Date Presented 04/23/21
Limited evidence-based intervention approaches are available to treat sensory-based feeding problems in children. This study explored the effects of tactile play on the oral acceptance of wet food items using the sequential-oral-sensory approach. After 6 weeks, all three subjects increased acceptance of the nonpreferred food. This research emphasizes the effectiveness of tactile play in nonfood items, group treatment, and exposure to aversive food while including caregivers in treatment.
Primary Author and Speaker: Julia M. Hawkins
Additional Authors and Speakers: Claudia List Hilton, Alex Casteel, Ickpyo Hong, and Yung-Chi Sung
PURPOSE: Feeding is difficult for children with sensory aversions and affects family mealtime and nutrition. While only 25% of all children have feeding difficulties, around 80% of children with developmental delays exhibit feeding problems (1). The purpose of this study was to determine: If given the opportunity to manipulate wet, non-food items will children with sensory aversion be more apt to place wet food items to the mouth after play? This study aimed to determine whether tactile play with wet, non-food items increased the oral acceptance of wet food items in children with feeding difficulties or sensory aversions.
DESIGN/METHOD: This mixed-methods, quasi experimental study explored the effects of tactile play on the oral acceptance of wet food items. Flyers were posted in the community to recruit children 2 to 18-years-old with sensory aversion and/or feeding difficulties. Five subjects were recruited for this six week, group feeding intervention study. Three children completed the study. Data was collected to track subject progression on the 23-step modified Sequential-Oral-Sensory (SOS) hierarchy developed by Kay Toomey (4). The researchers also documented direct observations of subjects' behaviors and statements. Also, caregivers tracked child progress daily throughout the week on the SOS hierarchy. Each research session consisted of three, 15-minute sections: play with a wet, non-food item, encouragement of eating the caregiver chosen non-preferred food, and reward play time. Children that did not progress that week assisted in clean up. Quantitative data from the hierarchy was organized and analyzed by the number of steps accomplished per session and during each reported mealtime at home. Qualitative data was collected from caregiver reports and observation of the subjects' behaviors and statements during direct intervention. The data was analyzed for common themes among subjects and for each individual subject.
RESULTS: Based on the information collected on the modified SOS hierarchy, caregiver report, and observation, researchers concluded that overall playing in wet, non-food items with a similar consistency to the non-preferred food positively influenced the child's acceptance of the non-preferred, wet food item. This is supported by the fact that 100% of the subjects reached step 23 of the SOS hierarchy after direct intervention sessions. There was also a positive relationship seen between how much a subject played in the wet, non-food item and the amount of interaction with the non-preferred food. As subjects increased interaction with the wet, non-food item, their interaction with the food also increased, suggesting that playing in a wet, non-food item could be effective in advancing children through the steps of the hierarchy. This suggests that repeated tactile desensitization during play with the non-food items led to greater acceptance of the non-preferred foods.
CONCLUSION: This study is helpful for occupational therapists treating pediatric patients with feeding and sensory needs. This research supports that the SOS approach provides a no pressure to eat environment that can increase a child's willingness to try an aversive food. By pairing direct intervention with a carryover program, children had more opportunities to be exposed to aversive food. Tactile play allowed the child to become desensitized to the aversive sensation which carried over into eating food of a similar consistency. This study suggests that tactile play in non-food items of similar consistency may be effective for feeding therapy in children. Although further research is needed, our research demonstrates that tactile play in a non-food item can increase the oral acceptance of non-preferred, wet food items with similar consistency.
References
Coulthard, H., & Sealy, A. (2017). Play with your food! Sensory play is associated with tasting of fruits and vegetables in preschool children. Appetite, 113, 84-90. https://doi.org/10.1016/j.appet.2017.02.003
Keen, D.V. (2008). Childhood autism, feeding problems and failure to thrive in early infancy. European Child and Adolescent Psychiatry, 17, 209-216. https://doi.org/10.1007/s00787-007-0655-7
Nederkoorn, C., Theiben, J., Tummers, A., & Roefs, A. (2018). Taste the feeling or feel the tasting: Tactile exposure to food texture promotes food acceptance. Appetite, 120, 297-301. https://doi.org/10.1016/j.appet.2017.09.010
Toomey, K. (2010). Introduction to the SOS approach to feeding program. Retrieved from sosapproach-conferences.com/wp-content/uploads/SOS-APPROACH-explanation.pd
