Mealtimes with a sensory seeker (long)

[Tigerle]

We are currently picking our battles, but mealtimes are the next one on my list. Because they are a battle as it is!

DS,4, is being evaluated for Asperger’s and we will get results soon which we have hints may be inconclusive, but I hope there will be an OT referral involved. However, until we get things set up, I’m trying to find strategies for home use, as it were.

DS is sensory seeking when hungry, tired and socially stressed out, ie particularly so at lunch after preschool and at supper at the end of the day. On good days of course it is mostly about getting him to stop chatting and start eating. On bad days he has a hard time even sitting down for the meal, he will keep getting up to get this done or that done or chase the cats. The problem is that in his hurry to get done whatever it is he wants to do before a parent starts shouting to sit back down he’ll fall down his chair or trip over his feet and hurt himself, so we may have the first drama before the meal has even started. He will keep wiggling as he eats, or prop up his head in his hand and his elbow on the table. Which I realize may be a postural or hypotonia issue but he does have a Stokke Tripp Trapp chair with backrest and footrest – what else can we do?

We do provide sensory smart foods: chewy meat, crusty wholemeal bread, crunchy carrot sticks, spicy bologna, the works. He will stuff it into his mouth with all ten fingers, fill it to bursting point, chew with his mouth open and let crumbs spill out, take another bite while his mouth’s still full. Instead of biting off pieces, he will hold food constantly to his mouth, sort of munching and chewing and pushing it in with his fingers. Recently in a restaurant, eating bread, he accidentally bit his thumb so hard he drew blood and needed a bandaid and the staff came up to our table asking worriedly what had happened to make him scream so.

He still has a bib (most kids his age we know don’t) because he likes to wipe his hands and mouth periodically and this way it’s not all over his front and sleeves. Recently he has started to wipe his mouth with it after every bite or use it to stuff the bites into his mouth. He struggles with inflamed lips.

He will refuse to use his fork to eat. If we make him pick it up, he won’t spear but use his other hand to stuff the food onto the prongs. It is not a fine motor issue- he is proud to be able and allowed to cut his own meat or pancakes using both knife and fork correctly. At some point, however, we may have to take away knife or fork altogether because he will brandish it about in hazardous ways or try to cut the table.

We’d love to have him use straws but they are just too much of a hassle. I could tolerate blowing bubbles, remembering my own fascination with it as a child, but whatever drink it is, with a straw around, it invariably ends up on the table. And standard parenting book phrases like “Your drink’s on the table. We need a rag!” are just so much noise to a sensory seeker who is splashing with his hands in the puddle... I am just glad these days his fingers stay mostly out of the butter..

We are trying to coach him as he eats, but he needs constant redirection with every bite and won’t always comply. More intervention with preparing and eating, ie cutting for him, feeding him, may result in tantrums because we are doing things “wrong”. Taking away cups, plates or cutlery as necessary for hygiene or safety concerns or even sending him off the table for our sanity (after redirection and warnings, of course) result in, depending on his mood, screaming meltdowns (these have thankfully become rare), yelling threats like “I’m not going to drink again, ever if you don’t put his back at once!” or clowning about with something or somewhere else.

Having had good results with a reward scheme for extremely disruptive sensory seeking at bedtime, I have begun to hold out on dessert as a reward for good eating habits. It is not really catching on yet. I do want him to eat dessert – it’s pure fruit and we use it to stir supplements in.

Otherwise, I am not actually concerned about his diet, which is fairly varied and healthy for a picky four-year-old, and he does end up eating most of what he is supposed to eat (he is tall for his age, but rail thin). It’s the behaviour surrounding it that’s the problem!

Can you think of any strategies we haven’t tried yet?

[BetsyS]

My 4 year old is neurotypical, so take what we do with a grain of salt, of course.

I feed him very, very small portions.  Incredibly small.  Like a tablespoon of rice, 3 green beans, 1 (1/2 inch) meatball, 1/4 roll.  When he eats those foods, he's free to have more.  I just keep the food on the table so that I can give seconds and thirds (our table is large enough that the bowls are near me, and they are too far away from him to reach--LOL). 

