Note: milk should be the main source of nutrition until a baby is 12 months old. Current guidelines state that premature babies should begin weaning between 5-7 months of age, actual and not corrected unless you have been advised specifically otherwise. Weaning can be slow as gross and fine motor skills are often undeveloped compared to peers. If in doubt, consultant a health professional involved in your baby’s care! As well as looking at sensory issues, it is also worth ruling in or out reflux (including silent reflux) which premature babies can be especially prone to as well as any problems with constipation or dietary intolerances which will affect how willingly or otherwise feeding can progress.

Breastfeeds well but refuses baby food
Sensory explanation: a baby who breast feeds well but refuses food is likely to not be ready for the sensory experience and multi-sensory input presented by food. Baby food involves new texture, smell, taste, temperature of the food and the texture presented by the spoon/cutlery. One or more of the sensory systems may be over-registering information and need more time to mature and process more efficiently.
Ideas to help:

  • Do not force the issue. The more you force it the longer it will take for your baby’s sensory systems to be ready to accept the new experience
  • Try various spoons with different textures and sizes
  • Encourage messy play and independent hand to mouth exploration of the food
  • Encourage mouthing and exploration with oral sensory tools of various safe textures and objects throughout the day
  • Try a variety of ‘first foods’. Begin with fruits that are sweet like breastmilk, such as bananas, avocados, sweet potato or yams. Stick to single ingredient food to check there is no allergy reaction and to let the sensory system become used to the new taste and texture.
  • Do not begin food until the advised age; this not only decreases the risk of allergies but allows time for the gut and sensory system to mature.

Turns body and head away from caregiver when bottle feeding
Sensory explanation: this can be due to variety of factors. One being that eye contact is not comfortable for the little one. Secondly it may be related to tactile input from face touching or brushing against the caregiver’s skin or clothing and turning away from the situation reduces the input. The same goes for smell; the baby may not tolerate different smells such as perfume, lotion, deodorant, washing detergents etc. Or, possibly the turning of the head in certain direction is uncomfortable for the vestibular system. One final explanation could be the entire experience is too overwhelming and offering too many forms of sensory input and so the social interaction is simply too much to handle whilst feeding.
Ideas to help:

  • Try switching to the other side whilst feeding as it may be the position of the head that is uncomfortable
  • Try using a supportive feeding pillow
  • Drape a familiar and favourite blanket that the baby loves over your shoulder to provide a soothing texture. This will also decrease any unfamiliar or strong scents.
  • If the baby seems to shift eye contact, offer only occasional and fleeting eye contact. Instead, sing soft and soothing songs or just be present, but silent, in the moment.
  • Gently rock whilst feeding in a quiet and dimly lit room.

Needs cheeks stuffed very full to chew and swallow.
Sensory explanation: this can be due to under-registration of the tactile and proprioceptive input of the oral structures and jaw joints. When the cheeks are stuffed full, it provides increased proprioceptive input, tactile input and deep pressure touch which provides the brain the cues and signals it needs to activate the muscles needed to chew and swallow.
Ideas to help:

  • Encourage regular and frequent use of a vibrating oral sensory tool, especially prior to mealtime
  • Offer a variety of textures to mouth (including non-food objects)
  • Provide regular, daily if possible, full body messy play opportunities. This will help the overall tactile system process information more effectively.
  • If the little one is able to use a straw, provide resistive sicking activities such as pudding or yoghurt through a straw.
  • Always cut food up into small pieces and monitor or ration through the meal
  • Direct and constant supervision during eating as the risk of choking is greater
  • Encourage resistive blowing activities such as a baby harmonica or horn
  • Providing firm pressure to the cheeks, jaw line and throat prior to the meal can be helpful in giving the mouth structure. This can also be helpful to facilitate the actual swallow.

Baby will only feed in the dark.
Sensory explanation: the most likely for this is that the infant is not tolerating visual input well and therefore needs a very low visual stimuli environment to focus and self-regulate while nursing or bottle feeding. This can also simple be a simple sensory preference for the baby who finds the dark more soothing.
Ideas to help:

  • Respect this as a true sensory need and honour it wherever possible.
  • Even in the privacy of your own home, try using a cover-up to block out light/
  • Try using a nursing hat; these hats are big, floppy, holiday-style hats that deliberately provide cover and block out light.
  • Along with low lighting, try other soothing and calming sensory techniques such as deep pressure touch, gentle rocking, instrumental music or a weighted lap pad whilst feeding.
  • Decreased the overall amount of sensory input to help the baby self-regulate.

Best with breast/bottle feeding when drowsy or asleep
Sensory explanation:  A baby may do this if they struggle with self-regulation and neurobehavioral organisation. The suck/swallow/breathe sequence is very regulating and soothing for the nervous system. Another possible explanation may be that the baby is distracted by the increased amount of sensory input when awake, making it difficult to focus on the task in hand, which is feeding.
Ideas to help:

  • Breast or bottle feed in a quiet space with minimal natural lighting.
  • Try white noise or soft instrumental music.
  • Try a rocking chair.
  • Use a supportive feeding pillow to further decrease the sensory input and provide full body pressure touch to the body whilst feeding.
  • Try a weighted lap pad (under direction of a sensory integration OT).
  • Provide calming and rhythmical swinging in a baby hammock or in a sling prior to feeding.

Stiffens or arches body during feeding.
Sensory explanation: arching or stiffening or the body are quite often sensory signals of discomfort in some way. It may be related to the vestibular system and position of the body and head or GI (gastro) discomfort such a wind or reflux. It could also be a sigh that the baby is trying to self-regulate in order to organize the suck/swallow/breathe pattern and is moving the body to help with the neurobehavioral organisation.

