Question: I am working with a 7 year old girl in feeding therapy who is refusing to open her lips and just purses. She has been involved heavily in food preparation which she enjoys doing and shows great participation.  However when it comes to the taste testing part she refuses all foods. She does eat ham and prunes.  I have tried to get her to chain to other types of ham but she refuses. I have gotten her to put a spoonful of food on a spoon and hold it in her mouth for ten seconds, but then she just spits it out. She lives with her grand parents who have been no help with the situation.  Any medical issues have been ruled out and she does not have any sensory or oral motor issues.  Any further suggestions?

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Try having her actually manipulate and  play with food.  Make faces with it, smash it, squash it, mold it, finger paint with it, etc.  It’s fantastic that she enjoys being involved with food prep, but she needs to manipulate it in her palms too.  So play with cookie dough as edible 'play dough' - cut out shapes and make cookie dough men.  Roll out a canvas and "paint" on it with yogurt or applesauce and so forth.

Go through a pattern of touching it to the hand first, then the arm, shoulder, top of head, nose, cheek, chin, touch it above the lips to make a “mustache,” run it over the lips to put on “lipstick,” use it as a “toothbrush” to brush the teeth, “paint” the tongue, etc. 

Regarding the food chaining, for some kids you can change the whole piece of ham / brand.  But for her, try backing up and making very tiny TINY adjustments.  For example, incorporate a little piece of a different type of ham (very small – smaller than your pinky fingernail) with the other ham she likes as a start.  

You can also try putting the mushy part of the prune (I think you can open up prunes and scrape out something spreadable?) on a ritz cracker and have her lick it off the cracker. Just licking the prune for now – she doesn’t have to eat the actual cracker (even if she licks a preferred food off of a new non-preferred food, that's progress).

If she’ll eat the ham with mayo, put a tiny tiny dot of mustard in the mayo. Next session put 2 dots. Work up from there very very slowly.

It's definitely not ideal that there’s no home follow-through, but she’s getting there!

Debbie

Debra C. Lowsky, MS, CCC-SLP

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