Q&A: Oral Input from Fingers and Hands in the Mouth?

Question:

I would like to get your thoughts on a student I worked with last school year and will have again this year who has a feeding tube. I want to do a better job of addressing his oral sensory needs. He puts his fingers and hands in his mouth quite a bit. 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 gets clinical OT, PT, Speech, and Feeding Therapy. However, I want your expertise on oral seeking strategies since he resists putting items in his mouth other than his fingers. I thought about trying sour candy spray. What are your thoughts about spraying it initially, putting his fingers in it, then letting him taste it. If he liked that, maybe I could put it on a chewy tube. Do you have any advice you could offer?

Answer:

This is pretty typical behavior for kids with feeding tubes. They need oral input. Since they aren’t getting it from food, they often turn to their fingers. 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. Good choices include vanilla pudding or grape Kool-Aid powder. Just ensure there are no oral feeding restrictions or precautions. As his oral input increases, his need to put fingers in his mouth will decrease (at least that’s the current thinking). Here are some other things to try:

• 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.
• 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.
• Try to get him to engage with blowing activities. Blowing through a straw to move a cotton ball toward a target, blowing a whistle, or blow toys like these at Therapro.com.
• 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. You might train a paraprofessional to do this task. Ideally, giving him more intense oral input periodically will reduce his need for fingers to be in the mouth.
• 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. Let me know if I can be of further help!

Best Wishes,
Gwen