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

2. 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)

3. 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)

4. 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)

5. Red Flags for Feeding
Indicators that a family should consult a SLP for a feeding/swallowing evaluation include:
Feeding more than 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)

6. 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

7. 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)

8. 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)

9. 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.

10. 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)

11. 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

12. 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

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