Sudden Difficulties Eating
(tiny bites and food only in front of mouth)

by Grandma Mary

My granddaughter, age 7, has mild SPD particularly in the areas of proprioceptive and vestibular systems. She also has low muscle tone. She has motor planning issues. This is mild enough, that the diagnosis only came in the last 6 months. She loves school, and can read. Her dad was transfered to a city where there is not great health care in general.

Very recently, in the last 2 weeks, she has developed an aversion to putting food in her mouth unless it is a very small piece. She only wants it at the front. About 40 foods that she did eat are now on the NO list! It can take 45 minutes to eat a chicken nugget. Obviously, school lunch time is not long enough! She also has a nut allergy, so peanut butter is not an option. She drinks okay.

She has only said she thinks she almost choked once. If she is distracted, she eats a little better. My daughter, her mom, is a dietician, and she is panicking about possible feeding tubes and stunted growth. She is small for her age, and doesn't have weight to lose. Where does this come from? Why would it start suddenly now? What can we do??? Help!!!

The SPD Help Line Answers...

You know, it always amazes me when grandparents are so very loving and concerned about their grandchildren, like YOU. What a blessing and a gift you are to your family. To be reaching out for answers on their behalf! I am touched.

I want you to know that there are indeed two possibilities for what your granddaughter is experiencing. One is oral defensiveness and low muscle tone (which can cause difficulties with chewing and swallowing) related to her SPD and the other is anxiety related to the choking incident. She could have either or both. Without knowing her, I can't officially tell you which it is, but I want you to know a similar story... one regarding my daughter.

My daughter does have a lot of sensory defensiveness in her mouth. It has lead to major anxiety at times, very selective food preferences, social issues, and expensive surgery bills for sedating her for various dental procedures. She has had these issues her whole life. However... I want to tell you about her anxiety as it relates to choking.

She has always been a "cautious" eater. There have been two occasions on which she choked pretty good. From that point on... food selections were SO limited and I thought she may never eat again!! Truly! She is a vegetarian as she hates the sight, smell, and texture of any meat. She claims it is because she is an animal lover (well, that is certainly part of it). And, she does not like peanut butter or milk (unless it is VERY chocolaty). So we too were very concerned about her protein intake and whether she was getting enough healthy foods. It seemed the only thing she would eat successfully was macaroni and cheese and pizza. Oh, veggies were out too (some vegetarian SHE was, huh? LOL).

Anyway, after her choking incidents (happened two different times at two different ages), she would have major anxiety about eating and didn't want to eat. The thought of eating and the fear of choking would literally bring her to tears. The ONLY thing we could do to help her was to help her through the anxiety. It took some time, but she eventually came around. She still refuses to eat certain foods due to her sensory defensiveness, but her food repertoire, for the first time in her 12 years of life, is finally increasing, s-l-o-w-l-y. And she finally tried the two foods she HAD choked on before and added them back into her diet... popcorn and salad. Hooray!

I tell you this to let you know there is hope. She will not be like this forever, even though it feels that way. She will definitely need some extra help and support from you and her family to get through this. I am so glad you are reaching out for that help!

Here is what I would suggest...

1. First, as you work on the underlying problem whether it is oral defensiveness or anxiety, or both, try to have her find a supplement drink to bring for school lunches... like Boost or Carnation Instant Breakfast, Slim Fast, Ensure, etc. At least she will be getting nutrition for now.

2. Make sure she is taking a multivitamin during this time as well.

3. Work on the anxiety with her. Your best bet here will be to contact a local psychologist that can work closely with you. We did a lot of talking, comforting, letting her go at the pace she was comfortable, letting her know we would be right there, that this won't last forever, that it is ok, etc. But, I suggest getting some professional help with this if possible.

4. Make sure her OT is aware of what is going on and can additionally work with her. A speech therapist would be valuable as well working around the defensiveness or the anxiety as it relates to chewing and swallowing. Especially if her low muscle tone or motor planning is interfering. Is she in OT or Speech?? She needs to be if she isn't already. Let me know if you need help locating one!

5. Also, a GREAT resource for kids that are picky eaters or have difficulty with eating is Just Take A Bite. I love this book and I think it may help you and your granddaughter through this situation.

6. Make sure you have also read the many articles on my site regarding oral defensiveness, oral sensitivities, and picky eaters. If you go to my site map, you will see them listed. These should help too, if you haven't already read them.

My gut reaction right now... her behavior is indicating this is more anxiety related than oral defensiveness. Mainly because of the sudden change. Can a sudden change happen with SPD? Sure can, but this one feels more like anxiety as the main cause with some defensiveness and low muscle tone or motor planning difficulties as a result of her SPD contributing to the problem secondarily. What do you think? Whichever came first, the "chicken or the egg", it needs to be addressed. A good team including an OT, SLP, and a psychologist is ideal. IF it continues to get worse? Find a feeding specialist. They can help too.

Anyone else have some input? Ideas for grandma? Let her know here!

Keep us updated on her progress ok?

Take good care. Thanks for being such a loving grandma!!

Michele Mitchell