General overview of swallowing disorder: Dysphagia

Feeding preferences make children picky eaters. Sensory processing disorder and ASD impact daily living activities, including mealtime. Sensory processing disorder leads to dysphagia, a swallowing disorder. If a person is taking more effort and time to move liquids and foods from the mouth, it’s time to seek help.  A trained  SLP can help you in this condition.

Dysphagia may occur at any age due to several medical and psychological reasons. However, it’s somewhat more common among older people. Dysphagia may be present in newborns if they have a cleft palate, born premature, or  Cerebral Palsy. Therefore, the reason could be neuro-physiological. A certain degree of dysphagia is also prevalent in neurodiverse children due to sensory information processing difficulties. Thus, we can say the causes that lead to swallowing problems & dysphagia may vary. The treatment plan is dependent on the reason for the issue. 

Here is a list of a few etiological factor or causes of swallowing disorder:

• Cancers & Tumors,
• Stroke,
• Injuries & Accident
• Autoimmune conditions like myasthenia gravis
• Cerebral Palsy,
• Learning Disability due to Global Developmental Delays,
• Cleft lip and palate
• Sensory Processing Disorder might be a reason for Dysphagia. 

Mild swallowing difficulties are present in 25–45% of healthy, typically developing children. Consequently, these feeding preferences make them picky eater. Every child, at a certain point in his childhood, is a picky eater. In this way, they demonstrate their independence. On the other hand, 80% of children with developmental delays or special needs may have some degree of dysphagia. One of the pickiest eater is children with higher emotional lability and lower self-regulation.

Sensory Processing associated Dysphagia: Signs and Symptoms

Following are the signs and symptoms related to Dysphagia associated with SPD and difficulties. Be careful about these signs.

1. Persistent drooling in toddlers even after the teething period is over.  
2. Food returns or comes back upwards (regurgitation). 
3. Food is stuck in the throat or chest frequently.  
4. Gagging or coughing while swallowing food or water.
5. Tooth brushing difficulties in ASDs
6. Behavioral etiologies such as disordered feeding relationships between the caregiver and the infant
7. Compartmental problems that persist in the rejection or selecting the texture.
8. Phobias associated with choking may lead to persistent eating avoidance or irregular habits such as prolonged chewing or preference for particular textures.

Now the question is how and why sensory processing disorder is associated with swallowing difficulties?

A pathway links taste and tactile perception as well as swallow response. This pathway is focused on visual processing and visual qualities of the food and aroma and texture of food. This swallowing activity involves all of our eight senses simultaneously. Sensory processing disorder hinders the child’s ability to perceive the oral sensory feedback and incorporate the information learned, which is essential for the proper development of adequate feeding and swallowing skills.

Sensory Processing Disorder affects one or more sensory systems (auditory, visual, tactile, olfactory, and taste). A child may over-respond or under-respond to sensory input, excessively seek sensory experiences, have difficulty discriminating sensations, or respond to sensory input. SPD symptoms are reported to be more varied in children with autism spectrum disorder (ASD) than typically developing children, affect multiple sensory systems, and impact many activities of daily living, including mealtime.

Challenges a picky eater is facing.

A child with any degree of dysphagia faces enormous challenges that lead to poor nutrition and affect the child’s overall physical and cognitive growth due to narrow color, texture, taste, or smell tolerance. That makes the mealtime very stressful. The challenges that a mother is facing are manifold. A poorly unbalance diet is the most important concern of mothers. It becomes hard for family and friends to explain why a child cannot eat a particular food. Eating out is very stressful in that case.

Sensory avoidant children are hypervigilant, fearful, and anxious about perceived “threats” in their environment. For example, the presentation of foods outside of a “preferred” texture range or brand type may elicit a strong reaction. Sensory-seeking children have a high level of arousal, become overly excited in response to stimulation, and are impulsive. When eating, such children may overfill their mouths with food and/or have extreme taste preferences for certain foods, such as highly spicy, sour, salty, or crunchy. Children with sensory discrimination issues, on the other hand, may have difficulty distinguishing between the sensations of hunger and fullness, as well as a lack of awareness of food residue in the mouth or the need to chew thoroughly before swallowing.

Intervention approaches for sensory processing disorders associated with dysphagia & picky eaters.

