Q&A: Replacing Oral Seeking Behaviors?

Question:

I am seeing a 2-year-old boy. He is a seeker for deep pressure and oral sensations and avoids vestibular input. He dislikes haircuts and getting his toenails trimmed but rubs his face on the carpet when he is playing and rubs other things on his body or face. We have started consistent sensory input throughout his day and have seen improvements. He has better attention to task, allows his parents to touch his feet now, and no longer rubs blankets/carpet on his face. We plan to move on to tooth brushing and joint compressions. We are doing a lot of crunchy/chewy/frozen foods and trying a vibrating toothbrush, but he is still licking and putting everything in his mouth. Do you have any suggestions on other ways to decrease or replace the oral seeking behaviors? Thank you for your help!

Answer:

Here are some thoughts/comments:

• Regarding the oral-seeking behavior: What is his cognitive level? If it’s below 18 months of age, this is typically seen as a developmental stage and isn’t easily addressed through sensory or behavioral strategies. Rather, aim at enhancing development, and he will probably outgrow the behavior in due time. However, if he is functioning above the 18-month-old level, read on.
• Here is my answer to a similar question that may have some helpful tidbits for you at Q&A: Oral Input from Fingers and Hands in the Mouth?
• Sometimes a behavior like putting everything in one’s mouth is just for the oral input itself. But sometimes it’s an attempt to use a preferred strategy to override a nonpreferred form of input or form of stress. For example, you mentioned he avoids vestibular input. So, movement may cause him to feel uneasy (or even queasy), and he has possibly found that oral input is soothing to him. For this reason, be sure to address the big-picture needs. This could be through increasing his comfort level with vestibular input as well as providing calming sensory input throughout the day to keep him modulated.
• These behaviors often start out as a sensory need and then become habitual, so we need to address both issues. I typically try to think about how to satiate a need during a set time and then work on breaking the habit in between satiation times. For example, you may spend the first 10 minutes of your session getting him regulated through a combination of sensory strategies but especially heavy on the oral input. Try to satiate that need during that time. Most kids show signs of satiation by voluntarily relinquishing an oral toy/tool or switching their attention to something nonoral in nature. At this point, engage him in fine motor or developmental play. If he starts to put something in his mouth, redirect him or even tell him, “No mouth.” Ideally, I would use a visual schedule. I would put a card indicating oral input, then cards showing other activities, and one with oral input again at the end of the schedule. If he starts to put something in his mouth during the other activities, show him the schedule and say, “Mouth time soon” or something similar. For a 2-year-old, you may want to start with a very basic FIRST-THE visual schedule. You may want to implement this first during your sessions then turn it over to parents for follow through once you are seeing some progress.

I hope that helps! Please let me know if I can be of further assistance.

Best Wishes,
Gwen