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What is sensory food aversion?
When you eat, you are experiencing a large number of sensory inputs: appearance, smell, taste, texture, temperature and more. Children can be over or under sensitive to these sensory inputs, causing aversion to certain foods because of its sensory properties. If a child is experiencing this, it can become very overwhelming for them and as a result, their caregivers as well, especially when it happens 3-6 times per day. This exaggerated negative response to food, related to difficulty processing the sensory aspects of eating, is sensory food aversion. Due to a child’s reaction to food and eventual rejection of many foods they are often labeled, “picky eaters.”
It’s important to note that sensitivities occur on a spectrum. You may experience foods you don’t like because of its texture, but it’s just a handful of foods and it doesn’t impact your ability to eat a well-rounded diet, order food at a restaurant, or eat while at a large holiday gathering. On the opposite end of the spectrum, a child with sensory food aversions might dislike the sensory experience of a large number of foods, or even eliminate entire food groups. This makes it hard to get certain nutrients, requires that they take safe foods wherever they go, or prevents them from eating at all at a large holiday gathering that has even more sensory inputs.
As an example, a child that is over sensitive to the sensory properties of food might gag, spit food out, or vomit at the sight, smell, or taste of a food, eventually learning to avoid those foods entirely.
In contrast, a child that is under sensitive to the sensory properties of food might prefer crunchy foods over soft foods or over fill their mouth in an attempt to “feel” food.
Sensory food aversion is not recognized as a formal diagnosis. However, it is generally recognized as a condition by providers based on a child’s interactions with foods.
How does our sensory system work?
It’s helpful to understand how our sensory system works, as you try to understand what your child is experiencing when they reject food because of its sensory properties. Even though it might feel like they are rejecting it just to make your life difficult, they in fact, are experiencing a response that they can’t control.
When we encounter a food with our senses (sight, smell, touch, taste, texture, etc.), our sensory system takes in the information and sends it to our brain. The brain processes the information it receives and sends it to our motor system, telling our muscles how to respond. If a food is too hot, spit it out. If a drink “goes down the wrong pipe,” cough. When a child is having negative responses to the sensory properties of food, there is a disconnect in the sensory-motor systems processing the information about the food. The brain then tells the muscles to respond, but not in the way we would expect, and we see things like gagging, spitting food out, stuffing food, and more. Ultimately, we see strong food preferences or aversions and we have a “picky eater” on our hands.
Sensory Processing Disorder versus Sensory Food Aversion?
Remember, there is no diagnosis for sensory food aversion, however the term might be used if your child eats a very limited amount of foods because they have difficulty with how foods smell, taste, feel, or look.
At this time Sensory Processing Disorder (SPD) is also not a stand-alone diagnosis, although many health care providers acknowledge it as one. It refers to a general condition where the brain has trouble receiving and responding to information that come through the senses. Essentially the response is the same as sensory food aversion, but it can be related to inputs that are not food, such as clothing tags, loud sounds, teeth brushing, etc. A response to these inputs is seen as excessive or outsized for the input. One sense can be affected or multiple and a child can be over or under sensitive. Any child can have some symptoms associated with sensory processing disorder, but it does not mean they have sensory processing disorder. A medical provider often considers the disorder a concern when it is severe enough to disrupt normal functioning as part of everyday life. Sensory processing disorder is often seen as a part of another developmental disorder, such as autism. Treatment involves physical and occupational therapy to help your child become accustomed to sensations.
If a child has sensory food aversions, it does not necessarily mean they have sensory processing disorder. However, sensory food aversions often occur in children with sensory processing disorder. If you have concerns about possible sensory aversions, it’s important to bring the concerns to your child’s pediatrician. They can refer you to an occupational therapist to work on increasing your child’s tolerance of sensations.
Oral Motor Difficulty versus Sensory Food Aversion
Although it may feel very clear to you that your child is avoiding certain sensory experiences, it does not automatically mean they have sensory food aversions. Their reactions could be a result of difficulty chewing or swallowing. Once this difficulty occurs, children learn what foods are a challenge and avoid those foods. For example, they might avoid all hard to chew fruits and vegetables. It can appear that they don’t like these foods, but in reality, they don’t want to eat them because they are difficult to chew. This scenario can also often occur with meat that is difficult to chew. You may feel like your child just prefers chicken nuggets, but when in actuality, the ground meat in a nugget is just easier for them to chew.
When a child eats, there is a lot they need to control and coordinate in their mouth. They need to use their tongue to push food to their molars, move their jaw in the correct chewing motion, and then again use their tongue to move food to the correct location for swallow. If any of these skills are lacking, a child can start to avoid categories of food and prefer those that are easier to handle in their mouth. Signs a child is having oral-motor challenges include refusing foods, gagging, vomiting, or spitting out foods. Instead, they may prefer foods that easily melt when chewed or are soft.
Oral-motor challenges can result from lack of muscle control or coordination, pain in the mouth or throat, dental problems, or physical differences in mouth structure. If you have concerns about your child’s reaction to foods, it’s important to bring your concern to your pediatrician so you can be referred to speech therapist to help.
Picky Eating versus Sensory Food Aversion
When a child is avoiding many foods, it can be difficult to distinguish between picky eating, versus an actual sensory food aversion. In both scenarios, the child doesn’t like to eat certain types of foods. However, they can be distinguished by the child’s reason for rejection.
