Dr. Gum's Knowledge Notes ② 🔵 There is a reason why they 'won't put it in their mouth' — The development of eating ①: The entrance to the mouth

🔵 Introduction

In the previous Knowledge Note ①, I introduced a way to organize children's 'not eating/cannot eat' issues into three phases.

Starting with this issue, we will delve deeper into each phase. The first part is about Phase 1 — 'The development of sensation and function at the entrance of the mouth.'

If you have concerns such as 'they turn their face away just by bringing a spoon close,' 'they won't open their mouth,' or 'they cry hysterically when they dislike the toothbrush,' this is content I would like you to read.

🔵 What is Phase 1?

To briefly review the three phases introduced last time:

Phase 1 is the stage where the sensation and function of the entrance of the mouth develop. The state where stumbling blocks such as 'they won't put it in their mouth' or 'they dislike having their mouth area touched' occur at this stage is the theme of this issue.

🟠 A talk about sensation

Various sensations such as touch, temperature, and pressure are concentrated at the entrance of the mouth. There are individual differences in how these sensations develop, and there are two major directions: 'hypersensitivity' and 'hyposensitivity'.

🔹 In the case of hypersensitivity

This is a state where the brain receives information more strongly than necessary when something approaches or touches the mouth. It is not 'selfishness' or 'not wanting to eat,' but rather that information from the mouth is arriving excessively, making it easy for strong rejection reactions to occur (Tamura, 2021).

Common signs include:

• Generally disliking contact around the mouth and face (including tooth brushing and face washing)

• Strongly rejecting the moment a spoon or eating utensil touches the lips

• Strongly reacting to specific textures, temperatures, or smells

🔹 In the case of hyposensitivity

Conversely, this is a state where sensation at the entrance of the mouth is dulled. At first glance, it may look like 'they are fine with being touched,' but because sensations around the mouth are difficult to reach, it can affect the development of eating.

Common signs include:

• Weak reaction to stimulation around the mouth

• Excessive drooling and difficulty closing the lips firmly

• Appearing unbothered when food touches the mouth area

Whether the issue is hypersensitivity or hyposensitivity, the foundation of the approach is to consistently provide appropriate stimulation to the entrance of the mouth. We will introduce detailed methods for gradually developing sensations around the mouth through massage with sponge brushes or fingers later on.

🟢 A note on function

In parallel with sensory development, it is also important for the movement of the mouth's entrance to develop. There are two functions that are particularly relevant during Phase 1 (Kaneko, 1987; Mukai, 2000).

🔹 Food intake (Prehension)

This is the movement of using the upper lip to firmly take in food placed on a spoon. When this movement is developed, food remains in the mouth when the spoon is gently pulled away. At a stage where food intake is still difficult, the child may push the food out with their tongue or be unable to keep the food in their mouth properly.

🔹 Lip closure

This is the function of keeping the mouth firmly closed while eating. If lip closure is not sufficiently developed, food and drink are more likely to spill from the mouth.

🌱 Why do some children struggle in Phase 1?

The background varies, but the following cases are commonly seen.

🔹 Children who have experienced medical care such as tube feeding

For children who have had limited experience using their mouths due to medical circumstances, or who have been accumulating experience slowly, the development of oral sensations and functions may also progress slowly.

🔹 Children who continue to have strong reactions to contact around the mouth

When starting baby food, if a child feels that the touch of a spoon is excessively unpleasant, repeated experiences can easily lead to a reaction where they perceive 'things entering the mouth' as 'something unpleasant.' Cases where a child once accepted it but later began to refuse it can often be understood through a similar process.

🔵 Approach to Phase 1: The concept of desensitization

When signs of Phase 1 are observed, we often use an approach called desensitization.

Desensitization is the process of gradually getting used to stimulation around the mouth. Whether the issue is hypersensitivity or hyposensitivity, it is important to carefully and consistently provide appropriate stimulation to the entrance of the mouth (Toomey & Ross, 2011).

As a concrete example:

For information on how to choose and use sponge brushes, please also see this article👇
▶︎ Dr. Haguki's Recommended Goods ① 'Sponge brushes to develop oral sensation'
https://note.com/haguki_sensei/n/n58ab21b415d4

The basic approach for Phase 1 is to take your time and build up progress at your child's own pace.

(* Specific approaches vary depending on the child's condition. We recommend working with a professional when putting these into practice.)

📋 What is the difference between Phase 1 and Phase 2?

Phase 2 will be introduced in detail in the next knowledge note.

🌱 Conclusion

When you look at the concern of 'they won't put it in their mouth' from the perspective of oral development, you may see things from a slightly different angle.

Struggles in Phase 1 often change little by little through appropriate approaches and the accumulation of time. Let's cherish that pace together with your child.

[References]

📕 Fumitaka Tamura (Ed.), 'How to Examine Children and Their Oral Cavity', Ishiyaku Publishers, 2021 - Refer to the development of perioral hypersensitivity and sensory aspects
📕 Yoshihiro Kaneko (Ed.), 'Disorders of Eating Function', Ishiyaku Publishers, 1987 - Refer to the development of eating functions such as food intake and lip closure
📕 Mie Mukai (Ed.), 'Feeding Guidance for Infants: Answering Mothers' Questions', Ishiyaku Publishers, 2000 - Refer to spoon introduction and feeding development during the weaning period
📕 Toomey KA, Ross ES. SOS approach to feeding. Perspectives on Swallowing and Swallowing Disorders. 2011;20(3):82-87. - Refer to the gradual desensitization approach