• About
    • Disclosure and Disclaimer Policy
  • Blog
  • Shop Ebooks
  • Recommended Products

Pediatric Feeding News

Dedicated to up to date pediatric feeding and dysphagia information

Welcome!

Hi, I'm Krisi Brackett, MS SLP/CCC this blog is dedicated to current information on pediatric feeding and swallowing issues. Email me at feedingnewsletter@gmail.com with questions.

Read More About Me Here...
  • Feeding Flock
    Research
  • For Parents
    & Caregivers
  • View The
    Resources
  • Pediatric Feeding
    & Dysphagia Newsletter
    • Volume 1
    • Volume 2
    • Volume 3
    • Volume 4
    • Volume 5
    • Volume 6
    • Volume 7
    • Volume 8
    • Volume 9
    • Volume 10
  • Workshops &
    Presentations
  • Ask Me A
    Question
  • Links
    We Like

The Long Road of Learning to Chew

July 2, 2016 by Krisi Brackett 4 Comments

child-559415_640
The Long Road of Learning to Chew, part 1

One of the more common reasons for a child to be referred to feeding therapy is poor chewing (also described as being stuck in a sucking or suckle pattern). This might present in the following ways:

  • gagging, choking or vomiting on lumpy bumpy foods and/or on solids
  • pocketing or holding food orally for a prolonged amount of time
  • sucking on solids
  • swallowing food whole
  • expelling or spitting out solids
  • refusal to eat solid foods with preference for liquids and purees
  • poor intake due to difficulty manipulating food

 

Chewing is a complex motor pattern and a skill that in typical development takes two years or more for a child to move from sucking on liquids and purees to move toward rotary chewing of solids. It can takes children who are not chewing a LONG time to learn this skill. How long will it take for a child who can not chew to learn? That depends on several factors including readiness, the age of the child, their gross motor function, their GI tract and sensitivity, muscle tone and motor control, their willingness and desire for solids, and last but not least- practice. All of these factors can influence the transition from sucking to chewing. Let’s break these down.

 

Readiness – Most children come to therapy drinking liquids, eating purees, and struggling with their solids. The therapist will determine if the child is ready to work on chewing. There are certain factors that may influence this decision. If a child is failing to thrive or underweight, it may be more beneficial to work on increased acceptance of caloric intake with liquids and purees before working on chewing which tends to slow a child down a bit at meal time. Similarly, if a child is receiving all nutrition via tube feeding, we would opt to begin therapy with easy textures. Build acceptance of easy textures such as purees and liquids before moving to chewables with a child who is a non-oral feeder. Some children will naturally move to chewing and solids with the practice of oral feeding.

 

The age of the child – in typical development infants are starting to experiment with dissolvable solids around 7-8 months. This is where we first see munching and with practice over the first year of life, this matures into a vertical chewing pattern (lateral biting, jaw shifting, still some sucking). The infant’s mouth at 7-8 months is still small and because of their lack of fine motor coordination, they typically only get one piece of solid at a time allowing oral practice with munching, sucking, and moving it around. When a 2, 3, 4, or 5 year old is learning this same skill, they have to deal with a much larger oral cavity which demands better lingual movement and oral control to prevent choking. They also have better fine motor ability and can put more in their mouth at one time making it difficult to manipulate.Thus, the older the child is when starting to learn, the more challenging it can be. When I am working with an older child on the skill of chewing, I expect it to take longer.

 

Gross motor function – in typical development, many of the gross motor milestones come before oral skill development. Before a child begins spoon feeding purees and then accepting solids, most will have independent stability in sitting, trunk rotation, and will be beginning to crawl. This postural stability and rotational patterns in the body supports the stability needed in the head and neck and oral cavity. This supports the transition toward jaw stabilization and dissociation of tongue and jaw. For some of our clients, working on gross motor patterns and stability, as well as supported positioning, will help chewing progress.

 

GI tract and sensitivity – if a child is exhibiting oral hypersensitivity such as gagging, retching, or vomiting with solids it will be difficult to encourage intake and practice due to negative and unpleasant experiences. This may very well be the reason the child did not progress to solids during typical development. Some children are gagging/choking because they are swallowing food whole and when you take them back to mashed or pureed foods the choking stops. Overall intake may improve as well because the child can handle the food better. Some gagging is more sensory based/hypersensitivty and may be triggered with food on the lips, tongue or cheeks. There can be an added behavioral component as some children gag or vomit on site of food. There are different therapeutic practice recommendations on how best to deal with this type of problem. Some therapists begin a desensitzation approach in the oral cavity. The feeding team I work with prefers to treat this medically and nutritionally. We have seen improvement for our children with the use of different types of medicines for reflux, motility, pain, nausea, and constipation and by changing formula and/or slowing tube feeds. The goal is to improve overall GI comfort which hopefully results in elimination of gagging and vomiting allowing the child to comfortably move to solid textures.

