Oral Defensiveness (hypersensitivity)
Oral defensiveness is like tactile defensiveness in the mouth. There may be difficulty tolerating specific textures such as cream of wheat, or mixed textures, like foods of differing textures put together into a dish (lasagna, nachos), or having sauces added to food. These kids might need their food to be separated, for that way it is easier for the child to see one texture and think “Okay I can handle that” and then see the next one and think, “Okay, I can now handle that one” but the two together could be overwhelming until the child feels competent with each separately. Oral defensiveness can also cause a child to be uncomfortable with sensations when moving the mouth, or food in the mouth, which can make learning motor patterns far more difficult. For example, the sensation of food at the middle or back of the tongue may cause an “early gag” reflex, making safe swallowing (and trust of food) challenging. Hypersensitivity in the mouth can also diminish exploration of, and attention to, motor movements in the mouth, delaying babbling, enunciation and speaking skills. Sometimes kids will try to desensitize themselves by mouthing non-food items, but not “risk” food (which changes and grows soggy and “falls apart” and gets less “manageable” with saliva and chewing). So there may be an increased desire or need for chew toys for hypersensitivity as well as hyposensitivity.
Oral Defensiveness Treatment
I like to start with treating the whole body, using the Wilbarger brushing protocol to brush the body, then switch to other methods that approach the face and mouth as tolerated. A rule of thumb is to let the child have as much control as possible over the experience. Speak with your therapist or book a consultation to discuss specifics for your child. Ultimately, we want to provide a wealth of experiences that involve exploring and moving the mouth, because when there is oral defensiveness, there is usually decreased awareness and control of movements in the mouth because the sensations are overwhelmingly strong and are “tuned out”, including the sensations we need to move in a coordinated manner to eat and speak, sip drinks and blow bubbles.
Under-registration of oral input (hyposensitivity)
Children who do not obtain adequate sensation in the mouth tend to exhibit the following behaviors:
- putting many non-food items in the mouth, perpetually and beyond the age this is normally expected
- overstuffing the mouth (with food, to the point of “chipmunk cheeks”)
- preferring very crunchy, dry textures (that poke the mouth, increase sensation, like tortilla chips)
- preferring cold or spicy, salty or pungent foods (increasing awareness of the food in the mouth)
- speech delays and/or difficulty with enunciation (it’s hard to move oral structures with coordination when you don’t feel them adequately)
Useful tools to address oral challenges:
To encourage oral exploration (to sensitize or desensitize), I like to use what I call “stick” items (foods and tools). The reason to use stick-like items is because they can be put in the mouth and brought immediately to the sides, avoiding any early gag areas in the middle/back of tongue (unlike pacifiers and spoons, which are best at midline). This also encourages the tongue to move to where the “stick” item is (at each side), exercising the tongue in such a way as to help with food movement/food management, while also increasing awareness of the various areas of the mouth. Rather than use a spoon to self-feed purees, applesauce, or yoghurt, a novice self-feeder might do best with a Nuk brush. This item has nubs which can hold tastes of food on it in any orientation (whereas a spoon needs to be used with the correct orientation of the bowl), and it can be brought to numerous areas in the mouth as tolerated. When a child explores in this way, it helps with oral awareness as well as hand-utensil-mouth coordination for self-feeding and later toothbrushing. Please note that it is not safe to let a young child access or put stick-like items in the mouth while “on the move” (crawling, walking, running). If the child fell the item could jab into the back or roof of the mouth; therefore, I use these only when the child is fully supervised, or is strapped into a high chair or car seat (it could be a good exploration device in the car).
Other stick items can include foods like Slim jims, pretzel sticks (including these thicker ones), twizzlers or other fruit “rope” (for a healthier version), and veggie straws.
Some kids benefit from oral exploration separate from feeding/food, perhaps due to high seeking behaviors, or because they need other senses (smell, taste, texture) or challenges (oral motor coordination for feeding) reduced before accepting foods. Ps and Qs are great for infant/toddlers: the Q allows a mini “stick” to go in the mouth without letting it go deep (due to the large “O” area, while the “P” is the next step up, with a larger “stick” that reaches deeper for greater exploration toward the molar area. Oral motor tools can also be classified according to whether they are smooth or add texture (there are also textured Ps and Qs), and according to how aggressive or strong any chewing is (tougher materials are required for older kids and those who need much chewing input). One of my favorite oral tools is the Beckman Tri-chew, because of the different “strengths” it comes in, and because each end of the triangle has a different texture to explore. The triangle shape makes it safe and easy-to-grasp, as well as affix to clothing or nearby items, using pacifier clips). The blue and yellow versions are soft, and the green version is made of tougher material.
For older kids, there is a wealth of “chewelry” that can be worn, with designs and colors to suit their preferences, such as shark teeth, Legos (even with a made-for-chewing pencil topper), dinosaurs, crystals, sabers, dragons, unicorns, robots, etc.
The use of vibration can be very beneficial. Sometimes vibration, like brushing, can help desensitize the mouth if there is hypersensitivity. With hyposensitivity, vibration just helps increase the input and awareness. Vibration can be applied to the mouth, internally or externally, with an electric toothbrush (even a cheap one, just to trial at first). For a big step up, I like to use Sensi or z-vibes, which can come one- or two-sided (see ARKtherapeutic.com), and come with a wealth of different attachments, such as tactile blocks or cylinders, smooth or textured spoons, and even pencil, pen or crayon holders (converting it to a vibrating writing utensil, which can be helpful for some kids).