Author: Krisi Brackett MS SLP/CCC
Kyle is a 2 ? year old who has a diagnosis of right hemiplegia (or weakness) due to a stroke in utero (in the womb). He started feeding therapy at 10 months of age because of refusal to take foods.
The focus the first year in therapy was to teach Kyle to accept smooth foods. This was done with medication to make his stomach feel better (reflux medication), motor therapy to improve his posture, strengthen his trunk and shoulder girdle, and with behavioral techniques to teach him to accept food.
The next 6 ?8 months were spent teaching him to chew and transition to textured foods
We broke down the components of chewing for therapy as follows:
1. lateral placement of pureed food ? we placed smooth foods into the sides of his mouth to start his tongue practicing going left and right instead of in and out which is used in a sucking pattern.
2. Biting ? he practiced biting on chewy tubes (biting and holding and biting up and down as many times as he could for jaw strengthening). He also practiced biting on foods placed on his molars such as graham crackers, Cheetos, cookies, etc. (things that would melt in his mouth).
3. Mouth closure ? The therapist would help sometimes with jaw stability or mouth closure by holding underneath his jaw.
There were many times that his mother expressed frustration and concern that his cousins wanted food more than him or that they were able to eat a hamburger and she was still bringing the food processor to family vacations. Kyle seemed to have weeks of doing great and then he would get sick with a cold and go back to gagging, sucking, and tolerating less texture for awhile. We kept encouraging her to do daily practice at home. Each stretch of time he was able to practice good chewing would make his recovery faster from minor setbacks.
After months of practicing, Kyle came in one day and seemed to have ?mastered chewing!? He was eating a variety of foods, chewing them well, and requesting more. We decided to give him a few weeks off of therapy, when he came back, he was still chewing well! We are now ready to discharge him from therapy, confident that he has had enough time using his new skill of chewing to maintain it. His mother is nervous about stopping therapy but is also excited too!
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