Category: Sensory Processing

Mouth Stuffing and Food Pocketing in Young Children

6/26/2018

Photo credit from top left, clockwise: @druckstarr, @shaysmomlife, @ccamila55, @lilmisskekeisen

Chipmunk cheeks - is this normal?

Has your baby or toddler ever filled her mouth with blueberries - one after the next - without chewing and swallowing? Perhaps she stores them in her cheeks or at the roof of her mouth and you find food a few hours later!

Is this normal?
Is it behavioral?
Is this a sensory processing issue?

This question comes up almost daily in my practice as an Occupational Therapist specializing in feeding therapy.

In short, food pocketing and stuffing can happen when children are eating too fast and haven't mastered chewing skills, but if pocketing becomes a persistent issue despite using the preventive measures listed in this post, it may be time to seek professional help.

To understand why your child may pocket or overfill their mouth, let’s briefly discuss her oral development.

Note: the images used in this post were provided by parents in our free Facebook Group and are used with permission. The children in these images aren't pocketing food but rather have adorable, squishy cheeks!

Disclosure: some of the links below are affiliate links, which means (at no cost to you) we will make a small commission if you click through and make a purchase.

@rukiperez

Mouth development and oral awareness

Starting at birth, we want your baby to learn to soothe herself by placing her own hands into her mouth. By doing this, she learns the landscape of her mouth. This type of self-soothing with hands is comforting to babies and is exactly what we want them to do!

Your baby eventually learns how to bring toys further into her mouth and learns to gum and teethe on these safe teething toys. This is a developmental milestone that should be encouraged. She first learns where her mouth is, and then she learns about the boundaries within her mouth, such as the tongue, the hard palate and the back of her mouth.

Your baby will also learn to open and close her mouth around toys and her hands, and she soon learns that placing a toy straight back in her mouth may cause her to gag. She also learns when her mouth is too small for a large toy. In the OT world, we call this mouthing and the development of oral play skills. This is exactly what we want to see babies doing before 6 months of age.

Mouth stuffing and food

Once your child starts feeding herself, which can happen around 6 months if you're doing Baby-led Weaning, she may discover that she can put lots of food in her mouth. Her mouth is now bigger than it once was when she was a young baby, and she may get excited about eating new flavors and textures - so excited that she jams them all in her mouth at once. Perhaps she stores them in her cheeks, chipmunk style.

What do you do?

In the case of pocketing and mouth stuffing, prevention is the best remedy.

Preventing your child from stuffing in the first place is the safest and most effective way to manage chipmunking.

How do you prevent mouth stuffing?

Be your child’s speed bump - help her slow down her pace of eating by offering only one or two pieces of food on her tray or plate. If she's old enough, give her the option of serving herself with small spoons, getting just one blueberry at a time.
Offer frequent sips of water from an open cup or straw cup. Model drinking water with meals yourself. This will help your child wash down food and will slow down her pace of eating.
Novelty utensils like GrabEase, animal bento picks, and Pick-Ease, as well as blunt toothpicks, require more fine motor control and will slow her eating speed.
If the food is a bread product, use cookie cutters to make various sizes that may feel different when she take bites. You can also try FunBites Food Cutter to cut sandwiches and other foods into bite-sized pieces.
Older toddlers may understand taking different size bites. Ask your child to take a mouse-sized bite, then a dog-sized bite, then a dinosaur-sized bite. Work with various sizes until she understands that she can control how much food goes into her mouths by the bites she takes.
Talk to each other at mealtimes and encourage other language skills - don’t just talk about chewing the food. Yes, sometimes we need to remind our children to chew and take sips of water, but we also want them to remember that mealtime is a positive experience. Model and imitate safe, slower eating skills and take sips of water yourself.
Make sure that your child isn't watching a device or TV during mealtimes, as this can promote mindless eating.
Ask yourself if you're pressuring your child to eat - sometimes kids stuff food in their mouths because they're required to take a certain amount of bites (perhaps to "earn" dessert) but really don't want to eat that food. We highly recommend taking our toddler course to help make mealtime better without bribery or using pressure.

Your child's mouth is already overstuffed with food - now what?

While prevention is key with overstuffing, if stuffing happens it's critical to maneuver food out of her mouth safely.

