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Finger-lickin’ good? : An evaluation of a pilot intensive messy play programme for severe oral sensory sensitive children

Amanda Harvey, Kate Jones, Chris Smith, Michael Hii and Assad Butt.

Royal Alexandra Childrens Hospital, Brighton

Introduction:

Oral Sensory Sensitivity (OSS) leading to significant feeding issues is rare, but complex medical conditions and negative disease-based experiences can increase the risk. This can negatively impact on many areas including emotional and social development and growth. Severity can vary but use of feeding tubes may become necessary further exacerbating issues. Progress to a more normal intake can be slow and families are often frustrated with the impression of little or no progress over long periods of time. Our centre developed a short intensive intervention messy play course for children with significant OSS

Aim:

To evaluate the impact of an intensive intervention course using a detailed scoring system investigating 7 key areas.

Method: 

Children with recognised established OSS were identified through dietetic and Speech and Language therapist (SALT) caseloads. Parents were invited to attend a series of weekly sessions over a 6-week block. The programme developed had a progressive hierarchy structure with graded sensory experiences involving desensitisation to food. It followed typical sequential feeding development using a range of tastes and textures. Parents completed a pre-course sensory sensitivity questionnaire covering 7 key categories (Food approach/Behaviours at meal, Food approach/Time, Range of foods, Sensory issues, Tactile/messy response, Ability to taste new foods, and Behavioural reaction to foods). Each of these categories had a scale score ranging from 1 (normal) to 5 (profound problems). On completion of the course, families repeated the questionnaire to identify any significant or subtle change in the 7 areas.

Results: 

Complete data was available for 7 children (4 male 3 female, age range: 3 years 3 months to 8 years 7 months) who completed the course. Pre-intervention results showed highest scoring (worse) areas of sensitivity as food approach behaviour, range of foods and behavioural reactions.

As a group, using the total score from each category, an overall improvement was only seen in 1 category (Food approach/time), no difference was seen in 4 and worse in 2. However, looking at the results individually, the range of changes within all the categories shows a more varied picture (Table1). Improvements were seen in tactile/messy response, food approach/time and ability to taste new foods. A negative impact was seen in behavioural reaction to foods (worse score in 4/7 children). On an individual level, every child showed at least 1 improvement in 1 category.

Discussion: 

Improvements in children with long established OSS will often be slow and subtle. However, our short-term intervention showed a positive impact on at least two areas of behaviour and identified areas in which the interventions were unhelpful. Worsening scores could be explained by the potential negative experience of the intervention, which is likely challenging for such a group. We speculate that longer term, regular interventions would likely yield better outcomes.

Conclusion: 

Detailed intervention outcome questionnaires are a useful tool to identify small, subtle but important positive steps for the child, family and health professional in OSS. Information yielded can help tailor future interventions according to individual patient responses in this challenging group of children.

 

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