Children who have food aversions go beyond “picky eating.” Avoidance of foods becomes a problem when it leads to malnourishment and limitations on daily activities. Signs of food aversion include: only tolerating a narrow range of food choices, anxiety when given a new food item, failure to thrive, difficulty chewing or swallowing, frequent gagging when presented with certain foods, prolonged mealtimes, and frequent vomiting. When treating food aversions, speech therapists work to introduce new textures, flavors, and consistencies, modify mealtimes, provide positive reinforcement, and treat any underlying chewing and swallowing disorders.
Deficits in Oral Motor Skills
A child with an oral motor disorder experiences difficulty controlling the lips, tongue, and jaw muscles. This can make eating, drinking, and speaking difficult. A child with an oral motor disorder may display: a “droopy” face, open mouth posture, refusal to eat food requiring chewing, frequent gagging, difficulty moving tongue side to side, up/down, drooling, and difficulty producing words. A speech therapist working with a child who has deficits in his/her oral motor skills will work to strengthen the muscles of the lips, tongue, and jaw and improve movement of these structures.
Teaching Use of Cup and Straw Drinking
Weakness or decreased coordination of the oral motor structures (lips, jaw, tongue) can lead to difficulty with drinking from a cup or straw. Children who have difficulty with these skills may cough/choke while drinking, display liquid “leakage” from the sides of the mouth, and demonstrate an inability to suck liquids through a straw. A speech therapist will work to strengthen the muscles of the mouth and increase the coordination of the structures to improve a child’s ability to drink safely from a sippy cup and a straw.
Children typically start using a spoon to feed themselves between 13-15 months of age but usually require assistance from an adult. Using a spoon allows an infant a sense of independence and improves self feeding skills. A child may have difficulty with spoon feeding because of hypotonia, hypertonia, structural deficits, postural impairments, aversive feeding behavior, or refusal. Speech therapists can help increase interest in spoon feeding and improve the strength and coordination of the lips, jaw, and tongue.
Biting and chewing are skills that require the coordination of all parts of the mouth (jaw, lips, cheeks, and tongue). Between 14-16 months of age, children develop a mature pattern of chewing in which they move food from side to side. Some children experience difficulty chewing their food, which can lead to long and exhausting mealtimes. Therapy focuses on developing a more mature rotary (circular) pattern of chewing to properly manage a variety of food items. Oral motor tools and exercises are used to improve strength and coordination of the jaw, lips, and tongue.
Children who are between 10-12 months begin to self feed by using their fingers to grab food items (soft crackers, Cheerios, etc.). As they grow older, their self feeding skills develop to include a variety of food items and use of utensils with less assistance from caregivers. Some children do not show interest in self feeding or display weakness and decreased coordination of the oral motor structures (lips, tongue, jaw). Therapy is focused on increasing interest in self feeding and improving strength and coordination of muscles in the mouth.
Decreasing Oral Hypersensitivity
Children who have oral hypersensitivity, or oral defensiveness, are overly sensitive to oral stimulation. Even a mild touch can cause discomfort and even pain, which can lead to texture and food aversions, picky eating, and speech and feeding delays. Children who have oral hypersensitivity will typically dislike having their teeth brushed and/or face washed, have a limited food repertoire, avoid certain food textures (especially mixed textures), gag easily when eating, and exhibit signs of tactile defensiveness (disliking being touched, avoiding messy play, etc.). During treatment, speech therapists will work to modify behaviors during mealtimes and create a more enjoyable eating experience. An oral sensory program will be used to improve tolerance to tactile stimuli (using a variation in texture, temperature, pressure, and vibration) and to increase the variety of food items in the child’s repertoire.
Lori Overland Motor Sensory Approach to Feeding
TalkTools Oral Motor Programs
Beckman Oral motor Program