1. Encourage your child to chew, but if she won't ask her to spit out the food, take a sip of water, and start over.
2. Offer her a small bite as her next bite and use the strategies listed above.
3. If your child won't spit out the food, won't chew and swallow, and won't drink any water, you may have to remove the food from her mouth. Be extremely careful, as you may push food further back in her mouth. Use your finger to slide food to the side and forward, not back. This may be a negative experience for your kiddo and should be only used as a last resort. This is not recommended when your baby is gagging while learning to eat and should only be used if you can clearly see the food.

When should you seek help?

@jennyslens

If you regularly find food stored in your child's mouth minutes to hours after a meal, it may be time to seek professional help. While it can be behavioral, food stuffing may also be a red flag that your child is not chewing her food and may not be feeling the food within her mouth. A lack of oral sensation can lead to stuffing because excess food helps your child understand the boundaries of her mouth better. She may seek out crunchy or chewy textures or may crave highly flavored foods (spicy, sour) to "wake up" the oral sensations within her mouth.

This behavior is concerning to feeding professionals and may require therapy. Speak with your pediatrician and seek professional help for your child if this is a persistent problem. We recommend scheduling an assessment with a Feeding Specialist (either an Occupational Therapist {OT} or a Speech Language Pathologist {SLP}) who has specialized training in oral/mouth development.

If your child is regularly pocketing food, please always do a mouth check before she leaves the table, as this can be a safety and choking concern.

We hope this helps you keep your kiddo's mouth safe and keeps her cheeks available for sweet mama kisses, not food pocketing!

Why do kids like crunchy foods?

5/3/2018

Have you noticed that your kiddo gravitates toward crackers, veggie straws, and all foods crunchy? Why does he love these crunchy foods, and how can we use his preference for crunch to improve his eating over time?

Judy here - I want to share a bit of my feeding therapy world with you.

Consider the crunch and texture of foods like croutons and cereal. What about this texture makes it irresistible?

Your toddler may find that crunch gives them the jaw resistance that teaches their mouths where the food is located. He learns that when he feels this crunch, it feels good inside his mouth, and because of this he learns to seek out crunchy foods more often. Not only does it teach his mouth where the food is located and awareness of what is happening between his teeth (or gums), but it also may feel great to a teething toddler.

As your baby and toddler experiences this jaw resistance that they practice in early chewing and biting, he seeks to repeat this feeling because it gives him positive sensory feedback. Whenever our sensory system experiences positive feedback, something our body enjoys, we want to repeat it! Over time, young children develop a sensory preference for this crunchy texture.

Think about the other types of sensory feedback your child receives when he hears the sound of his teeth crunching a veggie straw. His proprioceptive system is also hard at work - this system is the "GPS" of his body, the "positional sense" that allows him to know where his body parts are located as he moves and how much pressure or force his body needs to use to perform different tasks. Well, the proprioceptive sense is receiving input from the up and down movement of his mouth and the pressure needed to chew the crunchy food. His sense of taste also notices the saltiness and palatability that many crunchy foods have. Want to learn more about sensory processing? Check out this interesting article!

Biting, gnawing and hard chewing with resistance are a preferred exercise for babies. Not only does it help soothe teething spots, but it also gives them great sensory input through their gums. It is normal for your baby and young child to prefer things with crunch because it feels good!

To think of it another way, consider the foods you choose when you are craving something. Do you crave sweet? Salty? Crunchy? Smooth? Now, ask yourself this: "Why did I choose this food, and does it satisfy something sensory for me?" Does it help you self-regulate? Does it calm you, or wake you up?

Many of us use chewing gum or chewy/crunchy food to help ourselves focus or manage stress. Your sensory system guides your food choices more than you may realize.
Habits in our mouths start early in life, and we learn to choose these specific foods for the same reason your child prefers them, too.

Not surprisingly, as an OT specializing in feeding I get this question often: “My child loves only crunchy foods. How do I progress him off crunchy foods?”

This is a little question with a big answer.

If your child seems to prefer crunchy, follow the tips below, based on his age.

