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Sensory Strategies to Help Decrease Texture Aversion and Hypersensitive Gag

Before mealtime:

  • Play with sensory-stimulating toys, such as koosh balls, peanut balls, bubbles, play-doh, massagers, any toys/books with interesting textures, etc.
  • Give the child sensory input through physical sensory-stimulating activities, such as bouncing on a ball, jumping, swinging, etc.

In preparation for mealtime:

  • Put the child in a highchair/booster seat.
  • Offer the child a DnZ-Vibe, textured massager, sensory teethers, etc. to play with before food is presented.
  • Use other sensory-stimulating techniques, including, but not limited to, a Sensory Mitt (rub on child’s legs, arms, head, and cheeks) and therapeutic brushes (rub on child’s legs and arms).
  • Use the “rough” side of a washcloth to wipe the child’s hands and face prior to the meal.

During mealtime:

There are many ideas/options to try with children who have aversions to textures.  Please remember that each child is different and there is no “one way” to decrease these aversions.  Helping a child to eat/touch/tolerate textures can be a long process and therefore “trial and error” is often the best way to “figure out” each individual child.  Parents, hang in there!

Good luck!

Leila

Leila N. Bressler, M.Ed., CCC-SLP is a pediatric speech-language pathologist who has been working with the Birth to Three population for almost ten years.  She has worked in the school setting and the clinical setting in both Georgia and South Carolina.   Leila is also a mother to a toddler and feels that she has learned most of her knowledge from her daughter.

For more tips on normalizing sensitivities, this article is also helpful.

How to Teach Biting and Chewing Skills

For infants, learning how to bite and chew is a crucial stage of feeding development.  At approximately 5 months of age, babies begin using their fingers and teethers for oral exploration using a bite and release pattern.  The development of biting and chewing continues from this point on, with the baby refining the movements of the jaw, tongue, and lips.  When infants miss a part of this developmental process, intervention may be necessary to develop the ability to bite and chew.

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G-Tube Advice

Q:    I am a mother to a baby who is 6.5 months old, corrected age.  He was born at 29 weeks gestational age.  Because of being on a high level of O2 support for a long period of time, being intubated several times, and experiencing reflux, he has had an aversion to liquids and was not able to learn how to suck on a bottle effectively.  A g-tube was placed before he left the NICU.  He is now fed exclusively through the g-tube, but his speech therapist and I are making progress on his oral acceptance of liquids and solids.  However, his oral mechanics still do not allow him to process more than .1 to .2 ml for each swallow.  He has marked tongue thrusting.

Regarding tools —  at this point we are making use of the Baby Grabber and are using a 1 ml syringe for liquid practice.  We have attempted to use several sippy cups without much success so far.  His speech therapist has not suggested any other tools/devices at this point.  Could you suggest products that we could use for feeding practice, tongue placement/mechanics, and general oral work that will help us work towards g-tube independence?  Our speech therapist cannot provide them, so we are looking to purchase just a few items that will have maximum usage and effect.

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How to Teach Straw Drinking

  1. To start, cut a regular straw in half.  Not only is a shorter straw easier to handle, but it also takes less strength for a child to suck liquid from a shorter straw.
  2. Dip the straw into a cup with liquid preferred by the child. Place the tip of your pointer finger over the top of the straw to keep the liquid in the straw. Remove the straw from the cup, keeping the top of the straw covered with your fingertip.
  3. Place the straw on the child’s lips at a slightly tilted down angle (so that if you release your finger, the liquid will flow into the mouth).
  4. Remove your fingertip, allowing the liquid to flow into the child’s mouth. The goal here is for the child to comprehend that he/she is getting liquid from the straw.  As you are doing this, tell the child to “take a sip.” Continue reading

Q&A – Strengthening Mouth Muscles

Q:  My daughter’s speech therapist suggested we have my daughter sip thick liquids (i.e. yogurt, chocolate pudding, etc.) through a straw to work on strengthening mouth muscles.  I have not been able to find straws thick enough to work.  Do you have a suggestion?

A:  Straws are a great way to help individuals learn how to keep the lips closed, how to keep the tongue inside the mouth, how to improve cheek strength, etc. However, it may be difficult for your child to drink pudding or yogurt through a straw.  Perhaps your therapist may have meant for you to add pudding or yogurt to a drink in order to thicken it?

Personally, I have found that straws from McDonald’s have a large circumference, and they may just do the trick for you.  You may also be able to find straws in Target or Wal-Mart with a wider circumference to accommodate thicker substances.

Since it is a goal for your daughter to work on strengthening her mouth muscles, I would also like to suggest our Lip Bloks (pictured above).  Lip Bloks are essentially mouthpieces that can be inserted into the top of most standard drinking straws.  They come in three different sizes: ¾ inch, ½ inch, and ¼ inch.   You start with the longest (¾”) size, and then as soon as it becomes easy for your daughter to use that length, you progress to the next length level (½”).  When this becomes effortless, you progress to the final ¼” level.  The orange and purple Lip Bloks shown above are made out of a flexible material so that you can cut the stem to any custom length level.
The time frame between levels can vary for each individual, from one week or even longer.

