Nutrition and the Internationally Adopted Child: Sensory and Food Issues

Many children who are adopted internationally have sensory processing issues, which can affect their eating habits. The problem can arise from an overall lack of stimulation in the orphanage or it may be due specifically to what and how the child was fed.

First, many babies are fed formula through nipples with larger holes cut in them. In addition the bottles are usually propped up, so that milk may pour into the child’s mouth. These babies then do not have a chance to use their muscles to suck on a bottle. Next, as the children mature they may be served primarily meals that are mushy or watery. For example, a child may be given a creamy like cereal for breakfast and then watered down soups with rice for lunch and dinner. Fresh fruits and vegetables may hardly enter the child’s diet;  therefore, the child seldom has an opportunity to eat something crunchy or with lots of texture. Even crackers may be softened in hot tea or another beverage.

In spite of the fact that your child may have sensory issues surrounding food, it is important that you and your child enjoy feeding times together. This is a very important time for bonding with your child, even if your child is older. It should be pleasant, and, as much as possible, try to maintain eye contact with your child during meal time. If your child is pre-school age, you can still give your child a bottle to help develop the sucking muscles, to hold your child closely, as well as to have eye-to-eye contact with each other.

Mealtime is also important for establishing an overall good relationship with your child. In one study* children with regulatory issues as babies were assessed for later sensory perception problems and other challenges. The only babies who later had poor child-parent relationships (at 3 years old) were those who had feeding issues. It seems that the facial interaction with the parents and child is very important for creating a good relationship.

Of course, food issues can create control issues. Never let food become a control issue. Do not force your child to eat something your child does not like. This dislike may not be related to taste, but to the food’s texture. Your child may gag on certain foods. Some children are not necessarily consistent on the types of texture of foods that they cannot tolerate. For example, a child may eat primarily soft foods, but may love crackers. This same child may not be able to eat raw carrots—even if finely shredded. A parent may think if the child can eat crackers the surely the child should also be able to eat other crunchy foods.

Sensory issues can make eating time less than pleasant. Be patient with your child and let your child adjust slowly to eating new foods.

Here is some advice regarding what can be done:

• Let the child play with the food so the texture can be experienced with the child’s fingers.  Yes, your child may make a mess and never actually eat the food, but it does increase  your child’s sensory experience.
• *Offer a very small offering of a food that your child will not eat. You may need to mix it in something softer. Give your child praise and perhaps a non-food treat for trying the new food.
• Give your child some level of control in selecting the foods eaten. Put a few different foods on the plate. Control issues are often big issues for a child, so by offering your child reasonable choices,  your child can experience some control.
• If your child likes very soft foods, try grinding regular foods to a less “mushy” consistency. As you introduce new textures, make sure it includes flavors your child likes. To enhance flavor, you can have various condiments also available.
• If your child likes one type of food, try giving another type in the same category. If your child likes applesauce, perhaps a baked apples without the skin can be introduced.
• Children who are overstimulated by certain foods may be overstimulated by the environment as well. Make meal time as calm as possible and avoid outside noises if this seems to help your child.
• Keep mealtime as consistent as possible—especially for a child who has overall sensory issues. You may even use the same patterned plates for every meal and snack.
• If your child cannot tolerate very hot or cold foods, serve most at room temperature. You may begin to slightly alter the temperature of the food so that your child can learn to adjust.
• ****If you have other children in your home, have them model eating other foods. Children are great imitators, and this may help.
• Sometimes children will eat better if they are in a more comfortable position. If your child hates being confined to a high-chair, try meal time at a small table.
• Often children will have issues related to bowel control. If your child needs more fiber, you may want to switch your child to a whole grain version of the favored foods.  So if your child likes rice, try incorporating whole grain rice into the regular white rice. If you go straight from white to whole grain rice, it may be too much of a contrast
• ** “A mom suggests the following: “Try adding wheat germ to add texture to the food. Start off by adding 1/4 tsp of wheat germ to 4 oz of pureed food. Every three days or so add another 1/4 tsp. of wheat germ as tolerated. If he gags then wait another day or two and try to increase again. (Make sure your child doesn't have a wheat allergy first.)”
• ***Try distractions that calm your child, such as soft singing or reading

If your child seems to be really stuck on certain foods or meal times are more painful than pleasant, then you may need to seek an assessment by an occupational therapist (OT) to help your child with oral stimulation. Some of the other occupational therapy techniques that may help your child with other sensory processing issues may also help your child with food issues. Children who are under 36 months old are usually eligible for no cost services from an early childhood intervention program in your state. To contact the office in your state about getting an assessment and possible treatment for your child go to  http://www.nectac.org/contact/ptccoord.asp and scroll down to your state.

Before you see an OT, you will want to keep a diary of your child’s eating patters and likes and dislikes.

* DeGangi, G. A., Breinbauer, C., Roosevelt, J. D., Porges, S., & Greenspan, S. (2000). Prediction of childhood problems at three years in children experiencing disorders of regulation during infancy. Infant Mental Health Journal, 21(3), 156-175.

** From Rachel Browne at http://www.comeunity.com/premature/child/growth/feeding-hints.html

*** From http://www.sensory-processing-disorder.com/picky-eaters.html: See suggestions as to how to help give your child some OT like treatments

****Thompson, S.D., Bruns, D.A., and Rains, K. W. (2010) Picky eating habits or sensory processing issues? Exploring feeding difficulties in infants and toddlers.Young Exceptional Children 2010 13: 71 originally published online 18 November 2009

DOI: 10.1177/1096250609351805