A little over a week ago, during an ABA meeting, I learned for the first time that all my son’s eating problems could be, in part, a result of a physiological/medical problem. As a result, I scheduled a pediatric appointment to find out whether this was the case. It turns out, his anatomy is just fine. The musculature of his tongue is symmetrical and his frenulum, the part under the tongue, is not abnormal at all.
The pediatrician we saw was not our regular doctor but we have seen her before. She advised me to obtain assistance on his eating behaviors from an occupational therapist. Coincidentally, we had an OT appointment scheduled for the very next day.
I had previously mentioned to our OT the discussions that were occurring in ABA because of the eating issues and she asked that I bring in some foods so she could evaluate my son. This was an interesting appointment.
I brought some sugar-free Vanilla pudding, sliced apples and Oreos. All three are problem foods. First, with the pudding, just like ice cream, my son does not use his tongue or lips to clean the spoon when it is placed in his mouth. Instead, he closes his mouth around the spoon and it comes back out with pudding still in the curve. The spoon is never cleaned.
With the apples, he loves the taste and the crunch but he will not swallow them. He chews a few times and pockets the food in his cheeks. Then, when I’m not looking he takes more and more until I glance over and he looks like a chipmunk about to throw up. He will not swallow and ends up running to the garbage to spit out his apples.
With the Oreos, he demands someone break up the Oreos in half or thirds. Otherwise, he will leave it uneaten. He will not bite the cookie.
Our OT set the foods out on a table before she began the regularly scheduled program and asked my son which one he wanted to eat. He did not want to eat anything! He wanted to use the zip line in the gym. He loves the zip line. When the OT informed him that he’d have to eat to use the zip line, he chose the apples.
At first, he tried to make a liar out of me by delicately taking a tiny bite off the end of a slice, something he has never done before. Then, I took out an apple slice and started eating. He ate a little more. I suggested that the OT take one and once she did, he ate the rest of the apple. Sure enough, he pocketed the food. Eventually, after repeatedly coaxing him to swallow and gently stroking the front of his neck, she let him spit it out.
Next, she had him take a spoonful of pudding. True to form, he left the pudding on the spoon, just as I had described. The OT got gloves and gave him deep pressure to the roof of his mouth. She rubbed pudding about his gum line with her gloves. Finally, she applied pressure strokes from just under his nose to his upper lip.
She told me that she felt he needed some pressure input. As best as I understood it, she was saying that he’s probably never touched the roof of his mouth with his tongue and did not know where it really was. She was telling me that he needs some proprioceptive type of input to the inside of his mouth so he understands where everything is.
Then, the most fascinating thing occurred. She got him to clean the spoon. This was the weirdest thing. It’s like some kind of physiological reaction. She got pudding on the spoon and had him open his mouth. She set the bottom of the spoon on his tongue and applied some pressure to the tongue with the bottom of the spoon. Then, just after he got the pudding in there and closed his mouth around the spoon, she removed the spoon, applying pressure now to the bottom lip, still with the spoon as she pulled it out.
That pressure caused his upper lip to close in such a way that he cleaned the spoon each time it was removed. The pressure let him know where his lips and tongue were in relation to the food and helped him to eat the full contents of the spoon. Super weird and very cool!! She had me try. It was awkward at first and I was pulling the spoon out of his mouth too fast. When I slowed down and removed it with that pressure, the spoon was clean! It worked every time!
After that, he was in no mood to sit still any longer and went straight for the zip line. It was an interesting lesson. In response to my question, she told me that after a while of receiving this pressure, he should be able to clean the spoon by himself.
I’m so glad we’re finally headed in the right direction with the whole foods thing. I really had no idea that he might not be understanding the positions or locations of parts of the inside of his mouth. This together with sensitivity is what I understand, right now, is causing the issues I’m seeing with the mechanics of eating. Just another odd step in growing up with sensory processing disorder.