By Shirley Sutton

Nothing causes more exasperation to an already stressed out parent of a child with special needs than the child who makes mealtimes a disaster! In my 25 tears as a pediatric occupational therapist, and a mother of three children, I know firsthand how developing socially acceptable eating and drinking skills promotes quality of life.

In this article, I will share my “favourite four” clinical tips which will help restore the ‘fun’ around mealtimes.  These tips are drawn from a variety of theoretical backgrounds, including sensory processing, Floortime/RDI, behavioural , neuro-developmental ( “NDT”), and developmental pre-speech approaches.

1. Fun First !

If your child does not engage readily in face to face play, he has likely missed a great deal of stimulation to the cheeks, mouth, lips and teeth. Think of baby games such as blowing raspberries, sticking tongues in and out, making silly faces in the mirror and singing. I teach parents a family favourite song I created, “Funny Faces” (I promise to sing it for you if you come to the next Make & Take Workshop). This type of play builds muscle strength in the lips, cheeks and tongue, as well as addressing  the core deficits of ASD, such as attention, eye gaze, imitation and social referencing.

2. Know your child – sensory and motor differences must be considered!

Ask your speech pathologist or occupational therapist for assistance if you are unsure of your child’s responses. Once you recognize your child’s hypo or hypersensitivities, you can plan activities accordingly.

When low muscle tone is present, general alerting input is called for. This may include using strong tastes, cold temperatures, crunchy textures and/or strong muscle work (gum chewing) to “wake up” the mouth. Sour tastes are alerting (sour candy/popsicles, lemonade) and spicy, bitter foods are most alerting (taco sauce, cinnamon hearts.) Frozen cold things are alerting (frozen grapes, ice chips, and popsicles.) If, on the other hand, your child is a sensory avoider, they may over react to subtle taste, temperature or texture differences. You will need to provide more gentle challenges. Start with expanding their toy tolerances rather than food.

3.  Toys for Mouth Play are Everywhere!

The mouth and tongue are a young child’s “tool of identification”. Everything goes to mouth to taste, squeeze, and feel.  Jean Ayres the Occupational Therapist and founder of Sensory Integration (SI) Theory, coined the phrase  “feed the need”. Clinically, if a child is bringing toys or fingers to the mouth, there is a sensory need going on that you need to recognize. By providing a wide variety of sensory experiences with mouth toys, this develops sensory awareness and skilled movements needed for eating, drinking and speaking.  Of course, safety is the first consideration before encouraging any toys for mouthing. Choose larger toys if general tongue and lip exploration is wanted. If trying to encourage more chewing and texture tolerances, use toys with smaller pieces that will fit back on the molars. Look for favourite theme toys for older kids. A few of my favourites include: mirror mouth play,  straws ( regular, curly, and whistle straws), blowing bubbles ( there is a huge variety of bubble making toys at the dollar stores), blowing musical instruments, blow pens, vibrating toys, face paint, and puppets.

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4. Incredible Edibles

I always include activities that are fun with food, but that don’t necessarily involve eating. This provides non-threatening exposure to smells, sights and feel of certain food, without necessarily tasting it. As a “Make & Take” workshop activity, we make a Smelly Guessing Game, which appeals to all noses. When promoting Art with Attitude, paint with mustard, ketchup, and frozen juice straws. Check out recipes for edible playdoughs in the book Building Bridges. I demonstrate several other excellent fine motor activities using edibles; e.g. Taste the shape , Follow the Tongue. These art activities are inclusive for those children who are into oral seeking, or “everything goes into my mouth” stage. Often parents and educators find this stage in older children most frustrating.

I trust these ‘favourite four” clinical tips will help you and your child on your journey. Remember:

1. “Fun first”
2. Know your child’s sensory needs
3. Provide lots of mouth toys and opportunities
4. Food is for fun too – not just eating!

Suggested Readings

Ernsperger  & Stegen- Hanson. (2004). Just Take a Bite: Easy, Effective Answers to Food Aversions and Eating Challenges.

Greenspan  & Wieder (1998) The Child with Special Needs.

Guthrie Medlen (2002) The Down Syndrome Nutrition Handbook. A Guide to Promoting Healthy LifestylesOetter,

Richter and Frick (1993) MORE: Integrating the Mouth with Sensory and Postural Functions

Williams and Shellenberger (1994)  How Does Your Engine Run?

Yack, Sutton & Aquilla (1998) Building Bridges Through Sensory Integration: Therapy for Children with Autism and Other Pervasive Developmental Disorders (2ND ed.)

Suggested Websites

www.autismwebsite.com
www.new-vis.com
www.apraxia-kids.org

Shirley Sutton is an Occupational Therapist and author with over 25 years experience working with clients with special needs, from infants through teen years.  She presents training workshops across Canada for AACI and other organizations.  Shirley co-authored the book “Building Bridges through Sensory Integration- Occupational Therapy for Children with Autism and other Pervasive Disorders . Her private practice is located in Collingwood Ontario (705-445-8069).