Our friend and colleague, Lisa Aquilino Haley, Occupational Therapist, is at it again. Giving you the inside knowledge to help those trickiest of eaters.
Lisa Aquilino Haley has 15 years of pediatric occupational therapy experience. Her expertise shines through in feeding issues. She conducts videofluoroscopic swallowing studies and is a facilitator of an out-patient feeding program, supporting picky eaters and challenging feeders in an interdisciplinary setting. She has a special interest in transitioning children from tube feeds to oral feeds. You can access more great content on her website: Lisa Aquilino Haley, O.T. Reg. (Ont.) Occupational Therapist (podia.com).
As dietitians, I know you all love to get your young clients moving on to regular table foods. And yet, parents report back that their baby gags and vomits as soon as that speck hits their tongue. They seem to reject anything that isn’t yogurt-smooth and they’re not sure how to progress to table foods. Parents are understandably worried it’s the start of a negative association with eating. Well, here’s a quick post with some simple strategies to offer families during this challenging phase of normal development!
Gagging for survival
When babies are born, their gag reflex is placed near the tip of their tongue. This makes sense for survival! If little cave babies started putting rocks and twigs in their mouths as soon as momma cave lady turned away, they would be choking and the species would have died out.
Over time, that very forward-tip-of-the-tongue gag gets pushed further and further back along the tongue’s surface. This lets babies manipulate food within their mouths and eventually get the hang of eating. But how do we get that gag reflex to move back? Oral motor exploration. Babies need to put their fingers, toys, teething rings, in their mouths, and yes, gag themselves. Ideally, if this is done during play time, and on an empty stomach, it isn’t so much associated with feeding experiences. That way, when the baby does come to the table to eat, the fun of food can take centre stage.
Oral motor toys
Encourage your families to get their babies a variety of toys that will stimulate the blade of the tongue. Stick-like toys to desensitize their gag are great! Here are some of my favourites, but just look for items that are baby-safe and have a long, narrow “stick” to them:
As an added bonus, these toys also promote lateralization, which is the ability to move the tongue from side to side. This is an important skill for placing food onto the molars and then chewing!
To help reduce an overly sensitive gag, ensure that families are getting into their child’s mouth, in a fun and playful way! Even if they don’t have teeth, get them in the habit of having regular teeth brushing as part of their morning and evening routine.
At first, it may be just a simple swipe of their lips or outside of the face and cheeks before or after bath time. Over time, incorporate firm yet gentle pressure to their gums. Once that is well tolerated, consider asking families to start including brushing the tongue too. Again, remind families to follow their child’s lead and make it fun. The idea is that their baby should enjoy this time! If families come back to you, indicating that their child “hates” teeth brushing time, it’s a good sign to have them back up a little.
Here are some of my favourite toothbrushing options
Once families have been practicing chewing and moving their tongue to each side (lateralization) with toys and during teeth brushing time, they can offer “hard munchables”. These are food items that WILL NOT break off in their baby’s mouth. A raw carrot, celery, frozen slice of waffle, under careful supervision while seated at the highchair will act as the same learning tool as those toys above. Encourage parents to have these on hand anytime their baby is having a smooth puree.
After that, the baby should be able to progress to “hard meltables”. These are food items that start out hard or crispy, but melt as soon as they come into contact with saliva. Think baby mum mums, Gerber puffs, veggie straw, or baby Cheetos. Again, promote that the baby places it along their back molars, not just at the centre of their mouth.
Once that is sorted out, promote the introduction of soft “stick like” pieces of food, about the width of an adult finger. Soft-cooked veggies in French fry like strips, avocado rolled in baby cereal to facilitate grasp, or banana with just the tip of the banana poking out of the peel are all good places to start.
After these steps are in place, families will find that their baby is better able to handle mixed textures (shepherd’s pie etc.), and gagging will be reduced!
Quick steps to help families know how to reduce gagging
1- Increase oral motor exploration
2- Decrease sensitivity by tooth/tongue brushing
3- Promote tongue movement side-to-side and chewing
4- Explore very soft-cooked “strips” of food
5- Can manage “mixed textures/lumpy” consistencies!
Thank you once again Lisa for taking the time to write these wonderful tidbits for us. We hope you enjoyed them.
Charlene and Julie
P.S. Join our growing Facebook group: Pediatric Dietitians - Newbies to Masters
P.P.S. Love what Lisa has to say?! Join our wait list for our next round of our flagship course Infant Nutrition Essentials where she delivers a full module on Feeding Readiness, Safety and Function – An Occupational Therapist’s Perspective