How to help my DD to chew

[MooMummyMoo]

A bit of a lurker here, but I am looking for some help. My DD will be 3 in December. She has a chromosome disorder which means she has global developmental delay. To give you an idea of where she is, she has just started standing and slowly trying to step along the edge sofa and verbally she makes 'aaaaa' noises but nothing more.

Feeding wise I feel like we've hit a big wall. She has chopped up food (and by chopped I mean as tiny as I can cut), I don't puree anything anymore but basically she doesn't seem to actually 'chew'. She seems to either swallow food straight down or squash it in the mouth before swallowing.

I just feel like she hasn't really made any progress in this area since I weaned her at around 6 months.

We see a SALT infrequently and they haven't offered any support really as she does at least eat and I guess compared to some children she is doing ok so from their point of view it could be worse! And I know it could be a lot worse, but I also want to make sure I am doing what I can/should be to give her every opportunity to eat properly.

Does anyone have any techniques they have used with their children that I could try to encourage her to start chewing properly? Her 7 month old sister with no teeth can eat better than her already, feeling a bit down about it all.

Many thanks
MummyMoo

hi moomummymoo, welcome to the board. you will find lots of help and good advice on here. I had similar issues with ds1 (including the chromosome disorder). Have you looked into 'talk tools'?, it could help with the speech sounds and the chewing too. www.eg-training.co.uk With ds1 he had a weak/instable jaw and we worked for ages on biting on 'bite blocks' and i think it strengthened the muscles. I'm sure others will have more ideas, hope that helps x

Watching this with interest as we have exactly the same problem with food here.

Thanks JoMaman, I'll take a look at the link.

Moo I know you've said you see the SaLT infrequently but they are really the best to advise about chewing/feeding issues. Is there a Feeding CLinic locally that they can refer you in to?
There are so many things to consider; whether it is a structural issue i.e. the shape of her palate, jaw, whether it is a muscle strength or stamina issue. Whether her tongue and mouth muscles are working with good timing to transit food to the chewing surfaces and on to swallowing....
Is it that she has issues with the sensory aspects of food...i.e. taste or texture.

I am NOT a SaLT but I know that many of them would consider that the skills for feeding are similiar or overlap with the muscles used in speech so developement of one can affect the other.
I wonder if you can go back and ask for a blast of therapy to advise you and get you over this 'hump'?

If you are near London then I can recommend Alex Forsythe SALT Feeding specialist at GOSH.

Get some therabyte chews (SaLT can provide), as a starter. It sounds like she doesn't understand how to chew and how to push food around with her tongue.

Oh sallybear you are just a wealth of knowledge, aren't you. I think I will have to make a pitstop at yours next time on our way to see Diedre so I can download it all..

I like this site. It's run by a specialist feeding slt and has lots of ideas (click on the feed your mind link).

Dd2 had a specialist feeding slt from birth, and they are worth their weight in
gold.

Dd2 was a 'squash and swallow' kid using the roof of her mouth. After a few years (yep, really) we realized this was because she had no lateral tongue movement, so couldn't position the food between her teeth to swallow it.

has dd been doing the usual (non feeding) slt exercises - tongue poking, licking lips, blowing, etc? How does she do with copying tongue movements - have you tried her in front of a mirror?

I only mention the tongue thing because it's really obvious, but we didn't realize, lol.

We have always been taught (even prior to the realization) to put food into the side of the mouth, not the front. There are loads of specialist chewy toys on the market, some slts also recommend using muslin bags or pockets and putting food inside them to practice chewing. There are also lemon swabs and facial tapping techniques to 'wake up' the mouth prior to eating etc.

Dd2 essentially learned to chew using quavers, but any bite and dissolve stuff is fine. It can be tricky when they are used to coping by squishing it onto the roof of the mouth!

Dd2 actually has less sensation than usual around her mouth as well - so she overstuffs , and also doesn't know when she has food on her lips/ chin.

It's never too late thou. Dd2 is 9tomorrow, and about 6 months ago she finally managed to poke her tongue out and get it to one corner of her mouth! We are working on the other corner.

Def ask for referral to feeding slt.

To chew it, not swallow it. Clearly you chew with your teeth.

Came on here to recommended muslin cloths, but madwoman beat me to it! Things like dried apricots in a muslin, slipped into the corner of the mouth to encourage biting down and chewing.

http://www.nationalautismresources.com/chewelry.html Chewellry can actually help a non-chewing child, especially if you can get your hands on a flavoured one. It's satisfying to chew on and encourages chewing without the added stress of then having to co-ordinate swallowing. That can be worked on once the chewing is sorted!

Good luck!

Ha ha dev9aug!!! I am indeed a mine of information. I've been doing this tooooooo long!

I hope that your trip to Stratford Upon Avon is a fantastic success.

Thank you everyone. We haven't been doing any 'mouth' exercises at all. I was given a list of food types listed in order to work through (bite dissolve etc) but no information about how to progress from one to another. So you have all really helped thank you. I'll be trying some of your tips over the weekend.

Thank you all for your help.

MooMummyMoo

I'm cross on your behalf, moo. Time to start making some waves about your slt provision as it is entirely inadequate.

Can she use a straw? Blow?

What is her understanding like? Have you been working towards signing? Do they think she will eventually become verbal, or what methods of AAC are they suggesting?

MummyMoo, thankyou for starting this thread, ds (2.3) also has poor oro motor skills. He has had a videofluoroscopy, after which a report talked about the poor chew, slow swallow, lack of bolus formation etc. We haven't had any decent follow up support, and ds is still eating a very limited diet.

We found the bear bottle sold on the talktools website very helpful in getting ds to drink with a straw, but he still hasn't 'got' the idea of blowing and doesn't get the chewy tubes either - we have spent a fortune on stuff, which we don't know how to use!

I will be keeping a close eye on this thread though for suggestions{smile]

Hazey, did you have a look at new-vis? There's stuff on there for kids with poor swallow etc too (this was dd). The muslin is a really good way of introducing the concept gradually, with no danger of choking on lumps etc. it isn't a products site, just ideas on how to encourage oral feeding (for all sorts of kids, including tube fed etc. I haven't been on there for ages, but I found it very useful when I was struggling with dd. she isn't trying to flog you anything, just a slt passing on info to parents of kids with feeding issues)

Hello, sorry, I meant to respond ages ago, and then rl went a bit crazy!

I had looked at the new-vis stuff, but I think ds was in a different place then, IYSWIM, and so overlooked some of the advice on there. I am going to have another look though because it seems more relevant now, thankyou.

Definitely think you need a specialist SALT. I have been doing talk tools with private salt. Its early days but I think I am seeing progress.