Sometimes food hasn’t even hit the table and your child is gagging and crying – saying, “I’m not going to eat that!” Maybe even just the smell of something is enough to completely send them running.
You’ve been watching this happen, thinking, this just doesn’t feel right. You’re worried that these big reactions aren’t typical, but don’t quite know what’s going on. Read on to find out if sensory food aversion could be playing a role in your child’s picky eating.
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How does our sensory system work?
First, it’s helpful to understand how our sensory system works, as you try to understand what a 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, could be experiencing a response that they can’t control.
When we encounter 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 the food is too hot, spit it out.
- If a drink “goes down the wrong pipe,” cough.
- If the bite is large, chew until it’s small enough to swallow.
What is sensory food aversion?
Some children can be over or under sensitive to sensory inputs during eating, causing aversion to certain foods because of its sensory properties. 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 an exaggerated negative response and strong food preferences or aversions.
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.
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 what’s provided at a party.
On the opposite end of the spectrum, a child with sensory food aversion might dislike the sensory experience of a large number of foods, or even eliminate entire food groups.
Many kids that struggle with sensory food aversion end up being labeled ‘picky eaters,’ although their challenges are more significant than a typical picky eating phase.
Eating becomes quite stressful for these children as they are experiencing sensory challenges every time they eat, which is typically 3 to 6 times a day!
Is Sensory Food Aversion the same as Sensory Processing Disorder?
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 comes 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. 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 a sensory processing disorder.
Sensory processing disorder is often seen as a part of another developmental disorder, such as autism spectrum disorder (ASD)(1). A medical provider often considers the disorder a concern when it is severe enough to disrupt normal functioning as part of everyday life.
If a child has sensory food aversion, it does not necessarily mean they have sensory processing disorder. However, sensory food aversion often occurs in children with sensory processing disorder.
Treatment for SPD involves physical and occupational therapy to help your child become accustomed to sensations. If you have concerns about possible sensory aversions, it’s important to bring the concerns to your child’s pediatrician.
Could there be another reason for sensory preferences?
The root cause of eating challenges can be difficult to identify, since many different causes can present in the same way. Additionally, eating challenges are often a result of a combination of factors.
Two of the most common challenges that are confused for sensory food aversion are:
- Oral Motor Difficulties
- Negative Associations
Oral Motor Difficulty versus Sensory Food Aversion
Although it may seem very clear that your child is avoiding certain sensory experiences related to food, it does not automatically mean they have sensory food aversion. A child’s big reactions to food could be a result of difficulty with chewing or swallowing.
Children can learn very quickly what foods are a challenge to chew or swallow and avoid those foods.
For example, they might avoid all hard to chew fruits and vegetables (raw carrots, apples with skin, etc.). It can appear that they don’t like these foods because of their texture, but in reality, they don’t want to eat them because they are difficult to chew.
This scenario also commonly occurs with meat that is difficult to chew (steak, ham steak, pork chops, etc.). You may feel like your child just prefers chicken nuggets and meatballs because of the texture, but in actuality, the ground meat is 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 swallowing.
If any of these skills are lacking, a child can start to avoid categories of food based on texture, leading you to think they have sensory food aversion. In reality, they are showing preference for foods that are easier to handle in their mouth.
Oral-motor difficulty 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 ability to chew or swallow, it’s important to bring them to your child’s pediatrician.
Negative Associations versus Sensory Food Aversion
Another reason a child could be avoiding certain categories of 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 needs supplemental oxygen, and can 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, allergic reactions, or chronic constipation.
Additionally, negative associations can be formed from stress at eating times. If eating times are anxious and unhappy, 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, rewiring the brain and replacing negative associations with positive ones. This is another important time to get support with feeding your child.
Could it just be a picky eating phase?
Ultimately, when a child is avoiding many foods, it can be difficult to distinguish between a picky eating phase, sensory food aversion, and the other causes shared here. In all scenarios, a child doesn’t like to eat certain types of foods.
In the end, we need to get to the root cause of a child’s food 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.
Symptoms of food aversion can look like this:
- A child’s rejections are consistent each day or meal and are often fruits, vegetables and/or meats.
- When a child is willing to try foods, their response to them is unusually large, such as gagging or vomiting.
- This child struggles to make progress with acceptance of foods after repeated exposures and reactions can get larger and include crying or becoming more stubborn.