One of the children on my caseload is non-verbal, has sensory issues, autism, and can not close his lips due the position of his teeth.  I used a Lip Blok with him for 8 weeks, and the change was incredible.  His tongue is now closer to being inside his mouth, he no longer makes a suckle noise when he drinks through a straw, and he can now maintain closure with his lips.  Lip Bloks can achieve all of this by working the mouth muscles naturally.  Your therapist, however, should also be able to provide additional direction.  You can also click on the image above for more information.

I hope this helps!
Debbie

Q&A – Jaw Grading & Stability

Q:  Can you please tell me how to use (oral exercises) ARK’s Animal Tips for jaw grading and stability?  Also, where are the bite blocks? Please explain the different levels of thickness on the tips. I am working with a 20-month-old with limited sounds including vowels and consonants and low tone.

A:  Dear therapist,

I am glad you emailed me with such a great question.   The Animal Tips have bite blocks on their reverse sides to work on jaw grading and stability.  They are of three distinct thicknesses to increase the level of difficulty as the individual progresses.  The Dog Tip has the thickest block; the Mouse Tip a thinner block; and the Cat Tip the thinnest.  They also come in two different resiliencies (soft and hard) to accommodate various sensory preferences.

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Q&A – How to Improve a Weak Suck

Q:  I am looking for suggestions for our 2-year-old son with epilepsy. He currently functions at a 6 month level.  He can eat by mouth (only stage 2 or 3 baby foods), but lacks a suck.  He can swallow well, but we have to use a syringe to get liquid into his mouth first.  I do have the Z-Vibe with the Cat and Mouse Tips, but since his mouth is so tiny, they haven’t really helped. Can you suggest any others?  

I’ve also tried a ton of cups and nothing has helped.  If we don’t see improvements soon, we will probably get the g-tube just for liquids.  He has had one before, but we would prefer to get him to take everything by mouth.  I have seen him suck on his finger and make a sound – so he is doing it at times.  He will be getting Hyperbaric Oxygen Therapy in three weeks along with intensive speech therapy, and I want to make sure I have all the products that he may need.   Any thoughts?

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Q&A – Vibration with the Z-Vibe & DnZ-Vibe

Q:  I use the Z-Vibe in therapy daily.  I was wondering if there are any guidelines re. overuse of the Z-Vibe.  Can it be harmful?  Is it more effective to use it on and off?

A:  Dear SLP,

My guideline has always been to check with the individual’s physician about using vibration intra-orally if there are any doubts or concerns.  Since each individual is wired differently, how you use the Z-Vibe (or DnZ-Vibe) can vary.   I am sure you know that some individuals dislike vibration.  In this case, I still use the Z-Vibe, just without vibration.  The length of time varies, depending upon what your goals are.  If I am working on tongue tip elevation, I place the Probe Tip or Mini Tip (which now both come in soft versions) at a 45 degree angle to place on the alveolar ridge.  I apply pressure (not hard) and remove from the mouth to see what response I get.  If I don’t get elevation, I repeat this,  but only  if the individual allows.  I’ll do that one more time and wait for elevation.   Then I’ll move on to something else, such as feeding or sound production, then I’ll repeat the Probe/Mini exercise.  If there isn’t a response, I’ll continue again with feeding or sound production and repeat a little later.  So, I am really not inside the mouth very long for this exercise.   The same would apply for stroking the sides of the tongue for lateralization, applying pressure on the back of the tongue to assist elevation, applying pressure mid-tongue for a tongue bowl, etc. With the Cat, Dog, and Mouse Tips, I can be in the mouth longer, perhaps up to 30 seconds having the child close their lips around the animal’s face, explore the bumps and ridges with their tongue, bite the blocks on the back of the tip for jaw work, and so forth.  Then I’ll remove to stimulate babbling, sound production, or feeding.  I’ll repeat a few more times  based on necessity, acceptance, needs,  and tolerance.

Another technique that may work is to slowly introduce the Z-Vibe to the individual.  I use the unit without vibration first.  Then I turn on the vibration and show the Z-Vibe to the individual, letting them feel the vibration perhaps in their hand or on their arms, slowly working towards acceptance into the mouth.  The Z-Vibe is very alerting.  It provides the tactile stimulation that non-vibratory tools may not be able to do.  I recommend that you use any oral motor tool on yourself to see how it feels.  Is your pressure too firm, too light?  Does the tool provide enough texture and interest?   Remember, overuse of any oral motor tool may result in refusal, just as an individual may refuse to eat certain foods.  Your questions indicate that you are a very caring and perceptive therapist.  Keep the questions coming.

I hope this helped,

Debbie

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We’re excited to launch our new blog to share exciting news and stories with all of you.  Stay tuned for tips and techniques from ARK’s very own Debra C. Lowsky, MS, CCC-SLP.