Sensory Integration Education

In this month's Thoughts from a Therapist blog, Anna Willis explores the often-misunderstood challenges faced by children with extreme eating difficulties, highlighting how these behaviours go far beyond typical “fussy eating.” Drawing on the SOS Approach to Feeding, Anna outlines a compassionate, play-based strategy that gradually helps children tolerate and eventually engage with food, starting with just being in the same room as it.

“Oh they’re a fussy eater? So was mine. I just made them take a bite. They won’t starve themselves!”

Ahem. Thought I’d start with an incredibly irritating sentence. I have worked with families for a while now where children and young people self-restrict their diet. Even that phrase doesn’t do it justice.

ARFID (avoidant restrictive food intake disorder) was introduced in the DSM V in 2013. As per everything, there’s a sliding scale as to where people sit. I work with plenty of young people who don’t meet the criteria for ARFID and yet their difficulties with eating impact their daily lives significantly.

When else do you HAVE to do something so many times a day? At least with washing, dressing, toothbrushing and hair washing, it’s only once or twice a day, or even less. And if you don’t do any of those tasks (except dressing!), it won’t be as impactful as not eating for a day.

That’s why as an Occupational Therapist I’m extra interested in it. Difficulties with eating have a huge impact on occupational satisfaction. It causes tension in families and dysregulation all round.

I’m trained in the SOS Approach to Feeding which treats food aversions as a phobia. And generally, with phobias, we use relaxation to help cope with the waves of anxiety around our trigger. But for children, play and fun are the reinforcing principles. The approach breaks eating down into 32 steps, starting with tolerating being in the same room as a food. I recently met a toddler who can’t cope if mum eats food in the same room as him, which understandably, is causing quite a lot of difficulty!

So the ‘just take a bite’ thing just doesn’t wash. It's like saying to someone with a spider phobia, ‘Just give it a little stroke’. Can you imagine?! ‘Just take a bite’ is a perfectly fine phrase to use for a child without a food phobia. I use that with my children. Do I use it with the children I work with? Nope.

Instead, we work on tolerating food near them using play and slowly work our way up the 32 steps. Make it fun and realise the real fear that underlies their reluctance.

Best regards

Anna

PS I’ve created a new social media account, @annawillisot, so do come and find me on Instagram or Facebook if you want more of my inner monologue!

Thoughts From a Therapist is a regular series written by Advanced SI Practitioner Anna Willis about something that piqued her professional interest or inspired her in some way over the last month. Anna, an occupational therapist and owner of Active Play Therapies.