Not Chewing Soft Foods?

My 2.5 year old daughter has down syndrome. She has had feeding issues since birth and we are trying to work with her on chewing.  She will bite and chew crackers and other hard foods, but will swallow soft things whole. We are working with a speech therapist as well as an occupational therapist, but they do not have a lot of experience with the grabbers, and other bite tools. Can you recommend a tool that will promote chewing?
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You may need to teach her that soft foods (such as bananas, macaroni, etc.) need to be chewed just like hard foods, even though they feel closer to puréed foods, which can be swallowed without chewing.  Whatever’s on the menu, take a bite yourself first.  Concentrate on what your tongue is doing with the food.  Are you just swallowing it immediately?  Are you moving the food from side to side in your mouth?  How many times do you need to chew the food?  Count how many chews so you know how many is enough.  As your daughter chews, actually count the number of chews out loud to help her keep track of her chewing.  I count on and stick up my fingers as well.  You can put on some music and chew to the music.  It can also help to pretend to chew as she chews.  Overemphasize and exaggerate your jaw and mouth movements, saying “yum, yum, yum.”  Begin with foods requiring only a few chews, such as a banana.  Then progress from there.

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Another reason she’s not chewing soft foods could be related to oral sensitivities.  In my experience, children who have Down syndrome can be hyposensitive with limited oral awareness.  Soft foods do not have a lot of texture, and so they may not provide enough tactile information inside her mouth.  If she can’t feel the food, she won’t know that she needs to chew it.  Gum massage and textured oral motor tools can help increase oral awareness by providing proprioceptive feedback inside the mouth.  Sensory chews are also an excellent way for the tongue, lips, jaw, and cheek to exercise and ‘practice’ movements.  The textured ones simulate the feel of real food to help introduce new textures.  You can also dip them in sticky foods (like mashed potatoes, yogurt, applesauce, etc.) to promote chewing.
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Since she’s already biting and chewing crackers, you can also try Food Chaining, which is essentially gradually “connecting the dots” between foods to expand one’s diet.  Dip her favorite crackers in soft foods (dips, jams, sour cream, creamy peanut butter, cheese whiz, etc.).  This will give the soft foods some texture variety so she can slowly feel and experience with them.
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I hope this helps!  Let me know if you have any other questions.

All my best,

Debbie
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Tips for Toothbrushing with Oral Defensiveness

Oral defensiveness falls into two main categories: HYPOsensitivity and HYPERsensitivity.  Individuals with hyposensitivities have low oral tone and very little awareness of what’s going on inside their mouths.  This “oral numbness” so to speak can cause anxiety and fear when it comes to toothbrushing.  On the other hand, individuals with hypersensitivities are overly conscious of and sensitive to oral stimulation.  Even the slightest touch can be overwhelming and even painful.  In both cases, it is important to normalize sensation within the oral cavity in order to take care of those pearly whites!
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Continue reading Tips for Toothbrushing with Oral Defensiveness

Easy Oral Motor Exercises to Try – Today!

Oral motor therapy works on the oral skills necessary for proper speech and feeding development.  These skills include: awareness, strength, coordination, movement, and endurance of the lips, cheeks, tongue, and jaw.  The activities below are an easy way to work on these skills.  Incorporate them into your daily routine whenever you have time.  Practice them on the way to school/work, during commercials, while you’re making dinner, etc.  Make it a game and have fun!  Please note, however, that these exercises should not replace therapeutic intervention.  It is best to see a speech-language pathologist and/or occupational therapist trained in oral motor therapy.  They will be able to assess the situation, prescribe a course of action, and guide you through the process.
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FOR AWARENESS:

•  Use the Z-Vibe to normalize sensation within the oral cavity.  Hyposensitive individuals (with low oral tone) have little to no awareness of what’s going on inside their mouths.  On the other hand, hypersensitive individuals (with oral defensiveness) are overly sensitive and often experience aversions to texture, temperature, taste, etc.  Both cases can significantly affect speech and feeding development.

