RISA would like to thank Dr Fiona Jones who voluntarily contacted us to provide this information to RISA parents. Her practise is in Qld and details are below but if her observations strike a cord and you are living interstate, other practitioners are also available through Occupational Therapy Australia or similar organisations in your home country.
Sensory processing difficulties appear to be common for children with reflux. Approximately 51% of children with reflux also present with a major feeding difficulty such as food refusal, food selectivity, dysphagia or poor oral motor skills. It is interesting to note that 93% of feeding difficulties are found to result from a combination of organic causes (such as reflux) and secondary behavioural characteristics (such as avoiding meal times).
Many children with reflux also have sensory processing difficulties. Sensory processing is the process of taking in, organising and responding to the information we receive through our senses. There are 8 primary senses through which the body receives information:
- Visual (see)
- Auditory (hear)
- Tactile (touch)
- Gustatory (taste)
- Olfactory (smell)
- Vestibular (moving)
- Proprioceptive (body awareness and muscle feedback)
- Internal senses (e.g. hunger, thirst, temperature)
Everyone processes sensory information differently but some have more difficulty than others dealing with certain types of sensory information and creating an appropriate response. There are four main patterns of behavioural responses to sensory input, as described below.
| Level of input required to register | ||
| High (under-sensitive) | Low Registration The degree to which a person misses sensory input: ‘What’s happening?’Positives:
It can be difficult to:
|
Sensation Seeking The degree to which a person obtains sensory input: ‘I like it and I want more’, ‘on the go’Positives:
It can be difficult to:
|
| Low (over-sensitive) | Sensitivity to Stimuli The degree to which a person detects sensory input: ‘This bothers me’Positives:
It can be difficult to:
|
Sensation Avoiding The degree to which a person is bothered by sensory input: ‘I must get away from this’Positives:
It can be difficult to:
|
Children may have different responses at different times of the day, and for different senses. For example, one might be hypersensitive to taste and texture, but seek movement (vestibular).
How does sensory processing work?
All sensory information (sight, taste, smell, touch, sound, hunger, movement, etc) is initially processed at the brainstem, which works like a filter. Important information is sent through to the cortex of the brain for processing, whereas insignificant sensory input (i.e. weak, repetitive or familiar input) is filtered out. This happens at a reflex level – it is not something that you think about. This keeps the cortex, or “thinking part” of the brain, free to process new information or to think about what you are doing. Sometimes, the brainstem does not filter sensory information effectively, and may filter out important information mistakenly.
Once information has passed through the filter, it will go to either the “processing centre” or the “danger centre”. If sensory information is sent to the “danger centre”, this helps the body get ready to respond. Your body may then be ready for fight, flight (run), fright (scare) or freeze. This response releases adrenaline into the system to prepare the body and to respond.
EXAMPLE (adrenaline response)
If you put your hand on something burning, this information is sent straight to the “danger centre” in the brain, adrenaline is released, and you will respond instantly (e.g. flight – pulling your hand back). This is a protective response that helps our bodies get out of dangerous situations quickly, without needing to think about what to do.
When your body goes into an adrenaline response, you are unable to accurately think and process information. This means that if your child goes into “fight or flight” then it will be very difficult to reason with him/her until they have calmed down. In fact, they may not be able to process anything that is said to them during this time. It can take children quite a while to calm down, and if they are not fully calm before returning to task, they are far more likely to reach a meltdown stage again quickly.
Sometimes, our bodies remember something that felt uncomfortable a long time ago. It sends this information to the danger centre. This means that children can have this protective adrenaline response to sensory information that other people perceive as being safe and normal (or even unnoticed!). For example, think of how you might react if you hear a squealing tyre after a recent car accident.
Consequently, children with reflux may develop a sensory and emotional aversion to eating. They often experience hypersensitivity to the sensory components of eating, such as taste, texture (e.g. lumps in puree), changes in appearance or temperature of their food, or the feeling of food on their lips or hands. Their experience of eating may be linked with activation of their ‘danger centre’ due to the pain and discomfort associated with reflux. This may contribute to ongoing gagging, vomiting and food avoidance. Children may then rely on predictability, routine, distraction and control to eat.
The management goals for children with reflux are typically focused on:
1. Medical management to reduce vomiting, pain and discomfort
2. Rebuilding trust and confidence in eating by making it a pleasurable and safe experience
3. Develop oral skills
4. Decrease hypersensitive gagging and vomiting reflexes
5. Reduce the emotion and stress level
What can you do?
1. Speak with an occupational therapist or speech pathologist for assistance
2. Start with “safe” feeding experiences, and change or add one small step at a time (e.g. change the appearance of the puree by putting it in a different bowl, or eating it with a rusk stick as a spoon)
3. Engage your child in messy play with or without food. For example, you could finger paint with puree or make people out of food items.
4. Recognise the small steps. Smelling a new food (even if they don’t eat it) is a step toward feeling secure enough to taste it.
5. Encourage, but never force, the next step toward eating. If your child will allow a new food on their plate, you may like to encourage them to play with it, or give it a kiss. When they are comfortable doing so, you can encourage them to lick the food or taste and spit it out.
6. Take the pressure off yourself. Rebuilding trust takes time.
Written by Dr Fiona Jones
Suite 6, Leve1 1 Kenmore Village
(Cnr Brookfield & Moggill Roads, Kenmore)
Phone: 07 3378 9543
Back to September 2013 newsletter
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