Mouth Stuffing: What it is and How to Cope with It

As soon as my son, Xander, was old enough to start feeding himself, he did something I found rather alarming. When we put food in front of him he grabbed it with both fists and stuffed it all into his mouth. It didn't matter what the food was or how hungry he was or even if he knew he liked the food or not, he just shoved everything in there. Then, of course, he gagged on it and either spit out what he could or threw up. This is something he still struggles with.

Xander has several developmental delays, including sensory issues. We learned in Xander's recent round of OT that he has reduced oral sensation, poor chewing and tongue movements to develop the skills needed for eating and a high gag reflex. Tack those issues on top of his tactile and motor issues, no wonder he has so many problems with eating! Many of us don't realize that eating is actually a very complicated skill: getting the food up to the mouth, putting it in, tolerating the food near or in the mouth, understanding how to move the jaw up and down to chew, getting the tongue to move the food to the proper place in the mouth, understanding how much food is 'enough' to have in the mouth at one time, swallowing, making sure all the food is gone...it's crazy! That doesn't even include things like textural issues, gagging, or having the motor skills to get the food on the fork in the first place. Plus there are so many steps involved in any one of these bigger steps it's no wonder that kids just say, "Forget it. It's too hard. Just give me something soft and squishy I can get in and down easily!"

Why does my child 'mouth stuff'?

It's important to understand why your 'sensational' kid mouth stuffs so you can help him learn the skill of eating. Here are a couple of things I learned about Xander's situation:

1) I'm trying to 'feel'. Xander seems to have reduced oral sensation so when he shoves all the food in there, it 'wakes up' his mouth so he can both feel what's going on his mouth as well as the food.

2) I don't like how little things feel in my mouth. Xander has oral defensiveness that causes him tremendous discomfort when little pieces of food are floating around in there. The more food is in his mouth, the less likely those tiny pieces will touch the insides of his cheeks, causing him to gag.

3) I can't move the food around properly in my mouth. Xander's tongue seems to work against him in getting the food to the right place in his mouth. When the mouth is stuffed full, the tongue doesn't have to work as hard. Smaller pieces of food require more skillful chewing and mouth control.

4) I can't tell when my mouth is empty. Most children are able to feel whether they have swallowed all their food, leaving the mouth empty, and have the motor skills to make sure. Xander often has little pieces of food left in his mouth not only because he can't always feel its still there but also because his tongue doesn't know how to get around in his mouth to feel for it. If we have foods that are cold or spicy or crunchy or he dips things into something tangy or sour, he won't 'stuff' it. I finally realized that was because those foods gave his mouth some sensory input-waking his mouth up-without him having to seek it through stuffing (a very strong indication of sensory issues affecting eating.) Another thing we noticed was that when he discovered a bit of food later on that he hadn't removed during a meal, he'd gag because he didn't feel it, then suddenly it was there! (Another sign of lack of oral sensory awareness.)

So, what can I do to help my child?

Our OT gave us a wonderful information sheet from Dr. Suzanne Evans Morris, Speech-Language Pathologist, with suggestions on how to help Xander with sensory awareness (in his mouth), oral movement and chewing skills. Let me share some of these wonderful tidbits with you:

Suggestions for poor sensory awareness:

• Help your kid to wake his mouth up before, during and after a meal so he's getting sensory input throughout mealtime. Morris suggests having foods that are spicy, crunchy, cold and carbonated (just like we noticed with Xander!) She states that these four inputs help our kiddos be more aware of what their mouths are doing and gives them the oral input to stay organized for meals. Some suggestions include pickles, crunchy veggies or spicy dips; adding spices/herbs to food; create a 'pop' with fresh citrus juice and mineral water or club soda; and put ice in the drinks for added crunch.• Chewing on ice seems to help keep the mouth awake while reducing oral sensory defensiveness.

• An idea I thought was interesting was giving a child a little mirror so he can check his mouth after mouthfuls and at the end of a meal. This gives him a visual of what an empty mouth looks like so he can relate that to what it feels like.• Applying vibration to the cheeks, lips and tongue also helps to create some oral awareness as well as getting these areas moving.

Suggestions for poor oral movement and reduced chewing skills:

• The vibrator mentioned above also seems to help strengthen muscle tone.

• Using a toothbrush, finger or chewie to brush the sides of the tongue and mouth helps with tongue lateralization ('feeling' the sides of the tongue). It's suggested to use an electric toothbrush, if he can handle that, as that gives even more input.

• Providing strong and frequent stimulation to the insides of the cheeks is very important as well because the tongue and cheeks work together in the mechanics of chewing. Brushing the insides of the cheeks with a toothbrush or electric toothbrush or pushing them out with the fingers will help your child learn to feel the food in his mouth as well as to tolerate smaller bits of food. Morris states that poor chewing coordination is often the result of 'inactive' cheeks.

The most valuable lesson I've learned about Xander's mouth stuffing, and other eating issues, is that he's doing these things to compensate for his sensory and motor struggles. I've noticed that since we've addressed his sensory issues before and during our meals, his mouth stuffing doesn't happen as often. Not only does it include trying the above strategies while he's eating but giving him enough, and the right mix, of his sensory diet before sitting down for a meal as well as giving him a wedge to sit on at the table, having his feet at a 90* angle and allowing him to have his lap cozy all help him feel comfortable, 'safe' and more willing to sit and try eating.

I hope you find this information on Mouth Stuffing helpful. For more information on Mouth Stuffing and other eating issues, visit the new-vis.com Website.