This does a couple of things for me.  It means that he tries everything I'm serving.  Our rule is that you try some of everything before you get seconds.  If he really wants seconds (because of small portions), he'll try the not-so-loved broccoli or whatever.  The second is that there is less food to make a mess with or stuff into his mouth.  Mine does the crazy, I'm giong to take enormous bites like a crazy man then fuss if I drink water because "the food is wet!!!".  Prevention is the best mode here, imo.  It's a much smaller mess to spill 1 T of rice rather than 1/2 cup, you know? 

I don't know if this will help but sounds like it might be worth a try?

[earthmama369]

DS is nearly 5 and diagnosed with SPD. For us, also, there's the possibility of Asperger's on the horizon. We had an OT come to our house for about 7 months last year to work with DS primarily on eating and sleeping issues. She didn't do anything directly with eating or sleeping, because in those situations, he was already in the middle of the full-on sensory swing. For eating, she worked with him on sitting still, using stickers and a timer and a wide variety of games. Eventually they worked up to 7 minutes, which was long enough for him to sit down and get at least a few bites in. He hasn't had as much of an issue with stuffing his mouth to the point of choking, but he does do the chipmunk thing periodically, and we've tried to address that by doing the choking-safety talk at a time when food isn't around and we have more of his attention, and in the moment by either getting him to sit down and chew or hauling him over to the garbage can to spit the mouthful out if he's starting to choke. And then taking a break, going over the steps (take *one* bite, chew, swallow) and trying again with one-on-one attention. It helps to move the plate back between bites so that the food isn't right in front of him.

We're still figuring out what works, too, but it's reassuring to read about another family who's on the same learning curve as we are! Our kiddos sound very similar in behavior. *lol* I'm going to keep reading this thread to see if anyone else chimes in from the other side of the age 4-5 range.

[khaoskat]

Ask your Ped for a referral for a Feeding Eval.  I thought it would turn up nothing, since our ST said she couldn't see any issues.  Come to find out his jaw muscles are not at the developmental level they should be for his age.  THe muscles are weak and also has other issues with balance and coordination while eating.

[HollyBearsMom]

I have a sensory seeker too.  Here are some things that have worked for us:

• a sensory cushion on his chair
• thera-bands around the legs of the chair
• velcro strip under his side of the table
• heavy weight silverware- if you are afraid of the "danger" factor buy kids safety silverware and weight them yourself

Before dinner we often have him do wall push ups or have him crab walk to the table. We have also been successful by giving him a crunchy "snack" right before meal time-carrots with dip, pretzels with hummus, apples with peanut butter, etc.  Not enough to "ruin his appetite" but more to build up to the meal itself

As another poster stated we also serve VERY small portions to avoid the food cram factor.  We plate the food in the kitchen so no "family style/serve yourself" at dinner. We focus on manners and food safety but basically try to back off. He is expected to pitch in and clean up after dinner and that has seemed to be a bit of deterrent as well, LOL.

[Tigerle]

Thank you for your suggestions!

I have a hunch that his jaw muscles may be somewhat weak, as he took a long time to accept chunky food and stop drooling as a toddler. His language skills have always been stellar though so oral motor control can only be a small issue. I think. I'm no expert. Doing my best to become one - gosh, I have a real library going, and I haven't even started getting into ASD literature yet, the closest I've come is "Quirky Kids". Still hoping we don't have to go any closer. We are just beginning to navigate our way in expert land. I hope to be able to set up an OT eval soon and I'll definitely mention the feeding issues.

I've placed a sensory cushion on his chair and put a theraband round the table legs just now (I think with a Tripp Trapp, tying it round the legs might be a tripping hazard). Let's see how this works. It's not that we don't have the equiment, but it's hard to figure out ways to actually work the stuff into our lives. Same with the chewelry - he'll take it off to play with it, leave it lying about so we can't find it, then it needs to be washed and put somewhere to dry by one parent and then the other can't find it. After all, it's not just that these kids tend to be, um, somewhat fidgety and disorganized, their parents end up somewhat frazzled and overwhelmed too, KWIM? And I'm sure he'll carry the cushion around too and leave it in places, or try to find out how liquids run around the bumps or something...

