Oral-Motor Therapy for Children With Eosinophilic Disorders                                      

Children with disorders of the gastrointestinal tract, including those with Eosinophilic Diseases commonly experience pain during eating.  As a result, the child may develop resistance or anxiety surrounding feeding.  The placement of gastric tubes can further complicate the situation as children who require delivery of nutrition via a tube may not have the opportunity to explore the various tastes and textures of food. Typically, when a child does not have an impairment of the GI tract, feeding progresses naturally and is most likely a pleasurable experience. Babies are born with the innate ability to suck and as their gag reflex disappears, the child be gins to accept solid foods with variances in texture and taste. Eating becomes social and pleasurable.  As the child learns the skills of chewing, including moving food items with the tongue and muscles of the mouth, he develops key skills which will bring about successful eating habits in the future. It is also important to note that the ability to eat helps develop the oral structures necessary for speech production and vice versa.   

Oftentimes, when children have a negative experience with eating, a bad memory will form. If this is repeated over time, resistance to trying new foods OR anxiety surrounding eating can result. It can be difficult for families to determine exactly when or why a feeding difficulty may have occurred.  When a child is not able to eat a diet full of variety in texture and taste, sensory defensiveness may result. This means that the child may exhibit behaviors such as gagging, choking, or avoidance of certain foods based on their perception of the food’s properties. 

•         Here are some signs to look for:

•           Gagging, spitting, or vomiting "safe" foods

•        Refusal to use a fork or spoon.

•         Dislike of hands and mouth being messy.

•         Difficulty moving food from one side of the mouth to the other OR pocketing/holding food in the cheek.

•         Negative reactions to the smell of food.
  

•         Gulping or swallowing food without chewing it.

•         Throwing food or refusing it altogether.

•         Increased negative "behaviors" or tantrums surrounding mealtime.

  

Interoception is our eighth sensory system. It helps us to be aware of our thoughts and emotions. One of the most important things about interoception is it helps us know when we are hungry, thirsty, full, need to go to the bathroom (poop and urine). Many children with sensory sensitivities can work on their interoceptive systems with targeted activities. Learn more in our earlier post.

It is commonly the job of occupational therapy practitioners to help remediate feeding difficulties with children who may or may not have a medical diagnosis. OTs are specifically trained to consider the child’s unique situation as well as the importance of feeding in the family’s daily life. For example, many families with children who have feeding disorders, such as Eosinophilic Gastroenteritis, may not focus on mealtimes to avoid anxiety and disappointment to the child. There are, however, many ways to work with families on the skills that eating helps to develop in fun and non-threatening ways.

• Consider the meal-time environment.  Try to alleviate as much stress from feeding times as possible.   Placing pressure on a child to eat or force-feeding him may have a negative effect.  Keep mealtime conversation light and fun.  Encourage your family to listen to calm music or set the table with bright and fun place settings can change the atmosphere into a more positive one.
  

• Introduce a vibrating oral motor tool, such as wiggly toothbrush or z-vibe to a child’s face, cheeks, lips, mouth, and tongue.  The use of fun “tools” is a good way to allow the child to experience different textures and movements in the oral area. Sing fun songs such as Old Mc Donald had a farm and encourage your child to make the faces of the different animals. Use the vibratory input to the inside of the cheeks, teeth, tongue, and lips.  Allow your child to dip the tool into safe liquids with different tastes. Experiment with sweet, sour, warm, and cold.  Try to introduce foods with the tool instead of a fork or spoon if your child is comfortable doing so.
  

• Use washcloths or soft brushes.  Massage your child’s cheeks and around his mouth with a warm washcloth or very soft bristle brush. Allow him to dip it into the water and even place a mirror in front of him so he can watch himself.  Try to place a dab of safe food onto his lips and encourage him to use his tongue to get it off.  This is an excellent exercise for the mouth and tough muscles!
  

• Encourage Messy Food Play! Remember that children learn through play. Using food such as fruit or veggie shapes to make designs is fun. Also, try “finger painting” with foods of all different kinds. Use pieces of food as a stamper onto paper and see what creative ideas your child comes up with!  It is especially wonderful if your child takes a lick or two of the food while playing. This is a fun way to encourage small bites.

 
Mitochondrial Disorders affect children and adults. Check out our social story book written by Joshua, a child with a feeding tube due to mitochondrial disease. 

The most important thing is to make mealtime a fun and relaxing place for the entire family.  Never pressure or force-feed your child.  Help him to have control of food choices and prepare meals with you as he is able.  

Celebrate every success and work to build your child’s confidence. The bond you create will last a lifetime!
 

Cara Koscinski, OTD, MOT, OTR/L, CAS is an occupational therapist and the author of The Pocket Occupational Therapist book series. She has two sons with Eosinophilic Disorders and her younger son is fed via G-J Tube.