Tagged "sensory disorder"


Ask a Therapist: Considerations for Altering Diets

Posted by Deborah Grauzam on

Hi Ms. Lori Overland,

I am an Occupational Therapist from Chicago. However, I am now working in Australia as an OT. I have always been interested in setting up a feeding program here and therefore began viewing your course. I just love how you integrate a child's individual sensory needs into their personal feeding program! I was just awed by how you were able to assist a child who only liked round brown foods!

I was wondering if you have the time to provide me with your expert tips on how to go about slowly changing the diet of a child who only prefers white bland foods. For example, this child will only drink milk from a bottle, have arrowroot cookies-which are plain tannish in color, chicken tenders, kids' cheese pizza, but without the cheese, and white bread.

At the moment he is tactile defensive, but is seeking much proprioceptive input, not just to his body, but also to the inside of his mouth. He chews on his pacifier and bites hard on his cookies. He tends to hold food in his mouth and then swallow hard. He does have some tongue lateralization, but not much of a rotary chew.

He had a brain tumor and has been through chemo. He is currently cancer free. He was then diagnosed with Autism. He is babbling and singing songs without saying the whole word, but attempting the words.

Only if you get a chance, I'd greatly appreciate any input you have regarding how I should go about varying his diet a little bit and increasing his rotary chew, as well as slowly getting him away from the bottle.

Thanks and take care.

Hello,

Thank you for your email and your kind words. I am wondering if you saw the first or second edition of my two day sensory motor feeding class? It seems like there are many layers with this child:

1)  Medical - I frequently see children who have had chemo therapy have difficulty swallowing and some of his self limited diet may be secondary to pain he had during chem. Are there any other medical issues? Has he had a swallow study?

2) Postural - You did not mention posture and alignment but I am wondering (based on your description of his mouth and his sensory system) whether there are any issues with tone, posture and alignment (when did he have cancer? Did he spend time in prone? Any issues with pec/abdominal synergy? Are his ribs/abs connected ? Is respiration a concern?

3) Sensory - Does he tolerate teeth brushing? Can he tolerate vibration peri or intra orally? Does he have difficulty with transitions in life (what you see in life is often what you get in the mouth)?  Have you tried a Spio garment on him (www.spioworks.com). If you are not familiar...spio is a flexible bracing system which provides dynamic stability and deep pressure sensory input.

4) Oral Sensory Motor - I have a few questions: is he actually chewing the foods he eats? Do you see food in the front third of his mouth? Does he collect a bolus or is the food spread across his tongue? Do you see food pooled on the surface of the tongue? Does he lateralize food using the tongue tip and lateral border or does he dump or use a protrusion retraction pattern to move food laterally? Is food masticated on the canines or on the first molar? I am concerned about the hard swallow (does he have a reverse swallow?) ....is this because he has difficulty collecting the bolus? Is it because he has not adequately masticated the bolus, because he is not using the lateral borders of his tongue? Is he using a repetitive reverse swallow pattern? Does he have lip closure and lip rounding? Does he have cheek contraction for sucking, chewing, swallowing and to stabilize solid food?  If not, you may want to start with a pre-feeding program before you try to change taste or texture. When I am sure that the medical, whole body sensory, postural and pre-feeding issues are being addressed I will start to try to change taste and temperature. Move very slowly away from his home base. I may start by doing "science experiments" or cooking with foods that are very similar to his foods...different types of chicken nuggets, making our own pizza, cutting out shapes using a variety of different white breads, baking sugar cookies and eventually going to smell, lick, bite with the "new" food. With children on the autistic spectrum I may have to work with a behaviorist once I have addressed the oral sensory motor issues...but not always. If you would like to send me a short video I would be happy to take a look!

Lori Overland

Thanks so much Lori for your quick response! I had no idea how much was involved. I am looking through each and every question you asked. When next I see the family I will ask his mother if I can take video of a session to pass on to you for your expert opinion. I am just so inspired and awed by you! You are absolutely brilliant and a GEM to even consider taking the time to respond to my query in so much depth. Thanks so much for your time and your expert knowledge. I truly appreciate it and so will the families I work with. I will write back when I have more info for you. Thanks again and take care.

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