Is Eating Easy? Understanding the Sensory Journey of Learning to Eat
Written by Samantha Rocca, Registered Dietitian
As parents, it can be easy to think of eating as something that should simply come naturally. After all, we eat every day. We sit down, pick up our food, take a bite, chew, swallow and move on.
But for a child who is learning to eat and gaining more autonomy every day, it is not this simple.
Eating is a complex physical and mental task. Understanding what is involved can change the way we look at picky eating, messy mealtimes, food refusal, and even the funny ways children interact with food.
One approach that helps explain this is the SOS Approach to Feeding (Sequential-Oral-Sensory). Developed by Dr. Kay Toomey (a pediatric psychologist), the SOS Approach looks at feeding as a whole-body skill.
At the heart of the approach is the rather simple idea that eating doesn't begin when food goes into a child's mouth.
Even something as simple as swallowing requires coordination. Just one swallow involves the coordination of almost 26 muscles and 6 cranial nerves working together (Matsuo & Palmer, 2008).
We often hear and think about the five senses and how they may be involved in eating:
Sight
Touch
Hearing
Smell
Taste
Eating isn't just about taste. As outlined by Fraser Health, our bodies simultaneously rely on three hidden internal senses alongside the five sense mentioned above to coordinate every single bite:
1. Proprioceptive: Information from our muscles and joints that helps us understand where our body is and how it is moving.
Tells you where your body parts are in the moment.
Helps you judge how much force to use when chewing or holding a fork.
2. Vestibular: Information related to balance and our body's orientation in space.
Keep your head and body steady while you sit and eat.
Helps you stay upright in your chair.
3. Interoception: Awareness of internal body signals such as hunger, fullness, temperature, and other sensations.
Notices stomach growls or feelings of fullness.
Tells you when you are hungry or thirsty and when to stop eating.
So when your child sits down with a piece of food, their brain isn't simply asking, “Do I like this?” It is processing an enormous amount of information: What does it look like? What does it smell like? What will it feel like? Is it familiar? Is it safe? What will happen if I touch it? What will happen if I put it in my mouth? Can my body manage this texture?
There is a developmental process involved each time a child is eating!
The SOS Approach (Toomey & Ross, 2011) describes six major Steps to Eating:
1. Tolerates the food
2. Interacts with the food
3. Smells the food
4. Touches the food
5. Tastes the food
6. Eats the food
These six steps are a way for parents to understand the bigger picture. Within them is a much more detailed hierarchy of skills. There are 25 steps for typically developing children and 32 or more steps for children experiencing feeding difficulties.
This is why a child who doesn't eat a new food right away may still be making progress.
Imagine you put roasted zucchini on your child's plate.
Your child may first need to be comfortable with the zucchini simply being in the room.
Then they may be able to tolerate it on the table.
Next, perhaps they can tolerate it on their own plate.
Then they might look at it.
Maybe they will touch it with a fork.
Then smell it.
Then touch it with one finger.
Maybe they will pick it up.
Perhaps they'll bring it toward their mouth.
They might touch it with their lips or tongue.
They might put it in their mouth and immediately spit it out.
And eventually, they may be ready to chew and swallow it.
From the outside, it can look like, “They didn't eat the zucchini and they don’t like it”. From a developmental perspective, however, they’ve taken several important steps towards eating it.
If we expect every new food to go directly from plate to mouth to swallowed, we can unintentionally skip many of the steps a child needs in order to feel comfortable with a food. Sometimes, it can help to use gradual progression that allows the child to move toward eating at a pace appropriate to their skills and comfort level. If a child becomes distressed, the goal is not to force them forward. Instead, the adult can adjust and can move back to an earlier step.
What’s the bottom line?
Eating is a skill that develops over time and for some children, that journey takes more steps than we might realize. What looks like “picky eating” or “refusing food” may actually be a child working through the sensory, motor, and developmental skills they need to feel safe and successful with food.
When we recognize that eating doesn’t begin with taking a bite, we can start to notice and celebrate the smaller steps along the way: tolerating a food nearby, looking at it, touching it, smelling it, tasting it, and eventually eating it.
Progress at the table isn't always measured by how much a child eats. Sometimes, progress is simply becoming a little more comfortable with food.
References:
Toomey, Kay & Ross, Erin. (2011). SOS Approach to Feeding. Perspectives on Swallowing and Swallowing Disorders (Dysphagia). 20. 82-87. 10.1044/sasd20.3.82.
Matsuo, Koichiro, & Palmer, Jeffrey B. (2008). Anatomy and physiology of feeding and swallowing: normal and abnormal. Physical medicine and rehabilitation clinics of North America. 19. 691-707, vii. 10.1016/j.pmr.2008.06.001
Fraser. (2022). What an activity like eating can teach you about sensory processing differences. Fraser. https://www.fraser.org/resources/blog/what-an-activity-like-eating-can-teach-you-about-sensory-processing-differences-