I can't get him to do heavy work when he is already tired. I've tried. So far, fine motor sensory play has worked much better for us. If the weather is fine, I just let him play a bit in the sandbox after preschool while preparing lunch. I need to think of an indoor alternative to set up and clean away without much hassle (we have a very small house with very small rooms, I can't set up a sensory play table, everything will have to happen at the dinner table and have to be cleared away so we can eat).

We tried the small serving sizes, which did not go over well, but worked for the smaller bites. As always, he needs to get used to new rules. I'm sure this needs some tweaking but it is a promising idea!

We do the crunchy starters most days. I'll try to get religious about it.

Is heavy weight silverware something you can buy?

[HollyBearsMom]

Hi-

You can buy weighted silverware.  It is usually marketed to the elderly and/or those with Parkinson's. You can also buy bolts at a hardware store and superglue them onto your own silverware and then paint them to make them look fun.

http://www.caregiverproducts.com/site/270651/product/CAM10

Our OT also recommended using pencil fidgets on a fork too. We didn't have a lot of luck with it but she said many parents did love it.

http://www.therapyshoppe.com/therapy/index.php?main_page=index&cPath=8_1050&products_id=1818&sort=20a&page=2

If you are having trouble getting him to do heavy work before dinner you might want consider an indoor or outdoor trampoline. If nothing else I can always get our son on the tramp. Best money we ever spent!!!!  We also have a air pogo stick that he uses even in the dead of winter. Even just 5 minutes seems to have a huge impact. http://www.airpogo.com/?gclid=CJnTt8O28acCFcJx5Qoda16mcw

I don't know if you have this checklist?  I keep it key sections posted on the inside of my cupboard.  Sometimes its enough to get me to breathe and try a new or old trick!!!

http://www.sensory-processing-disorder.com/The_SPD_Companion-using-SI-theory-to-solve-problems-at-home.html

[Tigerle]

Thank you for the links, that was very helpful!

OT starts next week, feeding will be included.

[Fay]

Originally Posted by Tigerle 

Can you think of any strategies we haven’t tried yet?

I struggle with mealtimes here as well, but I do have some ideas that you may not have tried.

Put his beverage in a bottle with a sport top.  I use the Kleen Kanteen.  It seems to satisfy a deep primal urge, and is very calming for my kids.  The Kleen Kanteen can be annoying for some people because it squeaks when you suck on the sport top, but it doesn't bother my kids.

For a while, I put a sofa loveseat in the dining room.  My son could flop and bounce all over his sofa while eating.  The sofa had a machine-washable slipcover.  You can buy special no-slip blocks at Bed, Bath & Beyond to elevate the sofa 3-7 inches, so he's at the correct level for the table.  We've also used various types of seat cushions from IKEA to minimize the wiggling.  I would suggest letting him select the type of cushioning that feels best for him.

If he stuffs his mouth, then give him several small plates of food instead of one big plate.  You can pace the meal better that way.  My DS1 likes this because he can see the different types of food and knows they aren't mixed together.

My DS1 used to fall out his chair often, too.  The best exercise to prevent this is CRAWLING.  Have him crawl for 5 minutes before meals.  A weighted lap pad also seems to help with this.  You can get a machine washable lap pad from Dream Catchers Weighted Blankets, or just put the lap pad inside a pillow case for easy clean up.

[Tigerle]

Originally Posted by Fay 

For a while, I put a sofa loveseat in the dining room.  My son could flop and bounce all over his sofa while eating.  The sofa had a machine-washable slipcover.  You can buy special no-slip blocks at Bed, Bath & Beyond to elevate the sofa 3-7 inches, so he's at the correct level for the table.  

Wow, the lengths we go to to find whatever works, right?

I wish we could place a bouncy sofa in the dining room, but our house is seriously small.  In an old world way most of you probably can't imagine. Indoor trampolines being excluded for the same reason- ther is seriously no room to put it anywhere. And the ceilings are so low that DS is by now actually big enough that we have to stop him from bouncing on the bed because he might hit the ceiling - that would soon be an issue with a trampoline too.  Crawling however could work great for us! I'll tell him he has to teach DD, giving her a lesson every night.

So far the theraband that lets him do heavy work works well. Cushions that let him wiggle more, not so much. I'll have to give it more time.

I haven't been able to try anything else because I've been sick lately and not part of family meals, just heard the explosions (first DH, then DS) through the floor...