The joys of SPD and eating
Sensory Processing Disorder (“SPD”)
How does it affect eating and diet?
One of the biggest common elements of sensory processing for children is around food; struggling with the taste, smell and texture. Some to such a severe extent that they get diagnosed with ARFID. Far from being just “fussy eaters”, they will extensively avoid any foods that feel unsafe to eat.
This is why many children with sensory processing differences may typically only eat ultra processed food because they can guarantee it will look, smell and taste exactly the same every time, no surprises for their senses to contend with! With perishable foods such as fruit and veg, it can vary in look, sweetness, sourness, firmness and softness etc. One squidgy strawberry and it’s all over for that food group!
How many of us can relate to this issue? Probably a lot!
We all probably have varying war stories of times when we just wanted to sit and cry with worry over whether our child is getting enough nutrients to grow and be healthy. And let’s face it, leaning over the dinner table and saying to a four year old “now look my darling, this broccoli is going to help you grow up big and strong! Come on, eat up!” is not going to do much when they are visibly gagging over their plate at the mere smell and texture!!
With H, we had issues from almost day one. She wasn’t putting on weight as a baby and the ever so helpful community widwife told me that instead of feeding her every four hours, I needed to feed her every three. Right. So how was I supposed to do that exactly when she refused to feed? My mum suggested we left her to tell us when she was hungry and we quickly ascertained that H preferred a five hour feeding schedule.
But here is the interesting thing! I can now clearly see that her sensory processing differences meant that she wasn’t getting the hunger cues; those internal interoception signals just weren’t getting through cognitively. Until she was literally starving, and then the sensory signals would finally arrive she’d suddenly start screaming in desperation to be fed. In addition, the interoception cue that told her she was full up would seemingly kick in far too soon and she’d stop feeding before the end of the bottle.
My mum suggested that perhaps she just didn’t like milk and she’d be much better once she was weaned onto solids. Yes I thought! I will hang on to that!
Fast forward to the toddler years and we still had the same issues every day. The more I tried to get to her to eat (in the hope she would sleep better at night), the more she refused. We were still in the “too hungry to sleep, too tired to eat” wheel of doom!!
As we headed towards each mealtime, she’d start to show signs of desperate hunger but I knew if I let her have so much as two mouthfuls of small biscuit, she would refuse to eat any dinner. No dinner would mean no sleep that night. However, making her wait until dinner was ready would result in her blood sugars plummeting and she’d throw up. Game over for family mealtime that day.
I was honestly just crying constantly because I didn’t know how to get enough food into her at the right time. It was almost rendering us prisoners in our own home because we couldn’t feed the family and then go out! Or go out and then come home to dinner. The minute we got in the car to go anywhere, she’d say she was hungry even though we’d just tried to feed her before we left. Our car became a snack cafe on wheels.
Further fast forwarding to her now age of 11 and although it’s less severe, we still have blood sugar issues and throwing up episodes. The throwing up is now less common but she suffers a lot with migraines if she doesn’t have enough protein in each of her meals. Protein intake is apparently important for neurodivergent people - it can cause dysregulation if it’s not maintained throughout the day. It is certainly very true of lots of members of our family, H being the biggest sufferer!
Help - my child will only eat biscuits, chocolate and ice cream!
Hhhhmmmm, so after a few consultations with the professionals, it was concluded that H does not have ARFID because she could also eat cucumber, carrots and peas. So taking that out of the equation, we were left to deal with heightened food sensory challenges.
So how to work with that? My advice?
The more you push, bribe, persuade and insist, the more pushback you are going to get. Particularly if your child has a strong demand avoidance profile.
I really learned this the hard way, because I just could not let go and take my foot off the pedal.
When I was literally hanging off a cliff with this whole eating thing, I stumbled across an article about children who won’t eat (although I think it should be more about children who “can’t” rather than “won’t”).
Now for a child like H who has such strong demand avoidance, we were inadvertently creating an unhealthy relationship between her anxiety and food. If we let it continue through the early years and into adolescence, it could manifest as an eating disorder. Very frightening.
So that’s when my foot came off the push pedal. The advice was to do nothing. Stop asking her to eat - basically feed her whatever she wants whenever she wants it.
Phase one: the main aim being to break the cycle of bad association with food and to start cultivating a healthy relationship with eating.
Phase two: don’t ask her to eat anything specific at any particular point in time. The rest will come naturally over a period of time if you get the right framework in place.
So that’s what we did.
I am very proud to report that I took my new found independent parenting, without judgement, and we stepped into the light without apology to anyone for our methods. We pretty much let her dictate what she wanted to eat and we watched her enjoy eating it. Phase one was off to a great start and it was 100% the right thing to do. Homemade pancake every morning with half a jar of Nutella? No problem! You’ll be amazed how much protein there is in that although I am less keen to realise the amount of sugar it also contains! Nonetheless it meant a regulated morning every day - hurrah!
Only six pieces of pasta for lunch? That’s ok! Oh you are hungry again, just 20 mins later, no problem! What would you like? An ice cream, ok here you go!
Here come the parenting police!
Now for most parents, this goes against the very essence of good parenting, doesn’t it? What on earth?? This child is going to grow up thinking she can demand junk at the drop of a hat and everyone will rally round to indulge her.
