Question: Hi Debbie - I work at a school for children who have special needs. I serve a lot of students (many tube-fed) who really crave oral stimulation to the point that it is difficult to get them to do anything else with their hands. We have awesome SLPs, but their main focus is more on communication. I'm not so much looking for feeding preparation and support because most of these students are NPO anyway - I'm more interested in the sensory integration aspect - these kids cannot pay attention to anything other than their mouths - and that makes them less available for learning, less likely to use their hands to explore objects and materials, less likely to engage in other functional activities. I would so much appreciate any advice you can offer!!!
Hello! Great question and great points. Why are these students craving so much oral input? It's most likely because they are not eating by mouth - they're not getting the satisfaction and oral sensory input from biting and chewing real food throughout the day, so they're seeking that proprioceptive input to the jaw elsewhere.
I'd also recommend considering each student's developmental age. If a student is at a 6 month to about 2.5 - 3 years functional age, then mouthing/chewing is normal for that functional age.
As far as what to do to potentially help, working the mouth and providing oral input in other ways might help. Things like gum massage, blowing whistles, blowing bubbles, etc. We have these Bubble Straws which might be a good fit - you can blow through them, but can't suck anything up (so they're especially good for individuals who are NPO).
You could also try using a Z-Vibe to provide input to the mouth - stroke, tap, and apply pressure to the lips, jaw, tongue, inside and outside of the cheeks (with you holding the Z-Vibe, or using hand over hand assistance if they want to hold it). The Z-Vibe has a smooth, gentle vibration that provides a lot of oral sensory stimulation.
All of our chew tools come in 3 color-coded levels. It sounds like some of the students might need/want the toughest XXT level - it’s pretty firm, so it provides more resistance / feedback to the jaw as you chew. So with this firm XXT level, they may potentially get the input they need faster and not need to chew as much.
When using a chew tool, you can also have them bite down and hold for a few seconds. Or bite down and hold while you gently tug. This extra exercise will provide more resistance/input as opposed to just chewing..
Looking at proprioception throughout the rest of the body too would be important - oftentimes we see that if kids are on a sensory diet and are getting sensory input globally in other ways (through heavy work activities, weighted lap pads, etc.), they don’t need to chew as much. An occupational therapist (OT) can help put together a sensory diet for each student.
Consulting with their pediatricians may also be a good idea to see if they have any recommendations specific to each child.
Last but not least, I wanted to include links to these two related posts:
I hope this helps some! If you have any other questions please let me know :)
Debra C. Lowsky, MS, CCC-SLP