S-t-r-e-t-c-h!

Stretching-recommended-before-exercise is pretty common knowledge. You stretch your muscles (and soft-tissues: tendons, ligaments, nerves, blood vessels, joint capsules, fascia) before you exercise – don’t you?

 

Much of what you see therapists do in and around the mouth of your child-with-oral-eating-impairments is actually stretching  the muscles and soft tissue. 

 

 

Most children respond with avoidance or fussing or expressions that we interpret as pained or feeling discomfort. Some might use the words: orally defensive or tactually defensive or sensory processing disorder. Whatever words are used, stretching (and in some terms, massage) is used to change the physiological status of the muscles of the jaw, the face, the tongue, and the lips.

Why are stretching and massage used?  Because inactive muscles shorten and become smaller and weaker – a downward cycle unless there is intervention.

Why are some muscles inactive or contract in ways that prevent eating?  The muscles are not guided well by their 'masters' in the nervous system.  Muscles are controlled by the nervous system – as is developmental progression.  Some children with development-altering-diagnoses have mouth muscles that do not function for eating.

Enter the speech pathologist or occupational therapist serving your child with her latex-free gloves, flat spoons and syringes. Some might even bring in a small vibrator. [Cheesh, I hope that word does not bring weird searches to my blog.]

The first thing your therapist will likely do is specifically position your child for eating therapy. Particular attention to the position of his neck is important. Remember that the esophagus (tube between the throat and stomach) and the trachea (tube between the nose and lungs) are next to each other in the neck.

You might see the therapist press her gloved fingers into your child’s face – to each side of his mouth – with a massage-like pressure. The therapist might grasp the masseter muscle between her finger and thumb and pull forward. She might press around his lips and pull the upper lip down and lower lip up. Pressure directly onto the tongue is another commonly-used technique. She is stretching the muscles and soft tissue to prepare for activation.

After preparation (stretching), the therapist might specifically insert a bit of food into your child’s mouth and assist his jaw and mouth to chew  (if that is the intent) and swallow the food. 

 

This whole process is to help the child develop the ability to eat.  Some parents and therapists choose to do eating therapy just before feeding or while the child is experiencing hunger. 

Eating therapy is tedious and not necessarily meant to provide nutrition in the moment. Some parents give-up on oral eating  after a lack of complete success.  As mentioned in comments previously, eating/feeding  a child is an emotional issue for many parents. 

If your understanding of your child’s eating/feeding problem is primarily sensory, the same techniques might be used. Deep pressure is often used to decrease tactile hypersensitivity.

I encourage you to learn some of the techniques used by the therapist to promote your child’s ability to eat. But I suggest you incorporate the techniques slowly or one-at-a-time - whatever you and the therapist agree upon.

In almost every case, deciding on a position for feeding is the first technique to incorporate into your habits or lifestyle. I advise against trying to replicate a therapy session with every meal.

Whatever you are working on – developing oral eating while using a gi-tube for nutrition or transitioning from suckling to chewing, or broadening the range of foods eaten by your child, an ST and/or OT are your best resources for helping you and your child.

Next in this series: The techniques I have used myself to promote oral function – what I believe are effective. [Note to self: remember to mention gag reflexes.]

Comments

[Mrs. Mac]

A 'free' helpful hint: Along with developing the muscles in the mouth ... it's also important to begin allowing the child to get a little bit hungry. The mental/physical hunger discomfort is a good friend when attempting to transition a non or nearly non eater into an eater. How do you do this in a humane way. I'll post another helpful hint when Dr. B asks ... I don't want to get ahead of her again ;) (Great topic ... keep these posts flowing :)

[Mother Mayhem]

Emily's gag reflex was incredible. Especially if you gave her something like Jello. Snort.

[Danette]

This is really interesting. Bearhug had muscle weakness in his mouth (that has apparently resolved itself) that caused him to drool excessively until he was close to 3 yrs old. If there is any question of who is who in old pictures of them together, we can tell by who has a big wet spot on the front of his shirt (he wouldn't wear a bib) and drool on his chin.

Cuddlebug has a different kind of muscle weakness (or some kind of mouth muscle issue, I'll admit I don't totally understand the specifics) that affects his speech - he has a slushy sound when he makes the "sh," "ch," "x" or "j" sounds. Strangely enough, now that Bitty is talking more I can hear the same thing when he makes those sounds.

[The Barbara who lives here]

I appreciate that, Mrs. Mac. hehe. Your hint is especially helpful because you give example of a specific context for using it.

Thank you, too, MM. Your comment helps me distinguish gag that occurs with any food and gag that occurs with only certain foods - the latter certainly being a sensory aversion response.

You give credence to the importance of muscle function for oral function, Danette. Also, I have a nudge for exploring particular articulation issues relative to oral function, but I might not get there for a while. Thanks for the prompt to go after it!