 

Muscle tone and motor control – part of learning to chew, which involves stabilizing the jaw and moving the tongue is a motor pattern. If a child has hypotonia or low tone, it may make it harder for the child to stabilize the oral structures and have the strength for consecutive biting. The therapist may need to add jaw support or base of tongue stabilization (pressure under jaw to lingual muscle) to assist so the child can achieve a stronger biting pattern with less fatigue. Building strength with exercises takes time.

 

Willingness and desire for solids – it is easier to progress and practice when a child is excited about chewing and wants to participate in therapy. However, many children are nervous or anxious about having solids in their mouth. Therefore part of therapy may include encouraging the child and building a comfort with solids. This might include play activities such as feeding caregivers or a doll. This might also include crushing solids into crumbs and tasting, licking and practice moving solids on the tongue.

 

Practice – Last but not least, is the need for consistent daily practicing. Chewing is a skill that needs to be practiced. Children need to practice the components of chewing including lateral tongue movement, lateral movement and retrieval of the bolus, biting strength, and biting consecutively. I often help caregivers understand this and figure out the best way to fit in several short practice sessions during each day to help progression between therapy visits. This can be challenging as some of our kids have many doctor and therapy visits every week. Usually, our practice exercises are embedded into meal time to make it easier for caregivers.

 

Part 2: will discuss specific therapy exercises and strategies for working on chewing.

a

Share this:

  • Click to share on Twitter (Opens in new window)
  • Click to share on Facebook (Opens in new window)

Related

Filed Under: Chewing, Feeding Treatment, Oral-motor and Sensory Tagged With: chewing, feeding therapy

Comments

    Leave a Reply Cancel reply

    Your email address will not be published. Required fields are marked *

  1. Dana Hearnsberger, MS, CCC-SLP says

    July 2, 2016 at 2:44 pm

    Thank you for a great post! I see these type of kids everyday and this is a wonderful post to share with parents. The process to learning to chew is a marathon not a sprint. Looking forward to Part 2 🙂

    Reply
  2. Kristen Cole says

    July 5, 2016 at 12:18 pm

    You are so very helpful in all that you do to help children learn to eat. I am one lucky lady to be able to work with you!!! Thanks for sharing your expertise!

    Reply
  3. Lydia says

    July 12, 2016 at 2:04 am

    This is a great post! Thank you for sharing your expertise 🙂

    Reply
  4. free proxy list says

    December 4, 2018 at 6:26 pm

    Hi there,I check your blog named “The Long Road of Learning to Chew” daily.Your humoristic style is witty, keep up the good work! And you can look our website about free proxy list.

    Reply

Cart

Products

  • When Your Child Can't Or Won't Eat $10.00

Recent Posts

  • Education: When Frameworks Collide: Putting Intuitive Eating and the Division of Responsibility in Feeding to Work in Pediatric Nutrition Counseling
  • ABSSD Summer Webinar – Pediatric
  • What Makes Nutrition Confusing? The 101 on Structure Function Claims
  • Melanie Potock’s coming to NC
  • Neurodevelopmental Treatment Association (NTDA)  Annual Conference focused on Postural Control. 

Recent Comments

  • Alana on Feeding Flock – Feeding Assessment Tools
  • Cindy Belliveau on Oral Dysphagia (oral motor delay): Making recommendations for appropriate diet textures for the child with feeding difficulty
  • Denise on Cyproheptadine (or periactin) to Boost Appetite
  • Brenda Everman on ABSSD Summer Webinar – Pediatric
  • Krisi Brackett on Feeding Flock – Feeding Assessment Tools

Upcoming Events

<
< 2023 >
October
>
Month
Month
List
Week
Day
SMTuWThFS
1234567
891011121314
15161718192021
22232425262728
293031    

Education: When Frameworks Collide: Putting Intuitive Eating and the Division of Responsibility in Feeding to Work in Pediatric Nutrition Counseling

Please check out this workshop by 2 of my former RD colleagues! Details and Registration Link: https://www.knowingnutritionhub.com/self-study-cpe-library-for-dietitians/when-frameworks-collide Program Description The two best known, evidenced-informed feeding frameworks are the Satter’s Feeding Model and Intuitive Eating. Many parents align with one of these feeding strategies. While Keep Reading >>

Feeding Treatment

Challenging case with advice from Rowena Bennett

I presented a case to Rowena Bennett, RN, RM, MHN, CHN, IBCLC, author of Your Baby's Bottle Feeding Aversion. We have used Rowena's techniques many times to help our infants who come to us with bottle refusal or sleep feeding issues. She graciously Keep Reading >>

The Sensory-Motor Approach to Modified Baby-Led Weaning for Babies with Feeding Challenges

by Jill Rabin & Lori Overland Baby-Led Weaning has become “all the rage” with many parents choosing this method of transitioning their little ones to solid foods. Everyone is jumping in, with speech pathologists, dietitians, Keep Reading >>

