Sensory Related Oral Defensiveness & Aversions in Children Brooke Breaux Sensory Related Oral Defensiveness & Aversions in Children

Oral Defensiveness & Aversions Related to Sensory Processing Deficits Hyposensitivity Low muscle tone and very minimal awareness of what’s going on inside their mouths; “Oral numbness”   Hypersensitivity Overly sensitive to oral stimulation; too much oral awareness (Lowsky, 2011)

Hyposensitivity  The “Oral numbness” can cause significant speech and feeding delays Example: can effect an individual’s ability to create a food bolus which is a critical oral motor skill necessary for swallowing Lack of awareness can lead to mouth stuffing, leftover food particles in and around the mouth, drooling, etc. Oral defensiveness occurs because the individual is not used to new oral sensation and may be afraid or unsure of unfamiliar sensations (Lowsky, 2011)

Hypersensitivity Hypersensitivity to oral stimulation can lead to texture/food aversions, picky eating, and speech and feeding delays because even the slightest stimulation might be uncomfortable or even painful As a result, a client may present with a range of behavioral issues including crying, kicking, screaming etc. (Lowsky, 2011)

Red Flags for Feeding Indicators that a family should consult a SLP for a feeding/swallowing evaluation include: Feeding more than 20-30 minutes „ Stressful Mealtimes „ Not gaining weight in the past 2-3 months „ Cry or act out when presented with new foods „ Refuse entire texture categories „ Refuse entire food categories (Weaver, 2008)

Dynamic Assessment Important: a wide range of information should be collected across multiple domains of the client’s life in order for an SLP to make an accurate diagnosis determine the cause of the feeding problems and identify any Oral Motor and/or Sensory deficits Assessment Should Include Client/Caregiver Interviews Past Medical History Feeding Case History Oral Motor Structure Functional Assessment Feeding Tolerance Assessment/Observation Stimuli Response Assessment

Picky Eaters vs Problem Feeders tolerate new food on plate cry or act out when presented with new food usually touch or taste new food -refuse entire categories of food textures eating at least one food from most food textures -avoid one or more food groups balanced diet/four major food groups (dairy, grain and cereal, meat and protein, fruits and vegetables) -unusual aversions -typically demonstrate tactile and oral defensiveness , and over active gag (Weaver, 2008)

Treatment of Oral Defensiveness & Aversions in Children As with most communication and swallowing/feeding discords, there is no one approach or one answer for treating children with Oral Defensiveness & Aversions. The treatment plan should cater to the client’s individual needs. Including the client’s OT in the intervention process has many benefits esp. for a client with sensory processing deficits Goal of Intervention: develop a well-rounded diet eating from all of the food groups. (Lowsky, 2011)

Treatment of Sensory-Related Oral Defensiveness & Aversions in Children Hypersensitivity & Hyposensitivity Treatment Approach Recommended by Debra C. Lowsky (2011) For both forms of oral defensiveness: Get into the mouth and provide input in order to normalize sensation Calm and Supportive Environment Gum Massage Provides calming and enjoyable tactile feedback for hyposensitive individuals Slowly desensitizes the mouth for hypersensitive individuals Chew tools Different shapes and textures provide various types of sensory input Vibration (Z-Vibe) Effective in decreasing oral defensiveness/sensitivities Various tips to tap, stroke, and apply gentle pressure to the lips, tongue, cheeks, and gums Vary your pressure, the length of your strokes, and the duration of the stimulation.

Cont. If the individual is very sensitive: take a step back and identify exactly where the oral aversion is.  Is it the on the lips, inside the cheek areas, on the gums, teeth, different parts of the tongue, the whole tongue, etc.?  Proceed with each exercise slowly following the clients lead Stop stimulation when/if he shows signs of discomfort and then try to work past that point in the next session. Tip: Tell the individual you are going to count up to 2, 3, 5, etc. so that they can predict when you will be finished. (Lowsky, 2011)

Treatment of Oral Defensiveness & Aversions in Children Introducing Food through Play (Lowsky, 2014) When working with aversions, it’s important for the client to become comfortable with food, which is a gradual process Not asking them to eat the food right away Allow client to manipulate food by making faces out of it, smashing it, rolling, drawing, stacking, etc Have the client get used to touching all kinds of textures by playing with shaving cream, mud pies, fake snow, etc. This helps promote acceptance of different foods / sensations in the mouth because the palms of the hands are sensitive to touch like oral sensations

10 Steps to Exploring and Having Fun with New Food Look at it Smell it Touch it Kiss it Lick it Hold it Move it Bite it Chew it Eat it

References Lowsky, D. (2011, August 2). Oral Defensiveness & Aversions with Sensory Processing Disorder (SPD). Retrieved September 15, 2016, from http://www.arktherapeutic.com/blog/post/205 Lowsky, D. (2014, November 10). Food Refusal – Is It Oral Motor or Sensory Related? Retrieved September 15, 2016, from http://www.arktherapeutic.com/blog/post/1632 Weaver, C. (n.d.). Evaluation and Management of Behavioral-Based and Sensory-Based Feeding Problems. Lecture presented at ASHA 2008, Chicago.