Not to mention the food wastage. We have food recycling in our Council Borough - thank goodness they don’t charge by the bag for food waste.
Then there is the child’s dental health to worry about, and future health in adulthood.
I can assure you that every negative thought you are having about this, I have already had it.
Remember this though, phase one is a short and temporary moment in their life. It’s the foundation in which to build the house.
I do recognise that I had a slight unfair advantage at this point during phase one because we discovered that H was interested in baking. I am the only gluten free person in our house and we only keep “free from” flour at home but H took an avid interest in watching me bake whenever we had family gatherings to attend - so of course I jumped on that and H quickly became my sous chef!
Over time, her love of bonding with me in the kitchen extended to wanting to help me make savoury dishes, in particular mixing herbs and spices for Chinese or Indian dishes. This is a pivotal point for us but I was very careful to NEVER ask her to try something. Absolutely no pressure, just praise for helping (and then cooking her nuggets or pizza for dinner!).
One day, though, without any prompting, she asked to help me make a salad. She climbed up on the side while I chopped cucumber, tomatoes and red peppers. She was eating more cucumber than she was putting the salad bowl but that was fine! I made a joke and said “I am just going to get a red onion out of the fridge, don’t eat my red peppers will you, or daddy will have nothing to eat for dinner!!”. And out the corner of my eye, I watched her pick up a piece of pepper and pop it in her mouth! I came back to the chopping board without saying a word, pretending I hadn’t noticed. She took another piece, right in front of me! So much temptation to throw my arms around her and shower her with praise! No good for a demand avoidance child though, too much pressure. Play is down mamma, play it down! So I just said “red pepper is yummy isn’t it??” And she just grinned at me.
Phase two was triggered and then game was on and we never looked back.
Introducing the empty plate game!!
At the most difficult point in H’s toddlerhood when she was refusing to eat because I was asking, I took the advice about doing nothing and I made up a little game. Remembering it is geared to younger children, it goes like this:
Make dinner and set a dinner place for your child at the table;
Put food on everyone’s plate except your child’s and invite everyone to come to the table but don’t address anyone by name specifically (therefore no pressure on the child to come to the table);
Sit down and start chatting whilst you eat but be nonchalant about the whole gathering; pretend you haven’t noticed and you are not worried about the fact that the child hasn’t come to the table (this is going to get their curiosity going!). Just enjoy dinner and conversation - don’t look over at them or make any eye contact;
They may decide that they could be missing out on family time and might wander near the table to see what’s going on!. Particularly if this is not your normal stance, they could be thinking “what is happening here??!!”
Just continue as you are. Don’t let them know that you have noticed them hovering. It’s very unlikely that they will sit at the table but they may edge closer.
If they do get close, don’t say anything, just put one mouthful of food on their empty plate (something they really like and that they can pick up with their hands) without looking at them or addressing them directly; carry on chatting. If they think you are not looking or noticing, they may take the bait and grab the food.
If they take the food, and run off, just continue as you were. Repeat the same sequence if they come back. If they do eat something, don’t offer them any praise or attention because if they are demand avoidant, it could put “performance pressure” on them and they’ll back off and run for the hills!
This game may need to be repeated several times over before you see something concrete happening but it might be a useful tool if you are having trouble getting your child to eat anything. If it doesn’t work, you haven’t lost anything! Everything is trial and error with every child.
It worked after a few mealtimes with H, and she started to come over and take a piece of food. Over time, she started to sit at the table because she knew there was no pressure but there was always one leg stretched out sideways, ready for a get away! It wasn’t until she was about 9 or 10 that I noticed one day that both legs were now under the table at dinner time and she was happy to be there. To be clear though, lots of times it was just too much for her to be sat with everyone else and we often let her eat her dinner in front of the TV. Again, no judging here, we did what we needed to do in order to get the food in. The sensory aspect of eating was so overstimulating for her, that letting her sight and sound senses take over with the TV meant that she ate a lot more because she wasn’t focused on the food.
Over time, she has learned to appreciate food for what it is and although she still likes to watch TV when eating, she’s also happy to sit at the table when everyone is eating at the same time.
We don’t ask H to try anything new. If we do suggest she might like to one day when she’s older and she scoffs, we just smile and move on with the conversation. No pressure means autonomy. Autonomy means control over her eating and having control means she tells us when she’s ready.
Off the back of this decision to give her freestyle around eating, she is now enjoying a fairly wide range of foods from her own free will. She discovered this summer at a family camping trip that she likes burgers (after refusing to go anywhere near one for years!). She now eats steak, curry, noodles, mash potato and a fair amount of veg. Still not good with fruit. I have suggested to her that one day she might, when she grows up, like to try eggs and salmon! She just laughs and says “never in a million years!”. That’s what she said about steak and mash potato once upon a time!
I remember years ago when L was about six, she announced that she was only going to eat red food. That was a bit limiting and I had no idea why. She lived on eggs, salmon, macaroni cheese and bolognaise. So after that announcement, we were down to the bolognaise!! Luckily it didn’t last very long but we still laugh about it now!
Things change and evolve. Just roll with them and it will hopefully unfold.