To Pace or Not To Pace – And the Survey Says…

By Lisa Kleinz MA, SLP/L, CLC CNT Director of Education, Dr. Brown Dr. Brown’s Medical Healthcare Professional Pacing Survey Results– Where to go if guided by the data? Keep Reading >>

Book Review: Broccoli Boot Camp

Book Review: Broccoli Boot Camp by Keith Williams, PhD, BCBA & Laura Seiverling, PhD, BCBA I love to put up resources that I find helpful. If you are looking for an Keep Reading >>

More This Way

Swallowing

What is a MBSS- video for kids

I wanted to share a video we made to help children coming to UNC for a modified barium swallow study. Please share with your clients if you think it is helpful. It's also on our feeding team page Keep Reading >>

Swallowing Difficulties May Be Caused by Misfiring Neurons

in Genetic Engineering & Biotechnology News (GEN) Pediatric dysphagia (swallowing difficulties) is a frequent and serious clinical complication in a large number of clinically defined neurodevelopmental disorders including the genetic Keep Reading >>

Swallow: A Documentary- Dysphagia

Nice Documentary on Dysphagia from the National Foundation of Swallowing Disorders. Keep Up the Good Work Everyone! Keep Reading >>

A Survey of Clinician Decision Making When Identifying Swallowing Impairments and Determining Treatment

A Survey of Clinician Decision Making When Identifying Swallowing Impairments and Determining Treatment Speech-language pathologists (SLPs) are the primary health care providers who manage dysphagia. A report from the American Keep Reading >>

Oral-Motor and Sensory

Musculus masseter pars coronidea

Scientists Just Identified a Brand New Muscle Layer in The Human Jaw  DAVID NIELD23 DECEMBER 2021  It turns out there are still exciting new discoveries to be made in a field as well-studied as human anatomy: researchers have confirmed the Keep Reading >>

Poster: Child Cain’t Chew

This poster from 2018 was shared with me by Sally Asquith who gave permission to post here. The objective of this study: REVIEW CURRENT LITERATURE PERTINENT TO THE ROLE OF ORAL-MOTOR DEVELOPMENT IN DX AND TX OF PFD. COMPLETE A RETROSPECTIVE Keep Reading >>

The Sensory-Motor Approach to Modified Baby-Led Weaning for Babies with Feeding Challenges

by Jill Rabin & Lori Overland Baby-Led Weaning has become “all the rage” with many parents choosing this method of transitioning their little ones to solid foods. Everyone is jumping in, with speech pathologists, dietitians, Keep Reading >>

Grasshoppers…..

I hope I grabbed your attention with the title. More to come on grasshoppers. I had a wonderful opportunity this week- I got to spend an afternoon with Marsha Dunn Klein! This was an incredible treat for me and after several hours with Marsha, I Keep Reading >>

More This Way

Case Studies

Challenging case with advice from Suzanne Evans Morris, PhD

In this post, I have described a challenging case  and solicited advice from Suzanne Evans Morris, PhD, one of the experts in our field. Suzanne graciously provided commentary and advice and challenged me to look differently at the feeding Keep Reading >>

Complex Case – Changing Therapy Strategies When Needed

Complex Case - Changing Therapy Strategies When Needed *I shared this case with Suzanne Evans Morris and she provided some   guidance and analysis at the end. Hope you enjoy  John is a 6 year old male with a complex medical Keep Reading >>

Feeding Harley

I am excited to share Harley’s story, written by his Mother about her journey to help her son wean from his g-tube and become an oral feeder. Thank you Liz for sharing and inspiring us all to continue looking for answers! I feel I do need post a Keep Reading >>

Cases From Clinic

Cases From Clinic This is my second post highlighting some of our kids and how we provide multidisciplinary intervention using a medical/nutritional/behavioral approach. I post this hoping it might give some treatment ideas to clinicians. There Keep Reading >>

More This Way

search

Categories

Recent Posts

  • Education: When Frameworks Collide: Putting Intuitive Eating and the Division of Responsibility in Feeding to Work in Pediatric Nutrition Counseling
  • ABSSD Summer Webinar – Pediatric
  • What Makes Nutrition Confusing? The 101 on Structure Function Claims
  • Melanie Potock’s coming to NC
  • Neurodevelopmental Treatment Association (NTDA)  Annual Conference focused on Postural Control. 

Recent Comments

  • Alana on Feeding Flock – Feeding Assessment Tools
  • Cindy Belliveau on Oral Dysphagia (oral motor delay): Making recommendations for appropriate diet textures for the child with feeding difficulty
  • Denise on Cyproheptadine (or periactin) to Boost Appetite
  • Brenda Everman on ABSSD Summer Webinar – Pediatric
  • Krisi Brackett on Feeding Flock – Feeding Assessment Tools

Archives

search

Categories

Archives

My Account | Shop | Shopping Cart
Copyright ©2023, Pediatric Feeding News. All Rights Reserved. Custom design by Pixel Me Designs
 

Loading Comments...