PARA ESPAÑOL, HAGA CLIC AQUÍ
Sensory processing challenges can make family dinners difficult for everyone. Far more than typical “picky eating,” sensory issues cause physical reactions to foods and to the dinner table environment that are more extreme than parents might expect. At mealtimes, our senses are bombarded with everything from smells to tastes, textures, sounds, and even lighting within the room. For a person with sensory sensitivities, any one – or all – of these pieces of input can cause extreme discomfort. It’s no wonder that parents often name sensory sensitivities as a top mealtime challenge!
What are sensory sensitivities, and how can sensory processing challenges impact family dinners? What should parents know about sensory issues at mealtimes? What are some signs to look for? And, most importantly, how can families deal with sensory sensitivities and challenging feeding behaviors, so shared meals can be welcoming for everyone?
What’s the Difference Between Picky Eating and Sensory Processing Challenges?
Up to 20 percent of parents report that their preschoolers are often or nearly always very selective about food. So how can you tell if your child is a typical “picky eater,” or whether there’s something more serious going on? We asked Melanie Potock, MA, CCC-SLP to help clarify the distinction.
“The main thing is, if it’s stressing out the family, we need to address it now,” she says. “When there is stress over the feeding relationship, it can create a wave of challenges that take time to resolve.” But to help parents further evaluate their child’s eating habits, she outlines the following “red flags” that may indicate the need for professional help:
- Obvious medical issues related to the child’s eating habits, like weight decline
- Challenges should be consistent for 3-4 months
- Meltdowns that are very disruptive to family meals occur frequently unless the parent is a “short-order cook” and meets the child’s feeding demands
- Food variety is extremely limited
Potock stresses that it’s better to catch potential feeding issues early, so if parents are worried, it’s a good idea to approach the child’s doctor with a request for a feeding evaluation.
What Parents Should Know About Sensory Processing Challenges
Many people associate sensory processing challenges with the autism spectrum. While people on the autism spectrum are highly likely to experience sensory issues, they’re not the only ones. Many children exhibit signs of sensory sensitivities, and they’re relatively common among people with ADHD or other learning differences as well. Some experts believe that Sensory Processing Disorder should be considered a standalone diagnosis, illustrating the fact that it’s possible for people to struggle with sensory integration even without another diagnosed condition.
It’s also possible to have some symptoms of sensory issues, without necessarily rising to the level of a disorder. Experts generally agree that in order for issues to rise to a “clinical” level, the symptoms need to negatively impact one or more areas of everyday life. This can be a tricky line for parents to navigate. When does a child’s fussiness about touching and smelling certain foods, for example, cross the line from picky eating to an impairment? What’s the difference between a child with a typical “strong will” at the table, and a child who’s melting down because they’re actually experiencing real anxiety and discomfort they can’t control?
“Children communicate through their behavior,” says Naureen Hunani, RD., a pediatric and family dietitian who specializes in neurodiversity and weight-inclusive practices. “If he melts down during dinner, what is he telling us?” She cautions that parents who don’t know how to tell the difference between a sensory issue and willful behavior may cause more harm by reacting with discipline. “Parents may pressure kids to eat foods when they have aversions to those foods, and that can cause trauma,” she says. “Neurodivergent children are more likely to experience trauma because the world isn’t set up for them.”
Dr. Martha Straus, Psychology Professor at Antioch College and international expert on attachment and trauma, agrees. “We treat kids differently if we think about this as a control issue. But really, it’s not about control so much as it is about tactile or sensory defensiveness. They’re overwhelmed, or the foods are unfamiliar. If you think about it as overload, then caregivers will engage with less emotion. We really need to focus on the adults being regulated at mealtime, not the kids.”
What Do Sensory Sensitivities Look Like at Family Meals?
The most common clue that a child might be struggling with sensory sensitivities at mealtime is food refusal. “Kids with sensory-based challenges won’t tolerate smells, textures, how food looks,” says Jennifer Stornelli, an Occupational Therapist specializing in Pediatric Feeding Issues at Spaulding Outpatient Center for Children. “Sometimes a child will play with food but won’t put it in their mouth, or will put it in their mouth and then spit it out. Parents will come (for help), saying that kids are refusing to eat.” But what’s causing the refusal is the child’s unique processing of all the sensory information that comes with the food.
“Food sensitivity and selectivity is pretty common,” Dr. Straus emphasizes. “(Often, kids) can’t stand to have foods touching, or can’t stand certain colors and textures. They’re overloaded and not integrated. Their difficulties with sensory integration show up in other arenas too: Their socks need to line up in a certain way, strong smells are upsetting, tags have to be taken off.”