A child with a sensory food aversion is rejecting and avoiding foods because they are over or under sensitive to the food due to a sensory issue. Their rejections are consistent each day or meal and are often fruits, vegetables or meats. Initially when they are willing to try foods, their response to them is unusually large, such as gagging or vomiting. They do not make progress with acceptance of foods after repeated exposures and reactions can get larger and include crying or becoming more stubborn.
In contrast, a picky eater does not have difficulty tolerating the sensation of foods, and can reject foods for a whole host of other reasons. Picky eaters reject food to demonstrate their autonomy, in response to pressure or stress at meal times, when they are in a bad mood or are very tired, or because the food is new and unfamiliar. A picky eaters’ responses can change day to day or even meal to meal. Their response is often milder such as complaining or spitting food out. With repeated exposure, picky eaters will make progress, such as willingness to touch or lick foods. They may still face a long road to eating and enjoying certain foods, but progress can be made at a slow pace.
Negative Associations versus Sensory Food Aversion
Another reason a child could be avoiding certain foods is due to negative associations. When a child routinely experiences pain, discomfort, or stress while eating, they start to form negative associations with eating, even if the actual food is enjoyable. Once that association is formed, children can continue to avoid foods, even after resolution of the problem. For this reason, many parents don’t even realize that a negative association of the past could be making eating difficult now. Even a child that can verbalize their discomfort may not know the words to do so, or even realize that what they are feeling is not the norm for everyone when they eat.
Pain or discomfort while eating can be caused by many things, over the course of a child’s life. It can include breathing difficulty as early as birth, such as a baby that is born premature and needed supplemental oxygen, and span through to a child with chronic allergies that routinely can’t breathe due to congestion. A child that has heart issues is often tired and can have a decreased oxygen supply related to their heart condition, again resulting in breathing difficulty that impacts eating. Children that have any type of digestive issues throughout their childhood are also prone to forming negative associations with eating. This could include reflux, eosinophilic esophagitis, or chronic constipation.
Additionally, negative associations can be formed from stress at eating times. If eating times are anxious and unhappy times, a child learns that they don’t want to come to the table to eat. This could result from arguments among family, pressure to eat certain foods or certain amounts, or only being served disliked foods. Even after removing the cause of the negative association, it can take a child a bit of time to come back around to being comfortable in the eating environment, and replace negative associations with positive ones.
Determining If Your Child’s Food Preferences Are Sensory Related
It can be difficult to distinguish the subtle differences in these many reasons that your child could be rejecting foods. If your child has many of the behaviors in this list, it is possible that sensory issues with food is one reason for your child’s food preferences.
*Note that opposite extremes are included on this list as responses can be related to either under or over sensitivity.
- Gagging at the sight, smell, touch, or taste of foods. (This is different from a baby gagging as they begin to learn to manipulate food in their mouth during early eating.)
- Having a strong texture preference, often crunchy or soft foods.
- Dislikes getting hands messing related to food or any other activity, such as digging in the dirt or finger painting.
- Missed stage of mouthing and chewing everything as a baby/toddler
- Excessively chews on things, after this phase typically ends
- Overstuffs food into their mouth
- Oversensitive to touch, including disliking things like tags on clothing, certain fabrics, etc.
- Being extremely frightened by loud noises
- Not liking bright light
- Feeling very overwhelmed by crowds
It’s important to note that even if your child’s picky eating is related to sensory food aversion, it is likely not the only cause. Picky eating has many layers and is almost always the result of multiple causes. Often one cause leads to another and in the end they all contribute to a child’s limited diet.
Dealing with your Child with Sensory Food Aversions at Home
While the assistance of a feeding team can be helpful and for some children, absolutely necessary, there are things you can do at home to support your child in decreasing their reaction to the sensory experience of food. In fact, many do not even need to be directly related to food, but more importantly are experiences with different sensations that can be less intimidating and perhaps even fun.
- Establish a good routine around eating times so your child knows what to expect. Reduce conflict and negative associations with eating time. The Mastering Mealtimes course walks you through setting the necessary foundational pieces to help any child expand their diet.
- Reduce sensory inputs in other areas that are triggers for your child (noise, bright lights, etc.). Having a solid color plate rather than one with pictures or patterns, can be helpful to some children, as well as keeping portions of food small.
- Use descriptive words about the food, so your child can learn to explain what they do or do not like about foods. This can help you determine other foods to offer to expand their diet. 101 Descriptive Words for Food Explorers is a great book to help kids learn descriptive words.
- Incorporate sensory input into daily routines, such as, electric toothbrush, touching food to help in the kitchen, and access to sensory play experiences.
- Use food chaining to bridge from liked food traits to new food traits with small changes over time. The Mastering Mealtimes course, can help you learn more about this strategy and implement it at home.
- Do food play with your child as a way to explore the sensory components of foods and work toward getting comfortable tasting them. The Explore Food Membership helps parents make and implement food play plans that fit into busy lives, so they can help their child make progress at home.
And remember, kids are always developing and changing. They have great potential to overcome barriers and desensitize to sensations that they are struggling with now. They can build new and positive associations, which over time lead to great progress. The sooner you can start to implement strategies the better, so they can move forward to eat more variety in the long term.
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Kim Slack is a Registered Dietitian and founder of On Your Table LLC. She coaches parents on feeding strategies and parenting styles that support children to expand the foods they eat. Kim has helped many families have happier, calmer mealtimes and grow competent eaters. Kim also has 2 boys of her own at home. Learn more about her here.