The Importance of Supporting Children Who Have Eating Problems

Hello, I am the mother of an almost 12 year old daughter.  It has been a struggle ever since she moved from baby food to regular foods to get her to eat fruits or vegetables.  Thankfully, she remains healthy so far, but I am concerned about her health long-term with her limited intake of nutritional foods.  Mealtimes have always been a battle between trying to get her to try things and also not letting the situation monopolize family time.  She absolutely will not try any fruits – not even apple sauce.  Recently she tried a strawberry and just mulled it around in her mouth until she almost gagged and then spit it out.  I have tried “sneaking” pureed veggies into her diet over the years, sometimes with success, but sometimes I’m found out because she has an acute awareness of new tastes and textures.
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Long story short, I recently had her evaluated by a pediatrician, and after much questioning, he feels she has an oral sensory integration disorder (hypersensitivity) and has referred us to a speech therapist who specializes in this area.  I understand that this may well be the case, but have very little data from others who may have experienced this same thing with a child.  My husband is not on board at all with having her start therapy because he feels she is being stubborn and just needs to start eating.  This has been going on for 9+ years and I don’t see her changing anytime soon without some help.  Can you please give me some advice on how to best approach my husband?  I need good, accurate data showing why this sort of therapy would help her now as well as into the future.  I apologize for this lengthy story, but would appreciate any help/advice you can offer.
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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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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

 

Oral Defensiveness & Aversions with Sensory Processing Disorder (SPD)

Oral defensiveness falls into two main categories: HYPOsensitivity and HYPERsensitivity:
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•  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 significant speech and feeding delays.  For example, the ability to create a food bolus is a critical oral motor skill necessary for swallowing.  But how can I teach this skill to an individual who cannot feel his tongue?  Lack of awareness can also lead to mouth stuffing, leftover food particles in and around the mouth, drooling, etc.  In these cases, it is important to increase oral awareness by providing varied oral input and sensation throughout the oral cavity.  It is at this point, however, that hyposensitive individuals can become orally defensive.  Because they are not used to new feelings and sensations inside theirs mouths, they may be afraid/unsure of the sensations and therefore refuse intervention.

•  On the other hand, individuals with hypersensitivities are overly sensitive to oral stimulation.  Even the slightest touch might be uncomfortable and even painful, which can lead to texture/food aversions, picky eating, and speech and feeding delays.  Let’s say, for instance, that an individual needs to work on tongue lateralization.  To do this, I usually use an oro-Navigator to guide the tongue to one side of the mouth and then to the other.  Or, I’ll place the Probe Tip inside the cheek area and tell the individual to touch it with the tip of his tongue.  But how can we do these exercises if the individual won’t allow anything near his mouth because it hurts?
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Although these two forms of oral defensiveness are different, intervention is quite similar for both – you need to get into the mouth and provide input in order to normalize sensation.  As you proceed with the strategies below, keep in mind that there is no one approach or one answer.  Each individual has different needs that will in turn require a different approach.
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