Tagged "sensory input"


Ask A Therapist: Down Syndrome & Teeth Grinding

Posted by Deborah Grauzam on

Hello, 

 

I have a 23 months old baby boy with Down Syndrome, who is grinding his teeth so bad lately. It is so annoying sometimes. He has 9 teeth and feeding is doing much better at this time. We have the Parent Kit and we are using the Straw #1. My husband is thinking to take him to a pediatric dentist, but I believe I can find an answer from the TalkTools experts. Please help us, we are desperately.

 

 

Thank you,

 

Lucy

 

Hi Lucy,

What you are mentioning is a common concern I hear from parents of children with Down Syndrome.  You are right to follow your instincts. Often we see children grind their teeth as a sign of jaw weakness and a need for sensory input. When I see patients who are often grinding their teeth we work on chewing on the chewy tubes frequently throughout the day. This will help with jaw strengthening and providing sensory input.  If you would like more information about how to do this and why, there are two video that you might find helpful: "A Three Part Treatment Plan for Oral Placement Therapy" and "Developing Oral Sensory Motor Skills to Support Feeding in the Down Syndrome Population.". Please let me know if you have anymore questions. 

We are always happy to help.

Thanks,

Liz

 

Elizabeth Smithson, MSP, CCC-SLP is a Speech-Language Pathologist who has over 10 years of professional experience working with infants, children, adolescents and adults. She earned her Master of Speech Pathology at the University of South Carolina. Liz is also a Level 5 TalkTools® Trained Therapist. She has received specialized training in Oral Placement Therapy, Speech, Feeding, Apraxia, Sensory Processing Disorders, and PROMPT©. Liz works with clients with a wide range of disabilities including Cerebral Palsy, Down Syndrome, and Spinal Muscular Atrophy. She works through her own private practice Elizabeth Smithson Therapy, LLC in the home setting and in the TalkTools® office in Charleston, SC.

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Ask a Therapist: TMJ Sensory Feedback for Calming

Posted by Deborah Grauzam on

Hey Sara,

 

Recently you had a parent open question meeting in Corpus Christi, TX. I was there with my 8 month old baby. You were talking to a woman who's 5ish son with Down syndrome was repeatedly hitting his chin and you mentioned he was satisfying a feeling that was in his jaw by that action. I have noticed my baby has started doing that with her left hand. What do you recommend to help correct/redirect this behavior now?

 

-L

Hi L,

The sight of stability and calming for an infant is in the temporomandibular joint. This joint is where the upper and lower jaw meet right below the ear. There are more nerve endings going through that joint than any other location in the human body. When a baby sucks his/her thumb, sucks from a bottle, sucks on a pacifier, etc. the nerves in that joint are stimulated and the baby calms or even falls a sleep. If your child is doing other behaviors to stimulate the jaw like hitting the chin or for older children it may be teeth grinding, then it is probably time to introduce the Bite-Tube Hierarchy. You can learn more about this and other activities to increase jaw skills for both feeding and speech clarity in my book, "Assessment and Treatment of the Jaw: Putting it all together, Sensory Feeding and Speech."

If you do decide to purchase that book please read the chapter on Sensory first as it will explain to you in more detail the reason why babies and children with muscle-based deficits develop "habits" to compensate for the jaw weaknesses. I would also encourage you to share this information with your SLP as she may have additional suggestions.

I hope this has answered your question.

Sara Rosenfeld-Johnson, MS, CCC-SLP

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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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Ask a Therapist: Biting through Chew Tools

Posted by Deborah Grauzam on

My 5 year old son has Down syndrome and chews on grabbers (purple and green Ps). He chews and bites so hard that he bites through the tubes. Any recommendations? He only eats pureed food, bananas and cheerios. He can chew chicken but doesn't want to.

Thanks,

Susan

It sounds like your son likes the sensory information he gets from these tools and uses them frequently! You may want to look at how he is chewing on the tools. When using the tools on their own, many children who are sensory seekers grind their teeth back and forth rather than chewing up and down. Besides causing the tools to break down quickly, the children do not learn the up and down chew skill we hope to teach.

There may be a couple of options. TalkTools has a therapeutic Bite Tube Hierarchy that may be a good addition to your current program to teach him to use a controlled up and down chew (this is a pre-requisite prefeeding program when we work to introduce solids). By doing this systematically throughout the day, and being aware of the movement he's using, you can give him the input he's looking for, but also develop better jaw stability and grading skills that he can use for chewing foods and for speaking. You may also want to look at Lori Overland's course "Feeding Therapy: A Sensory Motor Approach.” She teaches how to develop these skills for feeding. Consider looking at some alternative tools for him to chew on that discourage a grinding movement as well. The Knobby Green Chewy Tube has bumps that often facilitate a better chew pattern.

I hope this helps!

Renee Roy Hill

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Ask a Therapist: Feeding Evaluation Questions

Posted by Deborah Grauzam on

We are just beginning our feeding clinic at a Medical Center for outpatient pediatrics. I have done one feeding evaluation since taking your class Feeding Therapy: A Sensory-Motor Approach, but now have a child on my caseload with an EXTENSIVE medical history, whom I am to evaluate. He has Tubuler/Tuberous sclerosis (tumors growing in his brain and other organs). He has seizures (is on seizure meds), severe Autism, nonverbal, hyperventilates, central sleep apnea, severe GERD, Bradycardia (when sleeping), desaturations (when tired or sick). He is seen by nearly every doctor imaginable. He had an MBS which showed aspiration with thin liquids, but was cleared for nectar liquids and pureed foods. He does not feed himself; he is held down by a weighted blanket because when awake, he severely injures himself by hitting his face. His adoptive mother indicates he was eating very well (not puree - he refused it, but would eat mechanical soft - whole without chewing) until January when his PO intake severely decreased to where he will only eat 1/2 of a meal. He had a PEG tube, which is now a Mickey tube, and gets G-tube feeds following meals to cover the calories he didn't get by PO means. He needs 1980 calories a day due to his constant effortful breathing. The family's goals for him are to increase PO and be able to chew foods. I did a very brief oral motor stim with him, and he tolerated facial massage and accepted a toothette to his cheeks and tongue. I'm not even sure of what questions to ask, but am thankful for any insight you may be able to provide. Thank you in advance! 

This sounds like a complicated child for your second feeding evaluation! So...the most important thing to remember is ..no extraneous "oral stimulation.” It is important to make sure you are mapping sensory input on to motor goals to support nutritive feeding. As you presented the toothette under his top lip, did you get upper lip mobility? Did he contract his cheek when you did the cheek stretch? Did you observe lateral tongue movement? In your assessment, look at the motor skills he needs to support safe nutritive feeding of texture modified solids and use your pre-feeding exercises to facilitate them. If he doesn't respond to the input you use...you may have to increase the sensory input (i.e.: dip the toothette in ice chips, cautiously experiment with vibration...etc). He sounds like a child who needs intense sensory input (i.e.: the weighted blanket, self abusive behaviors). Has he had a good sensory processing evaluation? If not, this is really important...a good sensory diet may help decrease the self injurious behaviors. I also want you to make sure you look at posture and alignment for both your pre-feeding and feeding programs. As you make observations, feel free to email me.

Good luck!

Lori Overland

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