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Tuesday, February 14, 2012

Sensory Processing Disorder and Oral Development

Of course as soon as I finished typing yesterday's post about how Raya was feeling better & hadn't had a fever or runny nose for a couple days, etc., she made a liar out of me. She's good at that. :) When I got home from the grocery store, Raya had been eating a couple bites of peanut butter. A few hours later, she was standing a few feet away from me and started fussing a little. I picked her up and she had some foamy white-ish snot coming out of her nose (sorry, TMI) and I could smell a vomit-y smell. I wiped her nose and realized that it wasn't her mouth that stunk, it was her NOSE that smelled like puke+peanut butter. Gross. It was about then that I realized she felt warm again and sure enough, her temperature was back up to 100. I put her in the shower since she needed one anyway and by the time she got out & got dressed her temperature was down to normal again. Today has been a better day. Her moodiness has returned to normal 2 year old moodiness, thank goodness. She's still pretty clingy and tells me all the time that she wants to hold me. :)

She had a really good feeding therapy session today too. They spent the whole appointment working on oral motor skills, and specifically chewing. The therapist started her out with chewing on a wet washcloth with her molars, which is one of Raya's favorite things to have in her mouth. Then she moved on to chewing on a piece of rubber tubing, some rubbery toys, and a teething toy that vibrates when she bites it. They practiced chewing with her molars because she has a tendency to try to chew with her front teeth and hold food on the tip of her tongue instead of moving it to the sides, chewing with molars, and swallowing.
Since she's been sick, she's reverted back to some of her earlier phases of oral development. There's always been a huge connection between Raya's sensory issues and all of her oral aversions and gut hypersensitivity. We also know (especially after the past week) that getting sick sends her sensory system (if you can call it a system??) into overdrive. She's gone backwards with the things she's able to tolerate putting in her mouth. This is exactly what we had expected to have happen if/when she ever got sick so it hasn't been shocking, it's just sad to see how such a small thing can send her several months back on where she had gotten to with eating. Instead of focusing on how many calories she's eating, now we're focusing on just getting her to eat something.

One of the things that we talked about again today is the "32 steps to eating hierarchy" by Kay Toomey. I couldn't find the exact handout I have online but here's the closest thing I could find to it:

being in the same room with food
being at the table with food on the other side of table
being at the table with the food 1/2 way across the table
being at the table with the food approximately in front of child
looks at food when directly in front of child

assists in preparation/set up with food
uses utensils or a container to stir or pour food/drink
uses utensils or container to serve self

odor in room
odor at table
odor directly in front of child
leans down or picks up to smell

fingertips, fingerpads
whole hand
chest, shoulder
top of head
chin, cheek
nose, underneath nose
tip of tongue, full tongue

licks lips, tongue licks food
bites off piece and spits out
bites pieces, holds in mouth for "x" seconds and spits out
bites, chews "x" times and spits out
chews, partially swallows
chews, swallows with drink
chews and swallows independently

copyright, 1999
Kay Toomey, Ph.D.

Some of the things at the top of the list like tolerating food being in the same room aren't an issue, but they used to be. This past week though, some of those seemingly simple steps like tolerating food on the table in front of her have started to bother her again so we're starting back where she's comfortable. This means that for now, I offer her food and/or she asks for food and then she plays with it. She might take a bite or two depending on what it is, and she might chew it a little and spit it out or she might swallow a little. The rule is that Raya is the one that decides how far down the list she goes. Encouraging her is fine but following her lead is important.

Sometimes I feel like Raya is a little bit of a science experiment. I think she'll get back to where she was quicker than it took her to get there to begin with.

Since today is Valentine's Day, I made some cupcakes for the kids. Raya wanted nothing to do with them but Kaida REEEEEEEEALLLY wanted one. Apparently not badly enough to eat her dinner though, so she didn't get one. I put Raya to bed after dinner and when I came back in the kitchen a little while later, I found this:

The funny part was that she told me Raya was the one that ate all the frosting off the cupcakes. Nice try, but next time blame it on a sibling that eats food and can reach the counter. :)

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