Thursday, July 25, 2013

Feeding tips for kids with special needs

Max has been eating a lot lately. For breakfast alone, the kid can down three oatmeals, an egg burrito and chocolate milk. Hello, growth spurt! Happily, Max's ability to eat and drink have improved over the years (the cerebral palsy messes with tongue control and swallowing), but he still has issues with retention and he isn't yet up to chewing on crunchy or hard foods.

I recently went to a therapy session at his school with a well-respected, experienced feeding therapist, and wanted to share some of her tips.

Practice with crunchy foods
Place a crunchy item that easily dissolves, like a Cheez Doodles or onion ring, on your child's molar to practice biting and crunching. We also practice this with French toast sticks, strips of grilled cheese and pieces of potato. 

Thicken thin liquids
The idea is to make liquids more of a nectar consistency, so more is retained. We add Hormel Thick & Easy to chocolate milk and other beverages. The stuff used to only come in canisters, but is now available in packets. CVS now makes its own Instant Food Thickener and it's a good deal. Hormel also has pre-thickened juices, along with already-thickened water (but, really, it's a no-brainer to dump the stuff in yourself). You can also mix applesauce and water for a thickened juice, or yogurt and milk, or just buy some juice purees like the ones Gerber Graduates and Peter Rabbit Organics make.

Strengthen jaws with Chewy Tubes
We'd been using these right before meals, to loosen up Max's jaw, but this therapist felt pretty strongly that meals should be focused on eating, not therapy. So now we use these before snacks and during the actual therapy. We place the stick on Max's back right molar, have him bite down and count to ten, repeat three more times, then switch to his other molar.

Practice sipping with fat straws
Dip a fat straw into chocolate pudding so Max learns to close his lips around the straw, the therapist suggested. Eventually, she promised, he will suck the pudding out from inside the straw. It hasn't happened yet, but Max sure has been enjoying practicing. Hot tip: Burger King has fat straws. (Combine that with my penchant for swiping those stubby IKEA pencils and I'm turning into a virtual kleptomaniac.)  
Make kids who drool more aware of swallowing
Kids with cerebral palsy and other oral motor issues often can't manage their front salivary glands and tongue, so saliva pools and doesn't get thrust back, toward the throat. Hence, the drool. There's a patch that can help dry up saliva, the Transderm Scop (it's usually used for sea sickness) and even surgery to reverse salivary glands, but I haven't wanted to go those routes. The therapist recommended that, using a straw as a pipette, we drip ice water into Max's mouth under his tongue to make him more aware of swallowing a pool of water. He has to learn to gather it together and move it back, a movement that does not come naturally to him. "Cue him if you see him pooling by tapping on his tongue," she said. She also suggested Max wear wristbands, and we could remind him to wipe the drool; it's a great tip, but Max hasn't been into the wristbands. Even purple ones. 

Lean forward during tooth-brushing
Tooth-brushing is a challenge because Max doesn't spit. So she recommended we bend him slightly forward, so liquid will run out. Such a simple thing, but a big help. 


  1. Great tips! I wonder if I had any issues with eating growing up I certainly don't now LOL

  2. Thank you for sharing Ellen, my daughter does not have CP but does have oral motor issues very similar to Max's. I will definitely try the fat straw. Thanks again.

  3. Sarah has a very limited diet due to some oral issues. She also uses a pacifier at night for mouth stimulation. We've tried an OT to try and expand her food palate but to no avail yet.

    1. Stephanie, can you get a consult with a feeding therapist? Or a speech therapist who knows a lot about feeding therapy? I've had consults over the years and they've been really helpful.

  4. Dude, the Burger King straw tip is gold. We're working on straw stuff with Zoe (so the pudding idea is one we'll be using too), but I didn't know where to find bigger straws. I'm joining you in the "my kid's CP made me a klepto" club. :)

  5. We went to our feeding evaluation this week and its already started helping! Bubbles as a reward between bites is such a game changer!! No more hour long feeding sessions or squirming to avoid the spoon full of food :)

  6. Tea shops may have the large straws (they use them for bubble tea). You might be able to get them to order a box for you.

  7. Definitely going to try pudding straws! Zach is a spastic quad with asymmetrical weakness in left face and legs, right arm. To get him used to different textures his feeding specialist had us sprinkle them on top of yogurt, starting with graham crackers, moving on to potato chips, etc. tiny bits at first and gradually increasing in size.
    Zach is 6, we've tried a lot to help with drooling but to no avail. We didn't use the patch but tried Robinul, wrist bands he wouldn't leave on. I am considering the surgery just because the drooling does affect how others interact with him (or don't) My nephew is autistic and is convinced Zach is spitting at him, my grandson and daughter don't want to share their toys because Zach gets them wet, etc.

  8. I don't know if there is difference in feeding therapy approaches in the UK and the US but my son's therapist here in the UK (for drooling issues) has suggested to always dab on the drool around the corners of the mouth and chin .... never to wipe. She said wiping increases the drool and dabbing/patting action is more suitable to reduce the amount of drool. May be something to ask your therapist the next time you see her!

  9. Zach is a spastic quad with asymmetrical weakness in left face and legs, right arm. No not really. Spastic quad CP is what he has NOT what he is.

    By saying that, you have accidentally perpetuated the idea a disability is all there is to a child with disability. Also you make it sound like spastic four quad CP has swallowed Zach up.

    Same goes for your nephew. Your nephew has autism however it does NOT define him. Stop enforcing stereotypes. As a parent to a child with extra needs, you should know better. It is so important to use PFL- people first language.


Thanks for sharing!

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