The Impact of Visual Sensitivities on Feeding

As I mentioned in November, I recently attended the S.O.S. Feeding Conference.  I had personal interest in it, as the parent of two problem feeders.  And as a Speech-Language Pathologist, I figured that there couldn't be a better time to venture outside of just language and speech in my private practice.

Yesterday, I talked about how visual hypersensitivities can affect children with SPD.  At S.O.S., I learned that visual sensitivities can impact feeding behaviours.  For instance, children who throw food from the highchair or table most often have a visual hypersensitivity and are unable to tolerate having the foods so close to them.  I learned that the simple solution of increasing the space between the child and the food can significantly decrease or eliminate throwing behaviours.

Some signs that visual hypersensitivities may be affecting a child's feeding include:

- avoiding looking at foods
- attempting to scatter the food off of the table
- turning the body away from the food or closing eyes
- moving chair back from the table
- repeated eye blinking or eye watering
- squinting
- vomiting

Yes, you read that right.  

In some children who are extremely hypersensitive, just the sight of food can make them vomit.  This is NOT behavioural.  It is a physiological response from the body.  However, vomiting does not happen exclusively for visual hypersensitivities.  Vomiting can also be an indication of sensitivity to smell, touch, etc. 
 
In our house, Chloé had become quite the skilled food thrower.  I'm talking, cover the walls with whatever we're serving kind of food thrower.  The kind that makes you sigh that you just cleaned your kitchen floor.  Or never bother to clean it at all because it's just not worth the 30 seconds that it stays clean.  The minute she had something on her highchair that she didn't like, it went a-flying.  I would pick it up a bizillion times, tell her "no throwing" and put it back on the highchair, thinking that she needed to learn not to throw.  But she would just keep throwing.  Again, and again and again.  It seemed that nothing I tried got her to stop throwing.

I understand now that it was because she couldn't visually tolerate the food in her space.  This wasn't behaviour.  No wonder I didn't manage to change anything.  I wasn't responding appropriately.

When a child throws food, S.O.S.'s solution is to say to the child "food stays on the table".  You pick the food back up, but give the child an alternative that he/she can tolerate.  And what is tolerable will be different for every child.  One option is to tell the child "food stays on the table, but you can push it over here".  You pick the food back up and encourage the child to push the food further away from them with their hand.  

S.O.S. recommends that by 14 months of age, a child should be sitting at a table with a chair that lets them sit directly at the table (without a highchair tray).  You can check out an example of the chair my sister bought (and we will be getting shortly) here.  Booster seats also work well, as do chairs that hook right onto the table, such as this one here.  Having the child sit directly at the table allows the possibility of pushing the food further away from the child than if he/she is in a highchair.  You can push it right to the other end of the table (or the room), if necessary.

If the child can't tolerate pushing the food away with his/her hands, you can encourage him/her to push it away with a utensil.  Or to cover it up with a napkin.  Or brainstorm what else might work for your child.

Given that we have yet to purchase an alternative to our highchair, I've opted to go with "food stays on the table, give it mommy".  This works because Chloé has been able to tolerate touching the food long enough to put it into my hand.  If I had seen that this was too challenging for her, I would have had to find another solution. 

The idea behind this is that if you properly read your child's signals and only gradually try to challenge things that are difficult for them, in a really small, stepwise fashion, you will be able to gradually desensitize them to the elements of feeding that are challenging for them.  Research has shown that although using a very forceful approach (i.e. you will sit here and eat this no matter what) may bring short-term results, but will not get you anywhere in the long-run, as this will only create an even more aversive relationship with food.

A few little tips that I picked up from S.O.S. for kids with visual hypersensitivities:

1.  Using a divided plate can help minimize the visual impact of foods.  

2.  Only put a small amount of a food on the child's plate because the more that is on the plate, the harder it is for them to look at it.

3.  Purées are particularly distressful for children with visual hypersensitivities, since they do not have a defined form and can just run anywhere.

4.  It is easier to visually tolerate one large piece of a food than many small pieces.  Hence, once the child can handle the proper chewing/swallowing required without a risk of choking, being given 1/4 of a pear is much less visually stimulating than to be given 1/4 of a pear cut into little pieces.  Even though we're talking the same amount of food.

We've made a bunch of changes around meal times since I got back from S.O.S.  Some of these are related to our kids' visual hypersensitivities and some of them address other issues we've been having.  I'll share some of this with you shortly, as we've had some major successes over here lately.  In fact, I'm pretty sure that at least Chloé probably no longer actually qualifies as a resistant eater!