By Paulette Schafir, MOT, OTR/L, Occupational Therapist at CW
Soggy shirt cuffs, toys with bite marks and pencils chewed with no erasers; these are often seen with children who are seeking oral input and spontaneously engage in “mouthing behaviors”. Of concern is not only safety, hygiene and dental/gastrointestinal integrity, but also impact in the social realm.
For the purposes of this article, “mouthing behaviors” are being differentiated from the medical diagnosis of “Pica” which typically involves persistent ingestion (swallowing) of non-food items. If Pica is of concern, seeking medical advice is recommended to rule out nutritional deficits, chemical imbalances or potential impact on gastrointestinal and digestive health.
Mouthing behaviors are not uncommon for children on the autistic spectrum, who often lick, bite or chew on toys or their own clothing. In typical, early development (up to ~18-24 months), mouthing non-food objects is essential for sensory exploration for taste, touch and smell, as well as assisting with development of oral motor skills necessary for eating and speech production. However, if mouthing behaviors persist into older childhood, especially when entering the intense social world of school where toys and tools are shared, persistent licking, biting or chewing of common objects, becomes not only an issue of safety and hygiene but may impact social relatedness. Cooperative play and sharing may be impeded.
There are a range of accessible tools and easy strategies for caregivers that are worth exploring to diminish mouthing behaviors. Mouthing may stem purely from a need to obtain sensory input in the mouth, but is also often seen as a self-regulation tool when under stress or experiencing anxiety. Thus, exploring environmental and behavioral adaptations may also be helpful. It is advised to seek guidance from your occupational therapist (OT) or speech language pathologist (SLP) to identify the most effective strategies for diminishing mouthing behaviors.
Tools and Intervention Strategies for Exploration
- Use a non-toxic/sturdy chewing tool (many options commercially available – talk to your OT or peer who has tried different options)
- Place 2” of food-grade tubing (available at hardware stores) on the end of a pencil or loop to make your own “chewing tool”
- Clip tool onto a shirt or belt loop via a retractable key chain to make accessible at all times (vs. a necklace that may be a safety risk)
- Provide “chewy” and/or “crunchy” foods (dried fruit, bagels, baguettes, beef/turkey jerky, chewing gum, rice crackers, etc.)
- Provide strong flavored foods (for maximum sensory impact)
- Provide cold foods (even freezing foods not typically frozen such as pudding, raw carrots, bananas)
- Use of vibration via a mechanical toothbrush or “specialized tool* (external to jaw/cheeks and internal for teeth brushing/oral sensory input) – Please seek advice from your OT or SLP if you are not aware of precautions.
- Provide a tent or “escape” space for calming to reduce anxiety
- Offer appropriate “replacement behaviors” for mouthing when necessary
- Facilitate engagement in general sensory activities throughout the day for self-regulation
Paulette is a pediatric occupational therapist with over 13 years of experience and currently works at Communication Works. She is experienced in providing intervention for those with fine/gross motor, visual motor and sensory-motor impairment and sensory-behavorial feeding challenges.