Hypersensitivity during Mealtimes

by Trish Angle

Students with severe disabilities are often hypersensitive in and around the mouth. This in turn can interfere with eating and toothbrushing. Oral hypersensitivity is defined as an "excessive or adverse reaction to oral stimulation" (Fraser, Hensinger, and Phelps, 1990). During meals hypersensitivity can trigger a tonic bite reflex and easily elicit a gag reflex. Also, oral hypersensitivity can create an intense aversion to specific properties of food such as acidity, smell, spiciness, taste, and texture, which may make it difficult for an individual to move from pureed to solid foods.

An individual may be hypersensitive for several reasons. Neurological impairment may cause an individual to overrespond to sensory information. In addition, postural tone and reflex patterns may cause a reduction in the amount of tolerance a student has to touch and movement. Also, limited motor capabilities (which inhibit a student from touching his face or feeding himself) or being fed via a gastrostomy tube, may limit a student's exposure to oral stimulation. Understanding the reason(s) why an individual is hyersensitive may provide important information in discovering ways to reduce this hypersensitivity.

Using a team approach which involves the teacher, occupational therapist, speech therapist, physcial therapist, and parents is extremely useful in determining ways to help decrease a student's hypersensitivity. Initial strategies for the team to follow are:

1) Examine the student's sitting posture to make sure the trunk and pelvis are in good alignment, the shoulder girdle is forward with abduction of the scapulae, the neck is elongated, and the chin is tucked;

2) Play calming background music during meals;

3) Auditorially (ringing a bell attached to the spoon), verbally ("Here comes the food"), or visually (placing the food on a brightly colored spoon) cue the student before touching this mouth or introducing food;

4) Touch the student's face using firm, deep pressure (light pressure or touch is often overstimulating);

5) Use a coated spoon since the metal surface of a spoon may cause an adverse reaction; and

6) Introduce new and dissimilar properties (temperature, texture) of food separately so that the student is not overwhelmed.

After trying the above suggestions, a student may still need additional assistance in helping to reduce oral hypersensitiviety. The team's occupational therapist and/or speech language pathologist may suggest certain procedures for feeding helpers to perform with the student before meals. These procedures may include stroking the lips and the outer surface of the upper and lower gums, vibrating the cheeks and lips, and using a toothbrush to brush the tongue, cheeks, and lips. The team should continuously evaluate the effectiveness of these strategies in increasing a student's tolerance to oral stimulation and in decreasing problems (gag reflex, tonic bite reflex) associated with hypersensitivity.

Oral hypersensitivity can create various problems for a student during meals. Using a team approach to evaluate the problem and consistently implement the intervention strategies selected will help to decrease hypersensitivity over time.

Reference

Fraser, B., Hensiger, R., & Phelps, J. (1990). Physical management of multiple handicaps: A professional's guide. Baltimore: Paul H. Brookes.