your child or young person's general health or development, you can contact the Healthy Child Programme by calling Just One Number on 0300 300 0123 or texting Parentline on 07520 631590. Our opening hours are 8am-6pm Monday-Friday (excluding bank holidays) and 9am-1pm on Saturdays.

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