Sensory Food Aversions

Sensory Food Aversions

Diagnostic Criteria

·           Consistently refuses to eat specific foods with specific tastes, textures, and/or smells.

·           Onset of the food refusal during the introduction of a different type of food (different milk, different baby food, or different table food).

·           Eats without difficulty when offered preferred foods.

·           The food refusal has resulted in specific nutritional deficien-cies and/or delay in oral motor development

Epidemiology

Sensory food aversions are a common problem among toddlers. A survey of 1523 parents of toddlers ranging in age from 12 to 36 months found that 20% of the parents indicated that their tod-dlers were eating only a few types of food “often” or “always”, and 6% of the same parents were indicating that they worried “often” or “always” that their children were not eating enough to grow.

Etiology

Several studies indicate that genetic predisposition as well as environment affect toddlers’ food preferences, though empirical studies have not explored the origins of selective food refusal in infants and toddlers. Some individuals avoid particular foods be-cause they find their taste and/or odor too aversive. Parents with extreme taste sensitivities may offer a restricted range of foods to their children and model eating only certain foods that they like. Limited exposure to a variety of foods may enhance the toddlers’ food selectivity.

Diagnosis

Sensory food aversions occur along a spectrum of severity. Some children refuse to eat only a few types of food, making it possible for the parents to accommodate the child’s food preferences. Oth-ers may refuse most foods, disrupt family meals and cause seri-ous parental concern about the children’s nutrition. The diagnosis of a feeding disorder should only be made if the food selectivity results in nutritional deficiencies, and/or has led to oral motor delay.

Sensory food aversions become apparent when infants are introduced to a different milk, to baby food, or to table food with a variety of tastes and textures. Usually, when foods that are aversive to the infant are placed in the infant’s mouth, the infant’s reactions range from grimacing to gagging, vomiting, or spitting out the food. After an initial aversive reaction, the infants usually refuse to continue eating that particular food, becoming distressed if forced to do so, and may generalize their reluctance to eat one food to other foods with similar characteristics.

If infants refuse many foods or whole food groups, their limited diet may lead to specific nutritional deficiencies, and they will experience delay in their oral motor development due to lack of practice with chewing. In addition, the children’s refusal to eat a variety of foods frequently leads to family conflict at mealtime, and puts a strain on the child and the family in social situations outside the home.

The evaluation of infants and young children with sensory food aversions should address how many foods the child consist-ently refuses and how many foods he/she usually accepts. A nu-tritional assessment needs to look not only at the anthropometric measures of the child to rule out acute and/or chronic malnutri-tion, but needs to address whether the child may lack adequate intake of vitamins, zinc, iron and/or protein. In addition, an oral motor assessment needs to determine whether the child has fallen behind in this area of development. Delayed oral motor develop-ment will limit the kind of foods the child should be offered in order to prevent choking, and may be associated with a delay in speech development. In addition, the parents’ food preferences during childhood and adulthood should be explored to assess whether the parents may be limited in the variety of foods they offer their child. Additional, nonfood hypersensitivities should also be explored.

Course and Natural History

No longitudinal data are available outlining the course of this feeding disorder. Sensory food aversions begin to show in about 10% of toddlers between 12 and 18 months of age, but then in-crease to 20% and stay around that frequency until 3 years of age. Older children with sensory food aversions may experience social anxiety when their peers become aware that they eat only certain foods, and some children avoid social situations that in-clude eating.

Treatment

In young infants (4–7 months of age), a few repeated exposures to new foods enhance the infants’ acceptance not only of that food but also of other similar foods. However, this changes in the second year of life, when the acceptance of new foods only increased significantly after 10 or more exposures to those same foods It appears that novel flavors become more preferred after repeated pairing with high caloric carbohydrates versus low ca-loric carbohydrates.

It is useful to introduce a variety of foods during the first year of life when infants in general are less discriminating in their food preferences. However, if infants show strong aversive reactions (e.g., gagging or vomiting) early on when offered a certain food, it is advisable to give up on that particular food and not offer it again. If the infant shows a less severe reaction (e.g., grimaces or wants to spit out a new food) it is also best to stop offering the new food during that feeding, but introduce it again after a few days in a small amount and paired with some other food that the infant likes, increasing the amounts of the new food very gradually until the infant appears comfortable with it.

For toddlers, the challenge remains how to keep them interested in trying new foods after they have had aversive ex-periences with some foods. Coercive techniques, for example, threatening children to sit at the table until they finish eating everything on their plate or depriving them of certain privileges, have a significant negative effect. On the other hand, toddlers are very responsive to modeling by their parents. Toddlers are more willing to try a new food if they can observe their parents eating it without being offered. If they ask for their parents’ food, it is best to give them only a small amount while saying that they can have more if they like the food. If the parents stay neutral as to whether the toddler likes the food or not, toddlers remain neutral as well and do not appear to become scared of trying new foods. However, once children fear to try new foods, their diet becomes more and more limited and, by 3 years of age, most young chil-dren are not swayed by what their parents eat. Some young chil-dren like to imitate their peers and may be willing to eat new foods in a preschool setting; however, others become anxious in social situations and try to avoid eating with others.