Open Wide…

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.

 His food issues are strictly behavioral.

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.

My son pockets food just like this...

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.

"What do I do with this? It's not broken up!"

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.

Leaving pudding on the spoon...

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.

Zip line reward!

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.


About solodialogue

I'm a lawyer and the mom of a 6 year old boy with autism. I work part time and spend the rest driving here and there and everywhere for my son's various therapies. Instead of trying cases, I now play Pac-man and watch SpongeBob. I wear old sweaters and jeans and always, always flat shoes to run after my son. Yeah, it's different but I wouldn't change it for anything. The love of my child is the most powerful, beautiful and rewarding aspect of my life.
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23 Responses to Open Wide…

  1. KWombles says:

    Yay! Sounds very productive and informative. 🙂 So many things we take for granted that it just doesn’t occur to us that a child might not know how to do something we do naturally.

    • solodialogue says:

      Thanks Kim! I know. I took for granted that he would know where everything was and was just being difficult. Now I know better. I guess as a parent, I still am learning every day! 🙂

  2. Amanda says:

    That makes great sense. There were many things my son wouldn’t do simply because he didn’t know how or what to do.

    I agree that after a few more sessions he will do it himself. What a great therapist.

    • solodialogue says:

      She is a good therapist – and thinks a lot about things on her off time and shares them later! I hope he is able to transfer this skill to self. That would be great to free up some of my sitting and watching him eat time…

  3. Lizbeth says:

    That’s great! I can see this with A. and some of his speech issues. It’s like he doesn’t know how or where to place his tongue, lips, etc to make the right sounds. Makes perfect sense as it applies to how to use a spoon, apple, etc. Great post!

    • solodialogue says:

      Thanks Lizbeth! It does make sense but I never would have thought of it! He sometimes even misses his mouth a bit with the spoon and then starts screaming to “clean!” I think that deep pressure around his mouth and above his lip before he eats will help too! Let me know if you try it out on A – would love to hear if it makes a difference! 🙂

  4. Jacksmom says:

    We share not only the same ABA, but fun in that quite familiar looking OT room. Our little guy and Tootles are practically the same age..we have way too much in common to not know each other!!

    • solodialogue says:

      That’s so funny! I LOVE that OT room! They are soo good there! Maybe we will run into each other soon… Does your little guy have social skills class there? We do – maybe he could come! 🙂

  5. Jen says:

    Wow…what awesome progress with the spoon! I’m surprised T sat for that. He must’ve really wanted to play on that zip line. I’ll have to try applying some pressure on my son’s mouth as he has spoon difficulties too. He also chews and spits out apples. Did she happen to say anything helpful for that?

    • solodialogue says:

      Jen, she just observed the pocketing and chewing. She said she was going to think on the apples thing. (You’ll have to stay tuned for an update!) He’s not too bad at sitting but he really wanted that zip line! You have to try the spoon thing! It’s truly like magic! (If you have trouble you can FB message me and I’ll talk you through it!)

  6. This is really interesting- I wonder if she was worried about getting bit? I’m glad you got some answers and things you can do to help at home!

  7. Denise says:

    It sounds like you had an excellent therapy session!

    • solodialogue says:

      Ooh Denise! I’ve been thinking of you and Steve! Yes, we had a great session! T made a card for you guys and I have yet to mail it! Shame shame, everybody knows my name! He loves the books. Will be in the mail over the weekend! ❤

  8. I love sessions that you leave with really practical, useful advice! Hope it keeps up for Tootles 😉

  9. Grace says:

    I’m so glad you got some positive results here! But just reading this made me exhausted. The pediatrician, ABA, OT. . .it never ends, does it? At least you’re figuring some stuff out. That rocks.

  10. eof737 says:

    Isn’t that amazing that we can find solutions to many things. Glad this one helped your son… 🙂
    Happy 4th!

  11. Trish says:

    So glad to hear of the progress being made! My son is hyposensitive as well and would pocket his food. With practice and reminders, he has learned how to eat more appropriately.

    He greatly prefers crunchy and chewy foods and has been resistant to eating anything smooth or gooey. I don’t know how he would be with a spoon because he stopped eating those foods when he was 2 and at the time he was still turning the spoon upside down and losing most of it. 🙂

    • solodialogue says:

      Hi Trish! Thanks for the comment. Please give the pressure method a try with him if you can. It is an amazing tool. There are so many parts of eating and the SPD that are related. I can totally relate to everything you are saying- the situations sound quite similar. Hope you have a wonderful 4th of July! 🙂

  12. Sorry it’s taken so long to get my comments on this post — but you kind of know where I’m at right now with things I enjoy… reading your blog is something I’ve missed — A LOT!

    I am so so happy to hear that T’s oral issues are not medical (told you so 😉 ) And I gotta say that it sounds like you have an incredible OT! Just knowing how far Little Miss has come with her OT feeding sessions, I can tell you that this is going to be really good for T. I have no doubt that you’ll have many of his eating issues cleared up in no time!

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