CHEWING

Meredith Paige, Alyssa Hazlegrove & Abigail DuBois

TYPICAL DEVELOPMENT ATYPICAL DEVELOPMENT

0-4 months: Jaw provides compression to
breast and/or bottle nipple.
4-6 months: automatic suck becomes
more voluntary, vertical munching=cycles
of alternating mandibular elevation and
depression.
7-12 months: may initiate rotary chewing,
phasic bite has largely been integrated,
jaw can be held closed during chewing,
can hold items between gums and teeth,
lateral lingual movements, sustained
controlled bite .
Jaw clenching: increased tone within the
jaw
Tonic biting: abnormal pattern for dealing
with a bolus
Jaw sliding: abnormal movement laterally
Jaw jutting: abnormal positioning of the
jaw anteriorly
Jaw thrusting: abnormal opening of the
mouth

15-18 months: coordinated vertical and

diagonal movement of the jaw, bite hard
substances with a controlled bite, overflow
GOALS FOR THERAPY
movements may still be appreciated, child Postural stability
will likely open mouth more wide than - postural control needed to support 
needed for the size of the bolus. functional movement
- attain and maintain closure of jaw 
24 months: body remains still during and lips
controlled bites, open jaw to - grade jaw movements
appropriately size for food, and turn head - inhibit jaw extension
to the side for a stronger bite when - Influence tongue positioning
needed.
Tone
3 years: child can chew laterally with head
in midline and the child refines a circular Mobility
rotary chewing pattern

INTERVENTIONS
Pacing: moderating the rate of intake by
controlling the rate of presentation of food
and the time between bites or swallow
EXAMPLE OF FEEDING THERAPY
Goal: To increase quantity of bites. To
provide shape chewing by initially
reinforcing each bite.
Step 1: Set timer for 10 minutes
Step 2: Place small piece of crisp
dissolvable food on the child's molars and
tell them to bite
Step 3: As soon as the child bites through
the food, reinforce the child with tangible
objects.
Step 4: Offer small amount of
preferred drink after each bite.
Step 5: If food is completely chewed,
additional reinforcement should be
provided.
Step 6: If the child expels the food, the food
should be placed back on the child's
molars
Step 7: If food is swallowed without
chewing, repeat Step 2
Step 8: If the child refuses to have the food
on his molars it should be held in his mouth
without comment until the food is
accepted.
Step 9 : Gagging should be ignored.
Step 10: Alternate placing food on right
and left side of the mouth
Step 11: End session
NON-NUTRITIVE OPTIONS
Chewy Tub: practice, but children have
difficulty generalizing it.
STRATEGIES
- Hold food between teeth and break off
outside piece 
- Thicken and add lumpy soft foods
- Increase awareness of teeth through
rhythmical biting
HELPFUL VIDEOS
For a sustained bite and jaw strength:
https://www.youtube.com/watch?v=4B-
zf1fItF8&feature=youtu.be
For jaw strength and stability:
https://www.youtube.com/watch?
v=Fe2dUn_b6No&feature=youtu.be
REFERENCES
Eckman, N., Paul, C., Riegel, K., & Williams, K. E. (2015). Teaching
Chewing: A Structured Approach. Retrieved from
https://ajot.aota.org/article.aspx?articleid=1867108
Eicher, P. S., Fox, C., Kerwin, M. E., & Manno, C. J. (2005). Early
Oral-Motor Interventions for Pediatric Feeding Problems: What,
When, How. Retrieved from
https://files.eric.ed.gov/fulltext/EJ846764.pdfe/
Polikaitis,Rima I & Wesling, Michele. n.d.The ABCs of Pediatric
Dysphagia: Evaluation and Treatment. Retrieved from
https://www.asha.org/Events/convention/handouts/2006/1202
_Wesling_Michel