Update on Occupational Therapy

Most of our close friends and family know about John's eating issues, but I thought I'd put a little update on the blog now that he is four sessions into his occupational feeding therapy. He was diagnosed with "moderate to severe texture aversion resulting in a low variety of oral intake" (although his caloric intake is fine). Another phrase used was "oral sensory texture aversion." He has mixed oral hyposensitivity (he can't feel where the food is in his mouth) and hypersensitivity (then the food goes down his throat too fast, alarms him, and sets off his gag reflex, so he chokes and vomits).

Part of me thinks this is potentially all hooey, one more thing to diagnose and manage. I think about how starving kids growing up in Indian shanty towns don't have texture aversions. But the other part of me thinks this is all very valid and I'm so extremely relieved to have a plan, to have something we can do to help John eat better. It certainly can't hurt, so we're going ahead with the occupational therapy.

John has been working on sucking out of straws and I've taken away most of his sippy cups, which apparently can cause oral problems (I suspect this happens more in kids who already have underlying issues). John wants to put any straw on his back molars through the side of his mouth and bite down hard, thus crushing even hard, semi-permanent straws. The therapist has the neatest way she has taught him to suck from the front middle of his lips and without using his teeth, although he still needs reminders and practice.

John is supposed to play with whistles. (Oh great, a two-year-old with loud noise-making devices!) There is a whole hierarchy of whistles that require the mouth to make different motions, so I am supposed to start with him on the whistles at the most basic level. They should be available at the dollar store, but three stores later I'm still hunting for them.

I'm supposed to be talking to John about textures--in food and in anything else--to give him vocabulary for what he is feeling. So I'll chat with him about how his cereal is crunchy, his ice cream is cold and smooth, the pudding is squishy, and so forth. Just a week into that, with my remembering to do it only a few times, John has already started to volunteer comments like, "I hear crunching!" (as he crunches his food).

Today John and the OT worked with pudding, which is a consistency John absolutely will not eat and doesn't even want to touch. The OT played a game of hiding John's sesame sticks in the pudding and asking him to dig them out. He would not use his fingers, but would use a spoon. Then he'd take the chocolate-covered sesame stick off the spoon and place it on a nearby napkin. Then he'd freak out about the pudding that was on his fingers, asking me to "clean it!" We would give him his own napkin and ask him to clean his hands himself, which he did because I refused to do it for him. We went through this game several rounds, with every step needing to be encouraged/bribed/manipulated with offers of playing with a toy he wanted.

Part of something I am supposed to do at home is find ways for him to play with the pudding texture he dislikes. Ideas are to use shaving cream, whipped cream, or mud. This has me reflecting on how several people who have watched John eat have remarked how fastidious he is for his age. I wonder if this is because John hates certain textures on his hands so much that he will only eat in a fastidious way. Reflecting back, he never played with food to quite the degree that I think is typical for babies. He never squished it all up in his hands and spread it around. Now, he does play with his food a little bit and we've always stopped him. Something we're going to try now is allowing him to play with his food (keeping it on the table, not throwing it), especially if it is a food texture that normally bothers him. He can always learn table manners fairly easily when he's so much as three years old.

(On a related note, this afternoon we played in the back yard, which John loves to do and asks for every day, but it was still rather muddy from recent rains. John got a little bit of muddy dirt on his feet (in sandals) and hands. He was so disturbed that he wanted to go inside and give up playing outdoors just so that I'd wash him clean. How sad is that?)

Also today, the OT used her "buzzy bee," as she calls it, with John. John did not want this thing near his mouth, so in a very friendly way the OT let him play with it and we talked about how it buzzed like a bee. Then the OT would let it buzz on some distant part of John's body, like his knee or his chest. Then John would get to buzz it on the OT. The woman worked closer and closer to John's mouth, putting the buzzy bee on his cheek, forehead, nose, and finally his lips. She works gently in order to avoid John becoming obstinate.

It's all very interesting for me! Now, it's probably not interesting at all for most other people, but I thought this was an effective way to update the grandparents and a few friends. Thanks for your patience!