Ideas to help:

  • If the arching and stiffening of the body occurs at other times as well and seems involuntary in nature, an evaluation by a health professional is recommended to rule out neurological and neuromuscular concerns unrelated to sensory triggers.
  • If it seems to be related to reflux or colic, make an appointment with your GP, HV or paediatrician to discuss the next steps.
  • Try using a supportive feeding pillow.
  • Try elevating the position of the head.
  • Try deep pressure touch to the arms, hands, feet and legs during the feeding.
  • Try a vibrating pillow.
  • Minimize the overall sensory input and feed in a quiet, calm and dimly lit space.
  • Try gentle rocking during feeding.

Latches and unlatches during breast or bottle- feeding.
Sensory explanation: The suck/swallow/breathe pattern is much more complex than one might think. If the infant is struggling with neurobehavioral organisation (self-regulation), then this skill can be extremely difficult. So when the baby is latching on and off, they may be needing a “breather” to coordinate the breathing and swallowing part of the sequence. Another sensory explanation can be that the tactile and proprioceptive receptors in and surrounding the mouth are under-registering and can’t “feel” what to do and where to latch on properly. The mouth and lips may not be getting the correct amount of feedback.

Ideas to help:

  • Prior to feeding, provide deep pressure touch to the cheeks, jawline and perioral muscle around the mouth.
  • Also prior to feeding, use a vibrating sensory tool for the mouth if the baby will tolerate this.
  • Before feeding, provide 15 minutes of vestibular input such as swinging, bouncing or swaying.
  • Be sure that the body and neck and supported well and in slight neck/head flexion.
  • Feed in a calm and quiet space.

Baby searches frantically when trying to latch for breastfeeding.
Sensory explanation: the tactile and proprioceptive receptors surrounding the mouth may be under-registering and can’t “feel” what to do or how to latch on properly. The cheeks, mouth and lips may not be getting the correct amount of feedback to tell the brain it is time to latch on. Another explanation may be that the little one is having a difficult time with self-regulation and neurobehavioral organisation, and that the commencement of feeding is simply too exciting and overwhelming to coordinate and organise the act of latching on to nurse.
Ideas to help:

  • Prior to feeding, provide deep pressure touch to the cheeks, jawline and perioral muscle around the mouth.
  • Also prior, use a sensory tool safe for the mouth that provides vibration if baby will tolerate this.
  • Before feeding provide 15 minutes of vestibular input such as swinging, bouncing or swaying.
  • Be sure that the body and neck are supported well have neck/head flexion.
  • Feed in a calm and quiet space.
  • Play soft, instrumental music during feeding time.
  • While nursing trying swaddling and full body deep pressure touch to help support self-regulation.

Does not seem to get hungry or eats way too much.
Sensory explanation: the ability to know when one is hungry or full relies on the sensory feedback from the brain to the stomach. This sensory feedback is from the interceptors to the gut. If the infant under-registers sensory information it is possible this information from the gut is also under-registered. This can result in not being able to detect if baby is hungry or full. On the other hand, they may not have much of an appetite.

Ideas to help:

  • Maintain a regular feeding schedule.
  • For the self-feeders, help them to pace. Often those who eat too much do so as sensory seeking behaviour.
  • Feed in small portions and small bites, allowing second servings if needed.
  • For those who don’t seem to get hungry, active floor play before meal times.
  • Frequent and daily doses of input via the power sensations are very important to increase overall sensory registration. This includes vestibular, proprioceptive and tactile input.
  • Try a vibrating pillow and/or vibrating mouth toy.

Baby is frequently spitting up.
Sensory explanation: once medical reasons are ruled out (such as reflux and/or a food intolerance or allergy) it is possible that the spitting up can be a systematic response to sensory overload. This can be triggered from one or more forms of sensory input but vestibular input would be the most common.

Ideas to help:

  • Rule out medical reasons and/or food allergies or intolerances first.
  • Limit the amount of movement following feeding or a meal for at least one hour. Even quick changes in position can trigger a vestibular system response.
  • After a meal or feeding, elevate the head and upper body slightly if it is nap time or night time and the baby would be lying down.
  • Use a supportive feeding pillow during breast/bottle feeding to help elevate the head.
  • If the spitting up seems outside of the normal feeding time range assess for sensory triggers such as too much movement, too much light, sound, smell etc.

Baby/child gags on textured foods, picky eating and extreme food preferences.
Sensory explanation: the oral sensory system is a multi-sensory system including tactile, olfactory (smell), gustatory and even visual and auditory…and if one or more systems is over-responsive then it can make eating an unpleasant experience. The gag reflex is a separate neurological entity, yet is triggered by one or all of the sensory components listed and can be hyperactive and over-responsive. The picky eating and extreme food preferences can be from any form of the above explanations.

Ideas to help:

  • Explore various textures, from dry to messy, with hands, feet and full body on a regular basis to help the tactile system process information.
  • Do not force the issue with the disliked food item(s). Let your little one explore the food with hands or utensils on their own terms.
  • Respect the need for a very specific temperature of food.
  • Encourage the use of various oral sensory tools prior to eating to prepare and help the oral sensory system to process information/sensations.
  • Use a vibrating mouth tool regularly.
  • Rule out underlying issues such as ongoing reflux which may be causing discomfort leading to not want to eat.

 

WEBSITE DISCLAIMER AND RELEASE OF LIABILITY
The information within this section is provided as a resource tool for general advice and recommendations regarding sensory integration and sensory processing development. Sensory enriched activities are beneficial for all children. This website is in no way intended to replace medical intervention or individual therapy. Please consult with your child’s paediatrician therapist for a customized program. The activities suggested on this website require direct supervision. The information on this website is attributed to Angie Voss, OTR.