Uncovering the Oral Motor Why: A Closer Look at Pediatric Feeding Behaviors
Have you ever received a referral for a child with picky eating whose parents main concern is increasing the types and volume of food their child is eating? This is a tricky situation, as the parent is likely looking to you to expand their child’s diet, after all, you are a therapist, and their child needs to eat more foods, NOW!
In pediatric feeding therapy, it's not uncommon to encounter children like Adam, whose picky eating behaviors and sensory symptoms seem to overshadow the underlying reasons behind their struggles. However, by delving deeper into the oral motor performance skills of these children, occupational therapy practitioners (OTPs) can uncover the root causes of their feeding challenges and develop targeted interventions to address them effectively.
Understanding the Link Between Behavior and Oral Motor Function: Behaviors and sensory symptoms often serve as red flags, signaling underlying oral motor coordination difficulties in children like Adam. While it may appear that Adam's food anxiety and sensory dysregulation are the primary drivers of his picky eating, a comprehensive clinical evaluation reveals a different story. Adam exhibits poor tongue lateralization and chewing coordination and endurance, which contribute to his gag reflex sensitivity and exacerbate his picky eating behaviors.
Developing a Targeted Plan of Care: Armed with this understanding of Adam's oral motor challenges, the OT can create a personalized plan of care that addresses the underlying WHY behind his picky eating behaviors. This plan encompasses several key components aimed at improving Adam's oral motor skills and expanding his dietary repertoire:
Establishing Home Routines: Adam will engage in structured routines at home to explore and interact with novel foods on his plate and during meal prep. These routines provide opportunities for exposure to new textures and flavors in a controlled environment, gradually desensitizing Adam to unfamiliar foods.
Expanding Diet Variety: The OT will work with Adam to incorporate more nutritional varieties of foods into his diet while staying within the realm of foods that he can safely chew and swallow. This may involve introducing new food textures and gradually expanding the range of acceptable foods to include items beyond his current comfort zone.
Tongue Lateralization Exercises: Adam will engage in specific exercises designed to improve his tongue lateralization skills, facilitating better chewing coordination and bolus management. These exercises focus on promoting lateral tongue movement, which is essential for manipulating food within the oral cavity and preparing it for swallowing.
Increasing Chewing Endurance: To enhance Adam's chewing coordination and endurance, the OT will implement activities aimed at prolonging the duration of chewing. By gradually increasing the time spent chewing foods, Adam can build strength and endurance in the muscles involved in the chewing process, improving overall oral motor function.
In pediatric feeding therapy, it's crucial to look beyond the surface behaviors and sensory symptoms to identify the underlying oral motor challenges that may be contributing to a child's feeding difficulties. By recognizing the link between behavior and oral motor function, OTPs can develop targeted interventions that address the root causes of picky eating and promote improved feeding outcomes for children like Adam. Through personalized plans of care that focus on enhancing oral motor skills and while supporting the child’s unique sensory and emotional needs, OTPs play a vital role in supporting children on their journey to successful feeding and eating.
While Adam is just one example of what a journey to identifying the oral motor WHY may look at, we recognize that each child has differences in how their skill development impacts their relationship with food. The exact same presentation of sensory and behavioral food avoidance could have an entirely different reason for Emily who has low oral tone and absent transverse tongue reflex, and a different reason for Jose, who has learned to retract his cheeks and chew just in the front of his mouth. The oral motor why behind behavior that looks similar on the surface may vary widely from child to child, and when we see the why we can develop client centered occupational therapy plans of care that lead out clients to success.
When we look for the oral motor WHY, we are validating the children that we are working with, focusing intervention on giving them the tools and ability to engage in mealtime routines, and expanding parents capacity to look beyond behavior in parenting as well as measure success in feeding therapy by oral motor abilities not just what foods their child eats.
Next time you meet a picky eater, look for WHY they are behaving the way they do! Happy Eating!
