QUESTION: Oral Input with Fingers and Hands?

QUESTION:

I would like to get your thoughts on a student I worked with last school year and will have again this school year. I want to do a better job of addressing his sensory needs. One thing that he does a lot is put his fingers/hands in his mouth. So, I think he is seeking oral input for calming. He usually does this when demands are put on him or while playing on the computer. Using other objects (chewy tubes, etc.) for self-regulation purposes probably won’t work because this student does not put anything else in his mouth—he has a feeding tube. He gets clinical OT, PT, Speech and Feeding Therapy, but I wanted your expertise on oral seeking strategies for a student who will resist putting items (other than his fingers) in his mouth. I thought of trying a sour candy spray initially putting his fingers in it and letting him taste the sour and get input from that . . . then if he liked that we could put it on a chewy tube? Do you have any advice you could offer?

GWEN’S ANSWER:

This is a pretty typical behavior for kids with feeding tubes. They need oral input and since they aren’t getting it from food, they often turn to their fingers instead. You’ve done a good job of determining what triggers this behavior. That will be helpful to you.

The sour candy spray is worth a try for sure. However, the taste might be too intense for him since he is over-responsive to oral input in general. You could experiment with milder flavors too like vanilla pudding or grape Kool-Aid powder as long as there are no oral feeding restrictions or precautions. The thinking is that as his oral input increases, he will have less of a need to put his fingers in his mouth. Here are some other things to try:

1. Fingers have very little taste, a smooth texture and are fairly warm. Try to find chew toys that have those same qualities. A nontextured chew tube might come the closest. You might even try warming it up by running it under warm water.
2. See if he will allow you to put your gloved fingers in his mouth safely. If he is okay with that, apply downward pressure through the lower teeth, upward pressure to the upper teeth, gently stretch his lips and cheeks, and give gentle pressure to his tongue.
3. Try to get him to engage with blowing activities. Blowing through a straw to move a cottonball toward a target, blowing a whistle or blow toys like these:

http://www.therapro.com/search-results.html?gsearch=Magic%20Corn%20Cob%20Pipe%20P6310C6305

4. Once you have found some strategies like those above that work for him, try setting aside 5–10 minutes periodically throughout the day to give him oral input. Maybe a paraprofessional could be trained to do this. Ideally, giving him more intense oral input periodically will reduce his needs for fingers to be in the mouth.
5. Use rewards and consequences. A natural consequence for hands in the mouth is handwashing. You can even set a timer and require him to wash his hands for 30 seconds at a time. The hope is that he will conclude it’s easier to not put his hands in his mouth in the first place. Appropriate rewards could include some kind of preferred oral input or a highly preferred sensory activity.

I hope that helps! Please keep me posted on what works for this child. And let me know if I be of further help!

Best Wishes,
Gwen

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