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.
- One of the ways I like to begin is to provide the child with the opportunity to mouth Oral motor chew tools (like the Grabber, Y-Chew, or Guitar). These tools were specifically designed to increase oral awareness, to provide stimulation and tactile sensation, and to exercise the lips, cheeks, tongue, and jaw. Through oral exploration, the child just might begin to bite on his/her own, and from there you can progress to chewing.
- Demonstrate how to bite so that the child can see and learn what the word actually means. Knowing the vocabulary will be an important part of therapy as you encourage the child to bite and chew. Over-exaggerate the movement to help communicate the concept. Use actual food when illustrating/showing. You can also use puppets with mouths to help illustrate biting (and later chewing). Take turns with the child to feed the puppet. Make it fun and playful. Make a bite sound or a glottal /um/ sound. Have the child feed you!
- A vertical chewing pattern (an up-and-down opening and closing of the mouth) will begin to develop first. Place either a Grabber or Y-Chew in between the molar area and assist the jaw to open and close. Use the word ‘bite’ as you are directing the jaw to close on the tool being used. Use a mirror for the child to watch himself/herself and you demonstrating a bite. Discontinue using the mirror if it becomes too distracting.
- Once the child knows the vocabulary word ‘bite’ and can perform the skill, add the word ‘chew.’ Have the child place his/her hands on yours to feel the bite-and-chew movement. Work up to 20-25 chews in a row on each side of the mouth. However, if using ARK’s Probe, switch over to a Grabber or Y-Chew after the child is able to chew 3-5 times in a row.
- If using a Grabber, have the child bite and chew on the loop as well. If using a Y-Chew, place the handle sideways across the front teeth. This works both sides of the mouth at once for bilateral chewing and jaw strength and stability.
- Alternate sides to promote the development of a rotary chewing action. Have the child bite and chew 3-5 times on one side of the mouth and then switch to the other side. Remember to have the chew tools placed to the side of the mouth, in between the pre-molar area. As the child progresses, move the Grabber or Y-Chew to the back molar area where the chewing of foods occurs. If the child gags, move back toward the bicuspids and slowly, over time, progress to the molar area.
- Once you are comfortable with the child’s ability to bite and chew, dip ARK’s tools into puréed or sticky foods and continue the biting and chewing exercises. Pairing these tools with real food helps to bridge the gap between practicing chewing and actually chewing real food.
- To assist with texture acceptance, begin using the Grabber and progress to the Textured Grabber. Then dip the Textured Grabber into puréed or sticky foods and continue with biting and chewing exercises.
- Have a drink handy in case the child needs to take a sip in between exercises.
- It is important to note that some children may seem frightened to eat because they know they do not have the oral motor skills necessary to handle food. These children are reacting to a real fear and not just refusing to eat. In this instance, you will need to work on bolus formation, tongue awareness, and/or tongue lateralization. To work on these skills, use ARK’s Probe or Z-Vibe to stimulate the top and sides of the tongue. Specific techniques can be found in Tips & Techniques for the Z-Vibe.
- It is also important to note that anyone who has direct contact with the child (caregivers, interventionists, ABA therapists, etc.) should be on board to follow through with intervention strategies. The best results happen when therapy is reinforced at home in between sessions. The more opportunities presented, the better. However, the child should never be forced to mouth, bite, or chew. Teaching these skills takes time, lots of patience, and creative thinking.
- Talk about the tools and let children feel them in their hands and on their arms first. Then progress to the face, cheeks, lips, and inside the oral cavity. Incorporate play therapy into your feeding sessions.
- Remember to praise, praise, praise. Use reinforcements that cater to the child’s interests. Get excited about progress. Be an actress/actor!
For further related reading on rotary chewing / a mature chewing pattern, click here.