Sensory processing issues don’t always look like aversion. Sensory challenges exist on a spectrum; at one extreme, there are people who are hyper-sensitive to input, who might gag or even vomit at smelling, touching, or tasting an undesirable food. They might exhibit what looks like fear, panic or tantrum behavior if the lighting is too bright or the music is too loud, or seem unusually sensitive to things like the temperature of the food or the way the napkin feels on their face. At the other extreme, there are people who are hypo-sensitive to input. For these people, it’s as if their experiences are muted; they might exhibit sensory-seeking behaviors like smearing foods with their hands to get a sense of the texture, fidgeting uncontrollably or bouncing, wiggling, and dancing instead of sitting still, or craving and even demanding strongly flavored and textured or highly aromatic foods like sucking on lemons, crunching ice, or adding large amounts of spice and salt to food.
Bob Cunningham, Executive Director for Learning Development at Understood.org and former Head of School of the Gateway School, says that it may be difficult for some kids with sensory processing challenges to explain what’s bothering them. He recalls working with a particular family whose 6-year-old child had developed sensory sensitivities after a traumatic brain injury. “She had a lot of food sensitivities and olfactory challenges, and she didn’t like the smells of the foods her siblings were eating,” he shares. “Her siblings had difficulty with that. We were working through her anxiety…it took us a few weeks to figure it out. She couldn’t explain that it was the smell; she didn’t know she was reacting to the smell. It was just, ‘I don’t like it when they are eating broccoli and boxed mac and cheese.’”
The struggle to communicate about sensory experiences, along with the fact that many of the signs of sensory overload or seeking behavior can look to parents like disobedience, can make it difficult for caregivers to recognize the signs and respond appropriately. Also, internalized expectations about what mealtimes “should” be like, what foods a child “should” eat, or what constitutes “good manners” can cause conflict for parents who have trouble letting go of their beliefs. But dealing with sensory challenges at meals takes patience, creativity, and empathy. “In the disability community, there is a lot of ableism and lack of compassion,” Naureen Hunani says. “Families will look different from what people think they should look like. Lots of accommodations need to be made. Sure, it’s hard that you have to eat just what your child eats, but you can meal plan so that everyone can have food preferences.” She cautions parents to remember that children who are struggling with sensory processing challenges aren’t choosing to behave in a certain way; they can’t be expected to eat and behave at the table in the same way as a typically developing child, so the family needs to adjust in order to make everyone comfortable.
What Can Parents Do To Help Kids With Sensory Processing at Mealtimes?
The good news is that, while challenging, sensory issues don’t have to totally derail your family dinner plans. There are a number of ways to help kids cope with sensory input, starting with identifying the major challenges or triggers that are most disruptive to your shared meals. Once you know what is bothering the child, it’s easier to make a plan to create a more welcoming mealtime environment. But stay focused, says Megan Mayo, MA, BCBA, LBA and doctoral candidate in clinical psychology at Antioch University New England. “Don’t work on too many things at once. For example, if a child is food smearing as well as having difficulty sitting for a whole meal, perhaps initially you’ll work on the food and not worry about sitting for the meal until things improve.”
To help with taste and texture aversions:
- Name, acknowledge, and limit offensive foods. Most parents want their children to eat a wider variety of foods, and may feel pressured to push kids past their aversions. But that may not be realistic for all kids, and it may not even be necessary. “60% of the kids I see on the spectrum only eat 4 things and they do just fine, particularly if those foods are from several food groups,” says Dr. Robyn Thom, Child and Adult Psychiatrist at the MGH Lurie Center for Autism. She encourages parents to acknowledge that there are some foods that don’t seem safe to their children at the moment, and to serve those foods sparingly.
- But offer the food in baby steps. Dr. Thom gives the example of pairing a tiny piece of a non-preferred food with a larger portion of a favorite, like a big bowl of plain rice next to a very small bite of chicken. Or, Jennifer Stornelli suggests, let the child experience being in the same room with the food; then having the food on the table; then having the food next to their plate; then having the food on their plate.
- Play with the taste. Stornelli advises parents to let kids rate foods on a scale of 1-5, with 1 being the least preferred and 5 being the most preferred. Work with your child to find ways to move foods up the scale. For example, maybe offering the child’s favorite dipping sauce will take a food from a 2 to a 4. Or maybe it tastes better roasted than raw.
- Play with the texture. Similarly, Stornelli points out, the texture of a food can change depending on how it’s prepared. Sliced vs. shredded, mashed vs. cubed, boiled vs. raw…what makes the texture of a food more appealing to your child?
- Interact with the food, but don’t eat it. “We want to develop a safe relationship with a food before we put it in our mouths,” Stornelli says. Potock agrees. “Expose, Explore, Expand!” she encourages parents. “Expose kids to tiny samples consistently and lovingly, help them explore the sensory properties of food on their own terms and expand their ability to interact with the foods from there.” She gives the example of having a child help wash beets, then make beet tattoos, then help to make and taste beet hummus. Other ideas include encouraging your child to be a Food Detective, or, says Stornelli, simply having the child help cook and serve unfamiliar foods, even if they’re not yet ready to taste the food themselves.
