Oral Motor Weakness
Disclaimer: Before I start I want to let you know that I am not a medical professional I have no certification, no degree, no special training. But, I am a mom who spent tens of thousands of dollars on food therapy for my child and learned an enormous amount along the way. Our Occupational Therapist was the highest certified Canadian Occupational Therapist in the world (specializing in feeding/oral motor therapy) and her treatment was hugely successful and caused no distress or trauma to my child. It was at times so fun that all the neighborhood kids wanted to join in – and we often let them!
Having a “picky/selective” eater is no picnic (pun intended!). As moms we obsess about what goes into our babies and what comes out. When they are picky we naturally become anxious and desperate to “fix” them. We feel like we are failing them and that their health is potentially in jeopardy. Then, society chimes in and our parenting gets judged and scrutinized. We begin to dread social gatherings and are often embarrassed by our picky kids. As they age even they begin to dread social events (like Birthday parties) and going to restaurants seems like more work than it’s worth. Children begin to have self-esteem issues and anxiety about food and they pick up on our worries as well.
I understand this dynamic all too well. I have been in your shoes. I had also tried EVERYTHING. I tried to be patient, I tried to force her to eat, I tried to make it fun – who doesn’t love a ham sandwich carved into a Pokémon character?? I implemented consequences – no dessert until you eat that! I tried to involve her in the cooking process. I attempted to sneak cauliflower into the mashed potatoes – HA! As if!!! I tried bribery, threats, guilt, rewards, and deceit and none of it worked.
The truth is that not only did everything I try fail – the situation actually deteriorated before my eyes. Each day it seemed that what was once a “safe” food, was no longer accepted. Each week it appeared that she was taking longer and longer to eat a small amount of food. Each month it seemed like she was losing weight and interest in eating anything at all. By the time we sought help (at age 10) she was essentially down to only 5-6 foods and most of them were soft like yogurt and ice cream. So when I tell you that I know what you are going through – I really do! And I am driven to help others better understand the reasons WHY their child is so picky.
Eating is meant to be pleasurable. Food nourishes us, brings us together and for most people is an enjoyable experience. If food isn’t fun – there is a reason. I am going to share our experience with you and what we did that enabled our daughter to begin to enjoy eating again. Hopefully something I say will resonate with you and you will begin to uncover the issues that your “picky” eater is struggling with.
First, when dealing with your “picky” eater I think it is important to rule out any Oral Motor weaknesses. Sometimes kids are picky, not because they don’t like foods but because chewing is a LOT of work. Many kids have weakness in their jaw, lips cheeks, tongue, bite etc. that actually prevents them from enjoying food much like you would dread going to work out at the Gym 3 times a day, every day, for the rest of your life. Of course kids have no idea that their jaw gets tired so they don’t say “Sorry that bagel is exhausting!” they say “No I don’t like it!!”.
Oral Motor weakness is sometimes obvious and results in kids who mumble or have a speech impediment like lisps. But sometimes you are unable to tell because many of the steps to chewing happen inside the mouth. As well, being tongue tied, cleft lip and other structural issues can cause issues and create picky eaters.
When our daughter was assessed by our O.T. I learned that the jaw has 8 positions – #1 is when it is closed shut and teeth together, #8 is wide open, like at the dentist. Positions #2 – #7 are used for chewing and talking, and our daughter only comfortably used positions 1, 2 & 3 when eating and speaking.
When I heard this I was blown away but quickly realized that is why she no longer liked eating steak or bagels. These are foods that require lots of chewing and also require that the jaw comfortably opens in the higher positions. Before you breathe a sigh of relief because: WHEW! – your little one loves steak and would eat it daily – I learned that there are many kids out there eating steak that are not actually chewing it. They just pop it into their mouth, bite once or twice and swallow it whole because it is too much work – but they love it and want to eat it. From therapy I learned that foods require a certain numbers of “chews” – a bite of steak (for example) should take approx. 12 chews (I am actually making this up as I can’t remember the number!). Some kids with oral motor weakness might chew only 3 times and swallow – thereby avoiding all the work – and some might chew 35 times (like my daughter). Both indicate oral weakness.
Our daughter’s tongue was also assessed as being weak. Very weak. In fact as she got older she would tell us that she had difficulty swallowing and often felt like she was choking. It turns out that as she started avoiding foods (for many reasons – weakness, sensory etc.) her mouth got increasingly weaker. In fact, her tongue had atrophied to the point that it was sliding back into her throat in an unnatural position, getting in the way of normal swallowing and giving Sara the sensation of choking. She truly was choking. Choking on her own tongue.
After we left that appointment and began to dialogue about the fact that she had such major weakness, Sara admitted that she was unable to make “fish lips”. She attempted to show me and sure enough her cheeks were too weak to suck in to form the lips. As well she laughed and said that when she tries to stick her tongue out it wriggles around like a worm on a hook. I asked her to show me and we both burst out laughing because it really did twitch and squirm the muscles too weak to hold still.
In total Sara was evaluated as having a weak tongue, cheeks, bite, lips and global Oral Motor weakness. In Part 2 I will discuss some of the therapies we did to strengthen these areas and return her mouth back into a properly functioning organ. If you have any questions feel free to contact me!