Z needs help!

Z was one of my clients when I worked in Dubai. He was a smart and sweet little 7 year old on the spectrum. He had a lot of sensory seeking and self stimulatory behaviours, of which chewing on his shirt and anything else he found within reach, was the most predominant one. Z had amazing and very supportive parents. The mom would regularly contact me for tips and remedies at each stage for Z. 

One holiday period, mom mailed me regarding Z's chewing behaviour which seemed to have increased due to the break in his therapy. Sharing here, the reply I sent to her.

(Names hidden to protect identity)

Picture courtesy: Google

Hi Mrs. F,

Just thought I’ll put the things I wanted to suggest into a mail so you can read over in your free time and try out with Z. I have used these tips for few of my children with oral sensory issues and they have helped them reduce their mouthing behaviors. So, nothing to worry. It’s going to be fine.

Always remember “DO NOT” force Z to stop.

It’s not that he WANTS to chew.  It’s that he has an oral sensory NEED to chew.  Telling him to stop is not going to help. Imagine being in a stressful situation and in order to calm down, you start taking very deep breaths.  Then someone comes up to you and tells you to stop breathing deeply.  That would be inappropriate, right?  Why shouldn’t you try to calm yourself?  Similarly, chewing is largely a coping mechanism - it’s a repetitive movement that helps one organize and de-stress. It's possible that it might be behavioral as well, but in my experience, however, regularly chewing on non-food items is usually sensory-based. Their bodies are telling them that they need proprioceptive input, and they’re listening and following it.

Don’t worry, there are things you can try to decrease the chewing, but you should not force him to stop, especially not without helping him find other coping mechanisms and therapeutic interventions first.  

But before everything you have to figure out WHY he is chewing. From there you may be able to help target the core issues. Study when and how he chews.  Keep a journal to see if any patterns or triggers become clear (perhaps he chews the most when he is bored, tired, upset, frustrated, etc.).

If stress is a main factor, for instance, try your best to limit stressful situations for Z.   Keep in mind that even if stress/anxiety is not the primary cause, typically kids will chew more during / in response to stressful situations. Don't some adults too, bite their nails when they are suddenly faced with a difficult situation? It's just like that. Also, what you find stressful may not be the same as what they find stressful.  Children with sensory needs can experience the world differently.  A noise you may not even notice, might sound intolerable to Z.

Children often reach for the closest thing available to chew on, which may be their fingernails, knuckles, shirt collars, sleeves, pencils, the remote control, etc.  Not only can it get expensive to keep replacing what's been chewed on, but more importantly, it can also be very dangerous.  So give him a  safe and socially acceptable alternative to chew instead.

There are lots of rubber based items like tubes, pendent sets available in the market called “Chewellry/ Chewy tubes” but I personally DO NOT support those. For one, it is unhygienic to have a piece of rubber hanging down your neck or around your wrist or in your pocket, that has been chewed and covered with saliva, and reused multiple times in a day. I find it extremely 'gross'. It is also not socially acceptable for a boy of Z’s age to chew a non edible thing all the time, that too in public! This is purely my opinion, other OTs may disagree. Instead, try adding harder foods to his diet (carrots, crackers, apples, etc.) during meals and snack times. Along the same lines as gum massage, this can help provide added input to the jaw.  Chewy foods may work, too, as they provide more resistance and make the jaw really work.  Sometimes spicy foods and/or foods with strong, intense flavors can help, too.  .

Gum massage can sometimes help decrease the need to chew by providing oral input in a different way.  It’s a very simple yet often very effective activity you can do anywhere.   You can provide deep input to cheeks/jaw externally to see if that helps, too.  If he won’t allow gum massage inside the mouth, try starting over the cheeks along the gum line at first. I think I have given you a demo about gum massage.

Incorporate other oral activities into the daily routine. Have Z blow through whistles, drink through straws, blow cotton balls across the table, etc.  Put bubble mixture in some water and have him blow bubbles with a straw, etc. Use curvy bendy twisting straws to make it harder to suck.  Drinking thickened liquids through the straw (like applesauce, milkshakes, yogurt, etc.) can also increase the resistance and make the mouth work harder.

Not only do these activities keep the mouth busy, but they also provide oral sensory feedback.

Try using a vibrating toothbrush for another kind of oral sensory input.  There are cheaper brands of vibrating toothbrushes in Carrefour. “Jordan” is one such brand. Most kids who need to chew are sensory seekers, so they’ll likely love the increased sensation.  You can also try using vibrating oral motor tools throughout the day - tap, stroke, and apply gentle pressure to all areas of the mouth, including the lips, gums, tongue, and cheeks.  Some kids who need to chew have low oral awareness, in which case this vibration may help "wake up" the mouth with a new, heightened level of sensory stimulation. 

Often when there are sensory needs in the mouth, there are sensory needs outside of the mouth, too.  When you meet those needs outside of the mouth (when the body gets the right amount of proprioceptive input), the need to chew often decreases.  “Heavy work” might sound intimidating, but for the most part this is just about getting active with resistive activities that push or pull against the body - things like swimming, hanging on monkey bars, etc.  I have already briefed you on these before.

These are just a few of the things you can follow at home. It is not a lot. Give it a try, and let me know how it goes. Don’t worry, you are not alone. I am available anytime if you need me. And I’m always happy to help my dearest Z.

Cheers,

Priya.