In contrast, a child in a picky eater does not have difficulty tolerating the sensation of foods, and can reject foods for a whole host of other reasons.
Symptoms of a picky eating phase can look like this:
- This child rejects food to demonstrate their autonomy, in response to pressure or stress at meal times, when they are in a bad mood/are very tired, or because the food is new and unfamiliar.
- Their responses can change day to day or even meal to meal and are often milder such as complaining or spitting food out.
- With repeated exposure, this child will make progress, such as small tastes. They may still face a long road to eating and enjoying certain foods, but progress can be made at a slow pace with consistent exposure.
Determining if your child’s food preferences are sensory related
It can be difficult to distinguish the subtle differences in the many reasons that your child could be rejecting foods. Here are some additional behaviors you may see if a child is struggling to process sensations related to eating.
*Note that opposite extremes are included on this list as responses can be related to either under or over sensitivity. This is not an exhaustive list and is not meant to diagnose your child.
- 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)
- Having a strong temperature preference
- Preferring very strong flavors
- Being upset about hands being messy
- Frequently wipes hands during eating
- Enjoying messy eating/play
- Missing the stage of mouthing and chewing everything as a baby/toddler
- Excessively chewing on things (after this phase typically ends)
- Over-stuffing food into their mouth
- Having big reactions to touching foods
- Taking a long time to eat
- Not taking interest in eating or lack of appetite
- Being fearful of foods
- Preferring to use hands to eat rather than utensils
- Being very sensitive to smells
- Difficulty sitting at the table/fidgeting a lot
- Having a difficult time describing food or distinguishing the difference between two different foods
- Seems to eat past point of fullness and/or have no regard for when to stop eating
- Has very large reactions around food
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 factors. Often one cause leads to another and in the end they all contribute to a child’s limited diet.
What are the consequences of sensory food aversion?
Sensory food aversion is not just difficult for the child, but for the whole family.
If it causes an extremely limited diet, a child can be missing out on important nutrients for growth and development (2). Additionally, this causes significant and often all consuming worry for parents each time an eating opportunity presents itself.
It can also be difficult to eat outside the home and complete routine daily activities when a child eats a very restrictive diet and/or has large reactions to non-preferred foods (2). This makes travel, family gatherings, and birthday parties a struggle and results in missed opportunities for social-emotional learning for a child.
Because of these consequences, it’s important to connect with a provider to make a comprehensive plan to address sensory food aversion, as well as the other causes of eating challenges. Although it takes time, it is possible for a child with sensory food aversion to expand their eating options.
How is sensory food aversion treated?
For some children, the assistance of a full feeding team can be necessary. This can include an occupational therapist, speech therapist, dietitian, and physician. This feeding therapy team works together to build tolerance to sensations, correct nutrient deficiencies, and guide a child to trying new foods.
Helping kids with sensory food aversions at home
There are also many things you can do at home to support your child in decreasing their reaction to the sensory experience of food. Consider trying some of these options:
- Establish a good routine around eating times so your child knows what to expect. Having all parts of mealtimes be familiar when food is new can help ground a child.
- Reduce conflict and negative associations with eating time. Think about eating times as a time to connect with your child, not as a time to “get” them to eat something.
- Reduce sensory inputs in other areas. For example, use a solid color plate rather than one with pictures or patterns, keep portions of food small, dim the lights, reduce background noise, etc.
- 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 to build tolerance. This could include, using an electric toothbrush, touching food to help in the kitchen, and playing in different sensory mediums/getting messy (3).
- Use food chaining to bridge from liked food traits to new food traits with small changes over time.
- Make time for food play as a way to explore the sensory components of foods, work toward building tolerance, and maintain consistent exposure.
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.
If you’re struggling to identify the root cause of your child’s picky eating, check out the FREE course, Causes of Picky Eating. This mini course helps you identify why eating is a challenge in your house and walks you through finding the best next steps to address your challenges.
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Kim Slack is a Registered Dietitian, Quality Improvement Professional, Parent Coach and founder of On Your Table, LLC. She supports parents, so that they can support their children to learn to eat a varied diet. Kim has helped countless families have happier, calmer mealtimes and grow competent eaters. Kim also has 2 boys of her own at home. Learn more about her from her about page.