Co-treatment: group or individual therapy

Models of intervention (SPD) include individual therapy and group therapy designs that might involve co-treatment by both a speech-language pathologist and an occupational therapist and sometimes a clinical or behavioral psychologist. Social stories are also helpful if used in language therapy sessions.

Play for sensitization

A sensory integrative treatment approach is described by sensitization play. This kind of play promotes sensitive and coordinated responses. It helps to link sensory stimuli and environments. As the child involves in sensory-based activities, he acquires immunity for a particular smell or texture. Food exposures in the sense of play include olfactory, visual, and tactile stimulation (touching or stirring the food). Food “play” should be kept apart from the meal or snack so that the child understands that he or she is not supposed to eat all of it.

Here are some bonus tips for managing picky eaters’ mealtime

These tips are evidence-based and equally valid for neurotypical children and neurodiverse children with a sensory processing disorders.  

Rule Out Any Medical issues

When you present certain foods, you find out that your child has clamped her lips tightly shut. It may be since the child knows it may make their stomach hurt. Gastrointestinal issues a particular allergy may be a reason. Many of these children who are non-verbal can’t even put in words to express their anxiety. You need to consult your pediatrician,  who may help you in dealing with the situation.

New foods and desensitization

Many children with sensory processing disorder require to taste food quite a few times before they’re ready to eat it. This process of introduction of food is called desensitization. Some children take a longer time. Give them an opportunity for distant sensory rehearsals to look- smell, taste, sound, touch. Also then provide them a close-up sensory trial. A picky eater child may require more frequent and repeated exposure to new foods before becoming comfortable enough to take their first bite of the new food. You can encourage your picky eaters by discussing the fresh food’s texture, color, aroma. Present the new foods with some child’s preferred food on the same plate.

Don’t follow child lead.

If your child doesn’t want to eat food you are offering him. then do not rush into cooking something he likes. It may encourage him to be a picky eater. Remember that a child establishes his authority by rejecting a meal you serve him. Offer new food in snack time rather than lunch or dinner.

Make the food look fun & attractive.

Serve fruits or veggies with the child’s favorite sauce or dip or sauce. The use of different shapes and sizes with cookie cutters may also intrigue your toddler to try the new food.  Present a plate in a fun and attractive way. The children with sensory needs are pretty particular for textures, so mom! Make sure that you modify your recipe that suits your child’s sensory requirement. Please don’t give them sensory shock without sensitization or desensitization.

Respect your toddler’s hunger and appetite

If your picky eater isn’t hungry, please don’t force him to eat. This situation may only make things worse, such as reinforcing a power struggle over food every time. In addition, your toddler may learn to associate his mealtime with frustration and anxiety. Children facing sensory processing disorder may get agitated if you force them to eat what they don’t want to eat.

Serve smaller portions

Present small portions so your child doesn’t feel overwhelmed by the food. It is a good idea to provide them an opportunity to request more food when they want. This way, you provide them a chance to speak up.

Make a routine and stick to it.

Maintain a routine of snack and mealtimes and observe that routine strictly. If your child does not want to eat a particular meal, a regular snack time will suffice for nutritious mealtime. Don’t allow for child refill of juice, milk, or snacks in-between time as this might decrease their appetite for meals.

Make him an active partner.

Involve your child in food preparation, cooking, and even shopping. Ask him what to choose from two options of vegetables and fruits. During food preparation, encourage and motivate your little one to assist you with rinsing veggies, stir batter, or to set up the table during mealtimes.

Use nutritious fruit as a reward.

Suppose you withhold fruit in your hand for reward. Little picky eater may get a message that it is the best and most nourishing food. This perception may increase your child’s craving for fruit.

This is essential to set small feeding goals for neurodiverse picky eaters.  Additionally, stretch the desensitization process. If there are above-described symptoms, then act timely and take professional help.     

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References

https://www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/childrens-health/art-20044948

Eating, H. I. I. (2020). 22 Why So Picky?. A Spectrum of Solutions for Clients with Autism: Treatment for Adolescents and Adults, 17.

Rachael Zimlich RN, B. S. N. (2021). Pediatricians are often faced with questions about Picky eating, But when is the time to act?. Contemporary Pediatrics, 38(3), 36-39.