Food Texture Issues in Children: Sensory Integration
Many children suffer from sensory integration issues at mealtimes. Some children are unable to tolerate foods that are not smoothly pureed. Some children tolerate crunchy foods best. Many are unable to mix textures or perform oral requirements to suck, chew, or swallow. Often temperatures of foods can impact the ability to eat. Sometimes external stimulation can distract children with sensory issues.
In addition, parents and caregivers worry that children are not receiving adequate nutrition or are concerned that their children’s diet is too limited. These issues and concerns are common and require strategy and patience to address.
Signs and symptoms
According to the American Speech-Language-Hearing Association, these signs and symptoms of feeding and swallowing disorders may occur in children:
- Arching or stiffening of the body during feeding
- Irritable or unalert during feeding
- Refusal of food or liquid
- Failure to accept different textures of food (eg, only pureed foods or crunchy cereals)
- Long feeding times (eg, more than 30 minutes)
- Chewing difficulty
- Difficulty with breastfeeding
- Coughing or gagging during meals
- Excessive drooling or food/liquid coming out of the mouth or nose
- Difficulty coordinating breathing with eating and drinking
- Increased stuffiness during meals
- A gurgly, hoarse, or breathy voice quality
- Spitting up or vomiting frequently
- Recurring pneumonia or respiratory infections
- Less than normal weight gain or growth
As a result, these children may develop:
- Dehydration or poor nutrition
- Aspiration (when foreign matter, such as food, liquid, or secretions, passes through the level of the true vocal cords) or penetration (when foreign matter, such as food, liquid, or secretions, enters in to the laryngeal vestibule, but does not pass through the level of the true vocal cords)
- Pneumonia or repeated upper respiratory infections, which can lead to chronic lung disease
- Embarrassment or isolation in social situations involving eating
Management of symptoms
Management of symptoms is individualized, but the following tips may help.
Touching food: Allow children the opportunity to feel the foods with their hands. Touching cereal often is messy, but it helps children process what the food is going to feel like inside their mouth. Prepare to clean up messes. Begin with small amounts, so that the portion will not appear overwhelming.
New foods first: Start with foods that might cause concern, followed by foods that were successful in the past. Choose one new food or texture at a time and go slowly. It may take several attempts to quiet a gag reflex. Praise children for their efforts. Apply the one-bite rule supportively.
Oral stimulation: Provide oral stimulation that is not food or nutrition related. Allow the child to suck on a wet washcloth, chew on a pacifier, or gum a frozen carrot. Choose to put something sticky, such as marshmallow fluff, on the upper lip and have them suck it off.
Sensory stimulation: Remove all stimulation if the child is easily distracted. Other sensory stimulation can override hunger and successful eating. Turn off the television or radio, clear the table of items not related to the meal, and make sure the table is properly lighted.
Meals: Make sure everyone is eating the same meal. Modify textures less and less as time goes on. If the goal is to eat baked potatoes and only mashed potatoes are tolerated, mash the potatoes a little less each time you make them (so they are more chunky) to help children get used to the difference slowly.
Diagnosis: Work with a speech language pathologist (SLP), who may help to better diagnose the problem. SLPs are trained professionals who customize recommendations, techniques, and strategies to improve symptoms.
References and recommended readings
Feeding and swallowing disorders (dysphagia) in children. American Speech-Language-Hearing Association Web site. http://www.asha.org/public/speech/swallowing/feedswallowchildren.htm. Accessed April 16, 2013.
Growth and feeding: food issues of children. Children’s Disability Information Web site. http://www.childrensdisabilities.info/feeding/index.html. Accessed April 16, 2013.
Swallow Center glossary. Duke University Health System Web site. http://www.dukehealth.org/services/speech_and_audiology/care_guides/swallow_center/swallow_center_glossary. Accessed April 17, 2013.
Review Date 4/13