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•  The tip attachments for the Z-Vibe come in various shapes, textures, and scents.  Use them to stroke and apply gentle pressure to the lips, cheeks (both inside and out), and the tongue.  Vary the pressure, the direction of the strokes, the length of the pressure, etc.  For hypersensitivities, introduce the Z-Vibe gradually.

•  Gum massage is also a simple and effective way to provide oral stimulation.

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FOR THE LIPS:

•  Say “ooo” with exaggerated lip movement.  Then say “eee.”  Combine them for “oo-ee.”  Really round the lips.

•  Say “puh” and pop the sound with emphasis.

•  Make a big smile.  Relax and repeat.

•  Puff out the cheeks while keeping the lips sealed.  Relax and repeat.  Puff out one cheek, then the other, then both.  Then puff out the upper lip followed by the lower lip (or vice versa).  Relax and repeat.

•  Purse the lips to make a kiss.  Slide the kiss to the right and then to the left or vice versa.

•  Blow bubbles.  You can also blow whistles, horns, kazoos, etc.

•  Drink through a straw rather than drinking from a cup.  This is also a great activity for the tongue and cheeks.  Drinking from a straw requires a lot of oral motor work: the cheeks tighten, the tongue tightens and retracts, and the lips purse.  For tips on how to teach straw drinking, click here.

•  In the above exercises, observe to see if the lips are symmetrical.  If not, document what they look like and compare them to future practice sessions to monitor progress.

Continue reading Easy Oral Motor Exercises to Try – Today!

Gum Massage for Oral Stimulation

Gum massage is a simple yet effective way to provide oral stimulation to a large surface area within the mouth.  This tactile input can:
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•  help decrease oral aversions for hypersensitive individuals
•  help increase oral awareness for hyposensitive individuals
•  help decrease drooling, mouth stuffing, and/or the need the chew
•  be very calming and enjoyable

 

Gum Massage Sensory Input

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For example, I once worked with a child who was mouthing inappropriate objects in the classroom – her hands, pencils, rulers, etc.  So during therapy, I massaged her gums every 10-15 minutes throughout the session.  She completely melted as soon as I started – she enjoyed it so much!  I showed her parents how to do this at home, and eventually along with other sensory strategies, her need to chew subsided.

 

There are many ways to massage the gums, so I’ll describe what is most comfortable for me (right-handed):

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1.  Place your pointer finger just above the upper middle teeth.  Move it across the gums to the back right molars and back to where you began.  Repeat about 3 times.  Then repeat the same motion on the lower gums.
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2.  Use your thumb to repeat the same movement on the other side of the mouth.  Start above the upper middle teeth and move your thumb along the gums to the back left molar area.  Repeat about 3 times.  Then repeat the same motion on the lower gums.
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3.  During each step, notice the child’s response and adjust accordingly.  Is he/she relaxing?  Great!  Is he/she tensing?  Try decreasing the number of repetitions, slowly working up to more over time.  Even just a slight touch is progress.  Make a note of the progress and try to go further in the next session.  Repeat this exercise several times throughout the day, as often as possible.  It MUST be done on a routine basis to have effect.

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Instead of your fingers, you can also use the Z-Vibe with the soft Brush Tip, which has pliable bristles for a gentle massage.  If turned on, the Z-Vibe’s smooth vibration provides additional sensory input and awareness.

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ARK’s GrabbersY-Chews, Krypto-Bite, and/or Brick Stick are another safe way to provide oral stimulation.  These chewies have long extensions that can reach all the way to the back molars for proprioceptive input to the jaw.  The textured versions provide additional sensory feedback, and they come in three color-coded toughness levels for mild to moderate to avid chewing.  To view all of the different options, click here.

 

If you can’t get into the mouth for gum massage, try doing it outside the mouth first (on the cheeks along where the gums are).   And be sure read this article on oral defensiveness.

 

All my best,

Debbie