To help with smell aversions:
- Label and reassure. Unfamiliarity can be a major source of anxiety for any child, but especially for a child with sensory processing issues. Naureen Hunani reminds parents that senses like the sense of smell are actually there to protect us and help us identify things that may be safe or unsafe. “It can be helpful to name an unfamiliar smell and reassure the child that it’s a safe smell.”
- Mask or replace the smell. Hunani recommends lighting a candle while cooking strong-smelling foods. Other ideas might include letting the child hold an object with a preferred scent, like a sachet, a favorite bar or soap, or a dish of cinnamon or ground coffee they can smell.
- Provide a change of scenery. Bob Cunningham advises thinking of easy environmental changes like opening a window or sliding door and allowing the child to be near the source of fresh air. But you could also adapt by serving the offending food outdoors, where the smell is more likely to dissipate, or by reaching a compromise like allowing the child to remove himself from the environment if the smell is too overpowering, then giving a cue to return once the food has been eaten or cleared away.
- Build tolerance to the smell. Stornelli recommends having the child smell the food in different forms. Does it smell different hot than it does cold? If it’s in a closed container, can you still smell it? What about when we crack open the lid just a bit? Can we work up to taking the lid all the way off? Maybe the child can tolerate smelling that food if they’re six feet away from it, but not closer; maybe they can tolerate being next to it if served cold, but not hot. Over time, the child may be able to sit closer or have the lid of the container open more fully if they’re exposed to the smell gradually in ways that feel safe to them.
To help with sensory seeking behaviors like food smearing:
- Ask yourself: Is this developmentally appropriate? Mayo reminds parents that some degree of tactile exploration with food – smearing, throwing, squishing, and “playing with” food – is absolutely to be expected for every child. Since kids all progress at different rates, age isn’t always the best gauge. Kids who have more challenges around food, eating, and mealtime behavior may still need to be progressing through a tactile phase with food later than their age peers, and patience may be the best response.
- Set up for success. Touching, smearing, and exploring food with the hands is an important way for kids to feel safe and comfortable with the food item before they eat it. It may be crucial for a currently selective eater to play and explore so they can eventually move on to trying the food. Stornelli advises setting up the child’s eating environment to make messy food play less of a concern. She encourages parents to spread a towel or sheet under the child’s chair, give the child a little more space at the table, and offer something like a tray or vinyl mat to mark out their space and help keep the mess from spreading.
- Provide tactile opportunities outside of meals. To provide an alternative to exploration at the table, Mayo recommends supporting a child’s need to smear and play with food in other ways. Try one of these Sensory Center activities to allow kids to get sensory input from food without disrupting dinner.
- Set boundaries. Even though tactile exploration is important, it’s also a behavior that will eventually become less socially acceptable as a child grows. It can also be upsetting to others at the meal if the exploration extends to shared foods or food on others’ plates. Cunningham and Stornelli both agree that a boundary should be set as soon as possible, explaining to the child that they can explore and touch what is on their plate (or on their mat/tray if you’re marking out a space for them), but not anything else. If need be, Cunningham recommends setting a visual barrier like a taped line to reinforce what’s off-limits.
To help make the dinner environment sensory-friendly:
- Reduce. That means reducing the amount of stimulus in the environment, from what a child sees to what they hear and how things feel. Stornelli recommends parents turn off televisions and gadgets and reduce clutter at the table to minimize challenges to a child’s visual system. Play softer, more soothing music, or no music at all – your child may want or need to choose a certain playlist or have a transition song that helps them feel calm and ready to engage at meals. Also consider lighting (is it too bright or harsh?) and easily changed items like napkins (are the paper ones too scratchy? Would the child willingly use a soft cloth instead?).
- Or add. Maybe there are support items that need to be added to your mealtime space to help your child feel comfortable. “What sensory inputs might the child need?” Stornelli asks, listing items like an air cushion for the seat, stretchy bands for the legs of the chair that provide input for their feet and ankles, or a closed chair or bench seat that can be filled in with pillows to provide a sense of safety and boundaries.
- Plan for transitions. Sometimes, successful meals are more about what happens before the family gathers at the table. Building in 15 minutes of active playtime, or making space for pre-dinner activities like bubble-blowing, jumping, dancing, or an obstacle course, can help kids get the sensory input they need before mealtime. Likewise, a family breathing exercise like 5,4,3,2,1 or Humming Bee Breathing at the beginning of the meal can help keep anxiety at bay.
Ultimately, sensory processing challenges can add to mealtime stress for parents and kids alike, but the most important takeaway for parents is to practice acceptance, patience, and understanding. “We need to help parents not take it as a reflection of their parenting skills,” Mayo says. Stornelli and the other experts we spoke to agree that despite the frustration a parent may feel, it’s important – especially for the child – to take the pressure off. With time, care, and practice, families can make adjustments to their shared meals to make the table a welcoming and sensory-friendly place for everyone.