When I am getting to know a new client with speech, I always ask the parent to tell me about what their child eats. Often, I get the answer that the child is picky. When I probe, I am able to categorize the types of foods that the child avoids and that gives me clues as to what is going on in their mouth which helps with treatment planning for their speech and language goals. This is not an always thing, but it happens enough that there is a definite pattern. So hopefully, these ideas will help you moms and dads at home working with picky eaters with speech and language issues.
If I hear that the child eats soft foods (mashed potatoes, applesauce, yogurt) and crunchy foods (crackers, chips, pretzels) but avoids meats and raw fruits and veggies, I conclude an oral motor weakness most likely in the jaw. If the jaw is weak, they child has difficulty either biting or sustaining chewing foods that cannot be quickly swallowed. These kids also often are munchers….they bite things like sandwiches in tiny bites and chew with their front teeth only. Crumbly foods such as crackers or granola bars are messy because they chew with their front teeth and lots of crumbs fall out. My theory is that at some point these children tried something chewy and either choked or felt choked, so they said “no more of that” (it only takes once to develop a learned behavior). Therefore, they never allowed themselves to develop the jaw strength for biting and sustained chewing necessary for eating chewy foods.
What to do?
- Practice chewing in a safe way. Wrap a soft but firm, highly flavorful food (gum, gummy bears, Tootsie rolls, mango, beef jerky, grilled chicken chunk) in a piece of fine mesh or cheesecloth, twisted so that to food is in a bundle and you can hold the ends. Place the bundled food between your child’s back molars have have them bite/chew 5 times. Count aloud. Do this on each side. Celebrate this victory and allow your child to have his favorite treat. At the next meal, repeat. If 5 chews was ok, shoot for 8 chews. Praise your child for a job well done and continue with the meal. Try this at each meal attempting to increase the number of chews by 2-3 chews each time. Give your child the goal “we are going to make it to 10 this time”. When he gets there, congratulate him then move on. This should only take a few minutes of your time. If your child is resistant, he might not be ready. Try using a food in the pouch that he is familiar to get him used to the idea.
- If you feel comfortable that your child will not choke on small pieces, you can use any long food that can be held by you and placed on the molars. I like to start with pretzel rods. The child bites and as you gently feed the pretzel in. Once he gets the hang of that and can munch for 8-10 times, you can try firmer foods that don’t dissolve such as carrot sticks, Twizzlers (I let mine get stale so that they are very firm), fruit leather rolled up like a cigar or pizza crust. Remember to set a goal and count out loud. Celebrate and reward with something easy to eat.
- Biting on a spring loaded clothes pin is good exercise too. Place the pin on the molars and bite and count.
- When your child is comfortably chewing for 25 or so times on each side, you can start trying things like sandwiches cut into strips, chicken strips, pizza cut into narrow slices and apple slices. Practice biting with the front teeth then moving the food to the back teeth for chewing.
- Chewing gum will give good practice when you can assure that your child won’t swallow the gum. I prefer the cheap, really hard gum because it is harder to chew and the flavor doesn’t last very long. I give it to kids and they chew for a few minutes and once it is soft, the flavor is gone and they are ready to spit it out. Job accomplished.
Now, If a parent tells me that their child only likes one or two foods, avoids soft foods or has very specific food preferences (“I only eat waffles that are circles”), then I suspect an oral sensory deficit. I think this can start in very much the same way as the motor deficit. One day, something squishy was gross, therefore, all things squishy are gross. An oral sensory deficit can occur along with an oral motor weakness and its sometimes hard to separate the two.
What to do?
- Many therapist begin with food exploration and food play. This is OK, but don’t spend too much time on it. If your child is ok touching food and being near food, its time to move to the mouth. Choose one food that you want your child to try…say….strawberries. Give your child a doll sized plate with a tiny piece of strawberry. Have him kiss the strawberry 3 times. Celebrate the victory and give him his favorite treat, on the doll plate. Then, you can be done. Or, it he doesn’t seem to stressed out, try again. Kiss the strawberry 3 times, favorite treat. And so it goes. On the next day, you might still be at the kissing stage, or you might be ready for licking the strawberry. Again, use a tiny piece and a doll sized plate so the task is not overwhelming and reward with a treat. I would recommend that you have a treat that is only given at these “trying new foods times” and not available any other times. It makes it a little more rewarding. You move from licking to popping the strawberry piece in their mouth. Spitting it out is not an option. No reward for spitting it out….it has to stay in and go down. Once you are successful with small tastes of strawberry, add another food. This seems tedious, I know, but the whole process will get faster. It will take a week or so to do the first food and after a few weeks, you’ll be trying several new things a week and before you know it you’ll find yourself skipping all the steps and your child will just be trying new things….on his doll plate. Eventually, you fade that out.
- Deep pressure before and after a sensory feeding session is always a good idea to prepare the mouth and to desensitize it afterwards to get rid of any leftover “yucky” feeling. You can do this by simply wiping your child’s mouth firmly with a soft cloth. Vibration may be helpful as well using either a hand massager or a vibrating toothbrush.
- This is a fun little plate that your kiddo might find rewarding
Improving oral motor skills for eating is often directly related to improving speech skills. After all, how can we expect children to perform the rapid movements necessary for connected speech if they are low tone, uncoordinated and can’t even manipulate food in their mouths? More tips on feeding later. My favorite source for all things feeding is TalkTools.com. There you’ll find more tips and blogs and success stories. Please note, this post is for typically developing children with speech and language development issues and who are picky eaters. If your child has a true feeding disorder defined by swallowing or aspiration difficulties, failure to thrive, severe reflux, allergies or if your child has a mobility disability, please consult with a feeding professional before trying any feeding intervention.