Babies 6 - 9 months:

Introduce a variety of colors, tastes, flavors, and essentially ”eat a rainbow” every day. Need help with this? Please check out our Infant Course.
Use dips with crunchy foods to introduce different textures. Try blueberry or raspberries blended with cream cheese or other soft cheese, hummus and guacamole, tzatziki, bean dip, and other savory spreads to add flavor, nutrients, and textures to a favorite crunch. Try to serve dips whenever you do crunchy foods.
Model eating different foods with your kids. If you want them to eat greens, then eat greens (and blues and oranges) with them.
If you have an older toddler or child, consider them the secret weapon in creating great new habits for the younger eater. Make it fun - create "lava" with red pepper hummus (you can squeeze it out of a Ziploc bag cut at the end) and play with it! Drive toy cars or cucumber "boats" through dip "rivers" and land the boats with a crash in their mouths. The secret to expanding a child's food tolerance is exposure and play. We talk all about this in our Toddler Course!

Older babies and toddlers/children (10+ months):

If your toddler has the skills to identify colors and shapes, use that to your advantage and make shish kebob’s out of different food shapes with fresh fruit and fresh veggies. Make it a production and play with the sound of the crunch! Then put your fingers into your child’s ears and have then crunch something and see how LOUD their crunch can be using the stuffed ears technique. Remember, play is key! Don't be afraid to get messy and have fun with it!
Try unconventional crunchy foods, like those listed in the image above! Baked cheese, crunchy broccoli, freeze dried fruit and pea snacks are a fun way to eat veggies and fruits!
If your child is not interested in soups or smoothies, I have found the following technique to be a huge success in feeding sessions. Start with three Dixie cups (or mini espresso cups) and cut straws in half. You are going to be the taster of the soup or smoothies - decide which soup/smoothie is the best, using only small tastes of each. Ask about the color of the soup/smoothie and play food detective. Perhaps they want to try the soup or smoothie too - maybe even with the straw or by drinkign from the cup! If your child is slightly older, I have had clients actually blend the smoothie for another adult, and the adult has to pretend to pay for the tastes (a la lemonade stand). Ask your toddler or child if they want to try the smoothie or soup to make sure it's made to perfection. Remember, don't ever force your kiddo to try something - it's all about him having fun, becoming comfortable with that food, and making the choice on his own to try something new.
Try a spiralizer! We love the Inspiralizer! This turns veggies and fruits into noodles. Try it with apples (I like the Granny Smiths the best for this). Kids especially like cold cucumbers or even jicama! Remember, kids love being involved in the kitchen with touching and smelling foods, as well as adding ingredients to recipes or choosing which foods to work with next.

As always, try to not make a big deal out of what your child is or isn’t eating. Instead, have fun with food, cook and shop together, and enjoy the art of play in all aspects of parenting as best you can.

Still need help? Our Toddler Course lays out a specific step-by-step plan for reversing or preventing picky eating utilizing feeding therapy and nutrition therapy strategies. Let us help your family make mealtime fun again!

Understanding Sensory Processing

10/4/2017

You probably know that you're supposed to involve your baby or young child in safe sensory play, but you may not understand the importance of sensory integration or how it relates to your child's feeding and general development.

In short, your child's sensory system dramatically impacts how he perceives the world, how he learns, and even how he eats. When it's functioning as expected, you may not even think about sensory processing. However, when sensory integration goes awry, it can affect many facets of your child's life.

We want to share with you some background regarding sensory integration so you can understand why your child may react to certain sensory inputs, how to best support your child's sensory system, and how to know if your child needs help with sensory processing.

Sensory integration/processing helps people “make sense” of the world around them.
Think of all the sensations you experience while dressing, bathing, walking or even driving a car to the airport.

Sensory Integration is the process of using our senses to:

Quickly take in sensory information.
Organize this information.
Use it for success in everyday activities.

We usually think of five senses: sight, sound, taste, touch (tactile), and smell.

We also receive information from our body position sense known as proprioception, and balance and movement sense known as vestibular sense.

Touch Sense - Tactile

The tactile sense gives us information from our skin, including inside and outside our mouths. Every time you touch something or you are touched, your skin provides you with detailed information; this comes from the tactile sense. It allows you to tell the difference between a friendly touch versus to the uncomfortable feeling of a bug biting you on the arm.

