What is sensory defensiveness?

Sensory defensiveness is a type of hypersensitivity that often includes anger or fear towards certain stimuli, and is highly emotional. The stimuli can be tactile, auditory, smell, or taste. When children experience this with food texture or taste, they can get very defensive and refuse food altogether, become fearful of food, and begin to thoroughly examine the food they are about to eat. Children can also experience emotional responses to the food such as screaming, hitting, gagging, vomiting and throwing the food (Morris, 2000).

                  Interaction Patterns between the feeder and the child is a very important one; it creates a bond and helps develop the importance of mealtime experiences. If the child has sensory defensiveness, they can give the feeder confusing messages while feeding. Since the reaction to specific sensory information can be an emotional one, the feeder can interpret their messages as unwanted behavior or as the child not wanting to eat altogether. This creates stress for the child and the feeder and can cause nutritional deficiencies. A child with sensory defensiveness may not react the same way to every bite of food. One bit may not stimulate a defensive reaction while the next bite will make the child react negatively. Things such as the way the utensil is entering the mouth can trigger the emotional reaction.

More than the food that is presented can also cause sensory defensiveness at mealtimes. Noises and lights can have an impact on mealtime for a child with sensory defensiveness. Mealtime interactions are a very important part of development for the child, so when the sensory defensiveness begins to interfere negatively with the mealtime interaction, modifications need to be made.

Understanding the Interaction Patterns

Hyper-sensitivity

Oral Tactile: The child will react negatively to being messy around their mouth and may have adverse reactions to specific textures and/or feeding tools.                                                   * Use a firm touch with wiping the face. (see activities)

Olfactory/Gustatory: The child will prefer bland foods. Certain smells may cause gagging or vomiting. They will often be a very picky eater and often refuse different types of food.

Hypo-sensitivity

Oral tactile and Proprioceptive:  The child may have atypical chewing patterns such as lengthy chewing or even swallowing food whole. They might pocket food in their cheeks. They are typically messy eaters. Choking or vomiting is not uncommon.

* To prevent choking modify food texture to chopped and present food in   small pieces.
* Pocketing food or extensive chewing – increase sensory properties of food and pace the bites. Be aware of the child’s visual and verbal cues.

Olfactory/Gustatory. The child might be disinterested in eating without enhancement of smell. They often prefer crunch and highly flavored food.                                                                * Gradually introduce new smells, labeling smells as possible flavors.

With any refusals to accept modifications remember that gradual subtle changes are best.

Force-feeding is not the answer!

Modifications for success during mealtimes

Preparation: Preparing the environment, food, and sensory experiences contributes to success.

Environment: reducing noise or lights in the dining room. The addition of music can have a calming effect for some children. Music can also help the child organize the sensory information.

Food: listen to the child; they will let you know what they don’t like. This can often be frustrating for parent but keep in mind preferences may change daily. It is important to pay attention to how your child is responding. Allow the child to help you choose the foods that work for them, and be sure to be able to adapt those sensations to get a favorable response from the child.

Introduction of new foods: utensils or favorite toys can be dipped in food to introduce new flavors. Remember, gradual changes are best. (Morris, 2000)

The body: Slowing down the vestibular system helps to slow down your child’s integration of sensory information.

*  Rocking with the child.
* Carrying the child up & down the stairs.
* Swinging the child.
* Use a big ball to roll or bounce on a ball.

Massage: touch that is firm but caring/gentle Light touch can over stimulate children.
Begin with firm pressure in less sensitive areas of the body and gradually work towards more sensitive areas.

Routine activities/Before feeding activities

Providing deep input to the joint and muscles helps your child to integrate sensory information such as; clapping, bouncing, marching, jumping, or pushing larger toys.

Toothbrush activities help with oral defensiveness. Always let your child know what you are doing and why. 

Have an adult soft toothbrush and take turns showing them on your mouth.                 Products such as a NUK trainer set are great tools to help the child explore their mouth.   

With your child’s permission, on their face, begin with firm even strokes on the cheeks then move towards the chin.

With your child’s permission, gently brush his lips, gums and sides of tongue and surface of teeth with a NUK  brush or finger toothbrush. Gradually introduce new textures such as a soft washcloth or sponge. With any of these activities, your child will let you know the appropriate amount of stimulation.

Watch for cues. These activities can be incorporated into a before mealtime routine to help the child become better organized to enjoy and participate in mealtime.

 “UNDERSTANDING THAT THE BEHAVIOR OF THESE INDIVIDUALS, IS THE RESULT OF A CONSTELLATION OF NEUROBIOLOGICAL IMPAIRMENTS RATHER THAN WILLFUL ACTS OF   NONCOMPLIANCE.” Twachtmean-Reilly, ET AL, 2009

Direct intervention and training in the use of these intervention techniques can be discussed with your speech language pathologist.

AnneMarie Finn MS CF-SLP

Additional Resources

• SPD Foundation-http://spdfoundation.net/
• NewVisons- http://www.new-vis.com/fym/papers/p-feed13.htm

References

• Greis, S.M.,Hunt, S.M. Textures Progression: The Effects of Oral Sensory Defensiveness on Oral Motor Function in ASD. The Childrens Hospital of Philadelphia Pediatric Feeding & Swallowing center. http://www.chop.edu/export/download/pdfs/articles/pediatric-feeding-and-swallowing/textureprogression.pdf.
• Morris, S.E., & Klein, M.D. (2000). Pre-feeding Skills; A Comprehensive Resource for Mealtime Development (2nd ed.). United States; TSB/Harcourt.
• Twachtman-Reilly, J., Amaral, S., and Zebrowski, P. (2009). Addressing Feeding Disorders in Children on the Autism Spectrum in School Based Settings: Physiological and Behavioral Issues. Language, Speech and Hearing Services in Schools. Vol. 39. 261-272.