Eating is a multi-sensory experience. What food looks like, how it smells, the sounds heard while they are cooking and wonderful textures all combine to create a positive relationship with food. But even before food is tasted and enjoyed, there can be several hurdles in the way making it difficult for some to see eating as a positive event.
Children diagnosed with sensory issues, most specifically Sensory Processing Disorder (SPD), aren’t able to enjoy eating as much as the rest of us do. Eating issues are multi-dimensional. In addition to sensory defensiveness (mostly in the olfactory, gustatory and tactile systems), the action of eating can be interfered with due to other unseen issues such as:
- weak oral muscles (mouth, jaw and tongue) which not only prevents a child from chewing food effectively, but also causes him to avoid any foods that are too textural (chewy, crunchy, lumpy, etc.) or that require the skill of more rotary-style form of chewing, such as when eating meat, where he’d use the back part of the teeth and mouth.
- the oral-motor skills needed for chewing are also poor because his brain isn’t giving his mouth the signal to chew, or to tell him when his mouth has enough in it, or even that he needs to swallow before putting more food in.
- poor oral-motor control where the tongue isn’t able to maneuver the food around in the mouth properly in order to swallow. Not only does this create a gagging sensation in itself, pieces of food are often left in the mouth that haven’t been moved back far enough resulting in textural triggers as well as gagging.
- poor proprioception or dyspraxia where a child needs a tremendous amount of sensation in his mouth to ‘feel’ the food resulting in ‘stuffing’ (shoveling food in to excess without swallowing).
- inability to feel full (resulting in throwing up) or even to feel hungry at all. Many children with SPD relate the pings of hunger to pain which can result in negative perception of eating.
- having an existing high gag reflex issue. What this means is that where typical children move slowly from liquids to mushy to lumpy to pieces to regular mouth-friendly proportioned foods, children with SPD struggle to move past mushy stage as food become more difficult to navigate in the mouth, chew and swallow.
- And, finally, because he may never have learned to tolerate lumpier foods, his gag reflex will kick in as if to say, “Quick! Get this out of here! Danger! Alert!”
An occupational therapist (OT) specifically trained in treating children with SPD and sensory issues will help parents understand that it’s not as simple as putting the food on the plate and saying, “EAT!”. The child literally has to learn the mechanics of eating from tolerating the food on his plate to keeping it in his mouth to teaching him what to do with it once it’s in there and all of the tiny steps involved leading up to swallowing.
A good place start is working directly on the gag reflex. If the child can push back his reflexogenic zone (the area that triggers the gagging), he can then work on what to do with the food in his mouth. For most of us, that reflexogenic zone is right at the back of the mouth. For many children with SPD, it’s right in the front of the mouth which is why gagging occurs when he simply puts food with a texture heavier than apple sauce in his mouth. To assist with this, OTs have a great gag desensitization activity called, ‘The Tongue Jumping Game’.
First, the OT locates the child’s gag zone so she knows where to begin and move past from. By using a finger, the base of a kiddie toothbrush, spoon or small toy, pressure is pressed onto the front of the tongue, moving back slowly until a gag reflex occurs. This is the area you’d do the activity in, moving back just a tiny bit each time as tolerated.
Tip: This may be a challenge for a child whose gag sensitivity is so high, he gags just having anything near his mouth. If that’s the situation, the activity would begin just outside his mouth.
Once this spot is found, the OT ‘jumps’ with the finger (or whichever of the above suggestions chosen) in that spot up to 10 times. The point of this exercise is to push the gag-sensitive area to the back ¼ of the tongue. It make take a long time so patience is needed. Never force progress by moving too quickly as it may result in having to start from the beginning.
Important: A child who also has tactile issues requires the right amount of pressure on the tongue or he’ll gag simply from the lighter touch.
Here are some tips parents can try while doing the activity at home:
- The use of music or rhyming while ‘jumping’ on his tongue sets a rhythm and predictability. It also makes the activity focused more on fun rather than an exercise that’s going to make him gag.
- Parents can ‘jump’ on their own tongue at the same time, or get the child to do their tongue while they are doing his. Then he won’t feel ‘singled-out’.
- As stated earlier, if gagging happens even before touching the tongue, start on the cheeks, jaw, chin or lips, then gradually move into the mouth. Baby steps is still a step.
- ‘Gag distraction’, which is using a favorite toy, activity, song, book or other tools to distract, helps the child learn to control his gagging on his own without a lot of attention being paid to the gagging.
- Excessive gagging can be controlled by having the child move his head down so that his chin pushes on his chest. This flex can be increased by pressing on the sternum of the chest with a hand. Essentially, this position makes gagging uncomfortable and anatomically difficult. It also helps a child learn to stop his gagging before the point of throwing up.
The most important thing to do while doing this exercise is to give tons of praise and positive feedback. As with any exercise, a child might be uncomfortable and, possibly, scared at first. After all, they’re being introduced to sensations they normally actively avoid. But after a while, with parents’ love, support and guidance, the child’s brain will make the neural connections to understand the sensation and it will become automatic.