She is resistant to toothbrushing in the morning and at night. Mother has tried multiple types of toothpaste and toothbrushes and nothing seems to work with her.
Limited play due to poor endurance. She is unable to play continuously with toys, play with others, or play with toys that have some strength to them. She has to take breaks and she gets frustrated when she is unable to play.
Educating the parent or caregiver will allow them to understand what they are seeing, what they should be looking for, what the concerns are, and what are some activities to do with the child in order to help the child improve. Parents may be encouraged to reach out and attend social groups to better connect with other families facing the same difficulties.
Parent education helps the therapist maintain the plan by following a schedule, corrected foods and liquids, and learning a routine.
The use of positive reinforcement will help increase desired behaviors while ignoring negative behaviors. Brooke is not wanting to try solid foods, use utensils, or use cups. Applying regular exposure and rewarding the child with positive reinforcement will eventually improve self-feeding and food consumption. Some examples of positive reinforcement that can be given are: social attention, verbal praise, TV time, playing with toys, or prizes.
For example, presenting a spoon during pureed food or dry cereal meal time, the spoon should be presented at the child's vision arid at the level of the lower lip. You can stimulate a sucking movement and if the child eats the food, the therapist will give positive reinforcement with one of the examples above. After positive reinforcement is given, the child is more likely to do it again next time the spoon is presented.
It is important to analyze the task into small, discrete steps, manipulate the antecedent condition by presenting food or liquid in a way that allows the child to complete the behavior expected successfully, and produce clear consequences for not completing the task as well as positive reinforcements for completing the task.
Children with oral sensitivity often turn away from feeding or toothbrushing activities, restrict food variety, or gag frequently. Using slow linear rocking before oral stimulation calms the child in order to create a balance of stimulating and calming sensory input.
Stimulations like gloved fingers, vibrating toys, teething ring, warm wash cloth, or a toothbrush can help improve oral sensory processing. It may help to start in the distal limbs like shoulders and arms before reaching cheeks and lips.
While practicing toothbrushing, the child is improving on motor control and coordination. The stimulators help gain trust in the child by being comfortable when objects are by the mouth.
This intervention can be graded by watching the child during toothbrushing time to see what reactions are given and the outcome of the process. It can be adapted to be easier or harder depending on how the child performs like having assistance making the movements in his mouth or making him brush for a longer period of time.
This intervention can be graded up by using a larger, slipperier cup like glass that requires more strength and coordination to hold onto. It can be graded down by having a handle on the cup and using two hands to hold onto.
Group activities can promote sharing, new toys, increased endurance, and potentially can make her tired in order for her to sleep better.
In 9 weeks, Brooke will improve self-feeding by requiring only 1 verbal cue with positive reinforcement, by using 3 different types of utensils everyday, within 2 opportunities, for 5 consecutive days per parent report.
In 3 weeks, Brooke will improve self grooming by brush her teeth with min assistance by her parent, after using a calming strategy of her preference, 2 times a day, within 2 opportunities each time, for 5 consecutive days per parent report.
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl.), S1-S48.
Cole, M. B., & Tufano, R. (2008). Applied Theories in Occupational Therapy: A Practical Approach. Thorofare, NJ: SLACK Incorporated.