Sensory Processing/Regulation

Understanding Sensory Processing for Feeding

“The task of the sensory system is to integrate the raw data of incoming sensory signals in a way that gives us an accurate picture of sensory events, as well as to modulate those signals in a way that is most adaptive to the situation at hand” (Lillas & Turnbull, 2009).

Sensory processing is an expansive term which captures several processes associated with the ability of an individual’s neurological system to interact, interpret, and respond to their environment (Dean, Little, Tomchek, & Dunn, 2018), (Miller & Lane, 2000), (Dunn W. , 2009), (Huebner, 2001). Neurological sensory processes include the reception (activation of sensory receptors), modulation (organizing), and integration (make meaning) of sensory inputs (Miller & Lane, 2000), (Humphrey, 2002), (Miller, Anzalone, Lane, Cermak, & Osten, 2007). The corresponding behavioural response provides a visible manifestation to the sensory process (Miller & Lane, 2000). The mechanism for sensory processing is intertwined with other brain functions (Dunn W. , 2014), with learning being an implied factor in linking sensory information to meaningful experiences and adaptive responses (Lillas & Turnbull, 2009).

As feeding is a complex, multi-faceted occupation, consideration of sensory processing in the context of feeding difficulties is important (Benson, Parke, Gannon, & Munoz, 2013); (Yi, Joung, Choe, Kim, & Kwon, 2015). Sensory based approaches have demonstrated benefits to children presenting with feeding difficulties (Benson, Parke, Gannon, & Munoz, 2013); (Kim, Kwon, Yi, & Kim, 2021) (Seiverling, et al., 2018) and have been shown to influence behavioural presentations (Seiverling, et al., 2018); (Kim, Kwon, Yi, & Kim, 2021), as well as physiological presentations such as feeding difficulties related to neurological (Benson, Parke, Gannon, & Munoz, 2013) and cardiorespiratory presentations (Davis, et al., 2014). 

Understanding a child’s sensory preferences, their response to their sensory environment, and the sensory nature of feeding itself can contribute to a holistic and comprehensive approach to supporting children with pediatric feeding disorder.

Intervention Strategies

When addressing sensory components of feeding difficulties, it is essential to consider sensory processing as a part of a bigger picture of feeding intervention/management planning (Yi, Joung, Choe, Kim, & Kwon, 2015); (Benson, Parke, Gannon, & Munoz, 2013). As such, an interdisciplinary approach is important in supporting children with sensory-related feeding difficulties (Davis, et al., 2014).

Cognitive strategies and strategies focused on experiential learning have been shown to teach compensatory approaches and problem solving to impact lasting change in how a child engages with the functional task (Macoun, Schneider, Bedir, Sheehan, & Sung, 2020). A combination of approaches, including sensory, experimental learnings, and cognitive-based approaches can be used. Some literature supports specific approaches for children with sensory-based selective eating difficulties such as the Sequential-Oral-Sensory (SOS) approach, (Kim, Kwon, Yi, & Kim, 2021); (Benson, Parke, Gannon, & Munoz, 2013) which is a systemic desensitization and play-based approach that incorporates sensory skills within feeding plans and cognitive-based interventions such as teaching around food hierarchies. Other studies reference sensory integration therapy (SIT) for children diagnosed with autism who present with sensory differences and feeding difficulties (Seiverling, et al., 2018), though some of these approaches are known to be intensive and require adherence to stringent protocols.

Regardless of the approach taken, outcome measurement is essential; applying sensory-based interventions need to be undertaken as a trial with clear informed consent, intentional application, and outcome measurement to ensure intervention efficacy (Pollock, 2009).

Feeding and eating inherently involve sensations and processing of these sensations. It is appropriate to give it due consideration for assessment and treatment, giving due diligence to treatment efficacy.

Refer to:
Appendix 8 - Sensory Systems
Sensory Processing – Occupational Therapy Pediatric Clinical Practice Guide) (AHS Staff Login required)
Sensory Processing – Standard Approach (AHS Staff Login required)
Get Permission Approach
Sequential Oral Sensory Approach to Feeding
Food Play
Your Baby's First Tastes
Introducing New Foods to Your Child

Preparing for Mealtimes

A child needs to achieve and maintain a state that matches the demands of the activity they are undertaking (Williams & Shellenberger, 1996). For mealtimes, a calm but alert state is required. A child may be able to improve their ability to self-regulate and manage their responses to sensory information, or require ongoing support from a parent to recognize and modify sensory input.

Preparation includes:

• activities or sensory preferences that prepare a child for mealtimes (these are highly child-specific)
• activities or techniques to increase oral alertness or to calm sensitivities
• consideration of the sensory aspects when setting up the environment, such as increasing sensory preferences and reducing sensory triggers (these are highly child-specific)

Supporting Mealtime Routines and Environments

Intervention that focuses on a child’s routine and environment is more likely to increase their participation as well as a parent’s feelings of competence in supporting the child. Accommodating for the child’s sensory processing needs rather than fixing atypical patterns leads to better outcomes, which are child and occupation focused within the context they have to function (Dunn W., 2009).

Consider the use of equipment to manage a child’s sensory preferences or triggers, e.g. brightly coloured or muted plates, dependent on visual preferences, noise cancelling headphones for noise reduction.

Preliminary evidence that compression and pressure provided through weighted tools, including vests and lap-blankets, may have a positive effect on a child’s sensory processing with appropriate evaluation by a trained healthcare professional and structured implementation (NSW Office of Kids and Families, 2016).

Refer to:                 

• Center on the Developing Child - Harvard University
• Alberta College of Occupational Therapists
• ACOT Position Statement on Use of Weighted Covers

Support provided by caregivers is important across all the settings in which the child spends time (home, school, respite). Caregivers can be encouraged to understand and be respectful of the child’s sensory needs especially aversions to touch, sight, sound, and movement by using strategies such as:

• letting the child know the caregiver is approaching and needs to provide hands-on assistance
• using the tone or volume of voice the child is comfortable with and responds to
• reducing the amount of food offered at any one time to reduce visual overstimulation

Additional Resources

New Foods Step by Step
New Foods Step by Step - Using the resource
From Best Practices to Breakthrough Impacts - A Science-Based Approach to Building a More Promising Future for Young Children and Families
Nutrition Guideline: Health Feeding Relationship