Think of a child licking ice cream from a cone as it drips down their arm. Does the child continue eating the ice cream and lick off the drips, or is the child bothered completely by the drips, drops the cone, and becomes very upset? This is the tactile system hard at work, it is either seen as pleasurable or averse. As you can imagine, when a child perceives certain tactile sensations as very averse, it can dramatically affect their success with feeding.

Body Position Sense - Proprioception

Proprioception is our body's position sense. Proprioception is the ability to know where a body part is without having to look, and it helps us know how much pressure we need to do certain things. We use this sense when we pick up a paper cup filled with water without spilling or holding it too tightly.

For example, have you ever watched your child pull a wheeling suitcase or push a play shopping cart around the house and then change the weight of the suitcase or cart? Her proprioception changes when she realizes she must push or pull the object harder. This sense is automatic and happens without much conscious thought, and it is a result of your proprioceptors hard at work within your joints. Pretty cool, right?

Movement/Gravity Sense - Vestibular

The vestibular system is our balance and movement sense. The vestibular sense allows us to move smoothly and balance while engaged in activities. We use this sense when riding a skateboard or sliding down a slide at the playground.

Watch a toddler as they practice their balance on uneven surfaces at the park. He may struggle at first, but it usually improves with each trial.

When Our Senses Unite

Integrating and processing information from the tactile, proprioceptive, and vestibular systems, along with the other senses (sight, sounds, taste and smell), makes it possible to successfully participate in everyday activities.

For example, visualize a six-year-old boy holding a baseball bat and trying to hit at a T-ball.
The tactile (touch) sense helps him hold his bat correctly. Proprioception (body) sense helps him know his body is in the correct position. Vestibular (balance and movement) sense helps him stay upright while swinging the bat. His vision (sight) and hearing (sound) are also key to his success in the game.

Our bodies are truly amazing when they work as expected. However, what happens when things don’t work automatically?

Some kids struggle with sensory integration, which can affect their success with feeding. These behaviors may include:

Overly sensitive or under reactive to touch, movement, sights, or sounds in the environment.
Unusually high or low activity level.
Easily distracted/poor attention to tasks.
Delays in oral motor skills, feeding skills, excessive pickiness and unexplained food refusals.
Delays in speech, motor skills or academic achievement.
Coordination problems - appears clumsy or awkward.
Poor body awareness - frequent bumps and bruises (beyond the average kiddo).
Difficult learning new tasks or figuring out how to play with unfamiliar toys.
Appears to be disorganized most of the time.
Difficulty with transitions between activities or environments.
Immature social skills for age.
Impulsivity or lack of self-control.
Difficulty calming self once “wound up.”

If you notice any of the above behaviors, which may affect your child's home or school environment, talk to your healthcare provider. Ask to be scheduled for a full assessment that includes a Sensory Processing Evaluation. Therapists trained in Sensory Integration utilize a play-based, child-friendly approach.

Children improve their ability to process and organize sensory information in a setting where the child can engage in a variety of fun sensory experiences. Therapy can help kids simply be kids, playing alongside friends, and fully enjoying their young lives while learning to respond to a sensory-rich world.

Want to help support and develop your child's sensory system? Utilize the following activities on a regular basis, and make sure to never pressure a child to do something he's not ready for yet (e.g. touch a texture he's averse to).

Swings, climbing structures, big pillows and bolsters can help vestibular input and deep proprioceptive input.
Moon/kinetic sand, shaving cream, Play Doh and messy squishy toys (slime, water beads) can help with tactile development. Furthermore, touching and exploring food, especially in infancy and toddlerhood, is a wonderful tactile and general sensory experience.
Balance beams, mini trampolines or climbing walls can help with balance and movement skills.
Pushing a weighted laundry cart or tossing weighted bean bags at a target can help develop proprioception skills. A weighted blanket or weighted stuffed animals are great to help calm kids down too.
If you'd like, introduce a fidget toy! (The real creators of fidget toys are OTs, I'll have you know!) Fidget toys are actually recommended to calm kiddos down and get their focus onto a simple movement or tactile activity. Great fidget toys include: “Bug Out Bob”, OOZE Tubes, Stress Balls, Bendy Man, Stretchy Mice Cheese, Stress Less Gel Ball, and Tactile Atom ball, all available through www.got-specialkids.com.

We wish you fun and playfulness on your sensory development journey!