Episode 133: Overstuffing and Large Bites

Quick Disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Welcome to the Untethered Podcast. I am your host, Hallie Balkan. I'm a certified orofacial myologist, feeding specialist and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, tethered oral tissue and airway space. I challenge you to keep an open mind and join my mission to get this information out to the masses. Let's get started. Hello and welcome to episode 133 of the Untethered Podcast. It's your host, Holly, and it's just me. Today we are going to talk about what I commonly see in regards to overstuffing mouths. So I'm talking about children of all ages and maybe even adults. This can apply to adults too. But we had an inquiry, we had a question about why do children overstuff their mouths? This could be twofold. There could be several different avenues of things going on here, but I'm going to talk about it first from a speech, language, pathology and orofacial myology perspective. And we're going to also consider the sensory system because we know we can't truly pull that out from motor However, I want everyone to think about why a child think about children. If you've worked with children, if you worked with kids either in myofunctional therapy or in feeding therapy, who stuff their mouths, take really large bites, what is consistent about their profiles? Meaning when you evaluate them, what do you see? What do you commonly see? This is not necessarily a single case study so much as it is let's have a conversation about kids in general who overstuff their mouths. Again, I'm going to preface this with saying that this could be sensory. I do note that a lot of children who overstuff might also pocket food in their cheeks. They might push that food into the cheeks and just hold it there, especially if they can't feel it. They also might be overstuffing their mouth because they can't control it. Okay, so sensory aside for a second, even though we truly can't treat in silos and we can't truly, like I said, we can't pull sensory out of motor they are all intertwined or systems all work together. If we look at this from a motor perspective and we'll pull the sensory component back in in a few minutes. What might be going on with a child who feels the need to overstuff their mouth. Right. Let's pose it that way. Instead of going like, why is a child stuffing? Or this child is stuffing. They have no self control or they have. I see a lot of labels applied to children who eat certain ways, like they're messy, food falls out of their mouth, they're lazy eaters, or they, you know, they're, they're little piglets. Or like I have heard everything under the sun and I'm going to tell you right now, children are doing the best with what they, with what resources they have available to them. Children do not choose to overstuff their mouth to irritate you or you, the parent or provider or teacher. Right. They don't overstuff their mouth because they want to be silly. They're not overstuffing their mouth because they're too lazy to take smaller bites. They're overstuffing their mouth for a reason. And so that's when we want to dive into what is going on from both an anatomical form standpoint and then also physiologically like function. Let's look at the function of the anatomy, let's look at what it, let's see what everything looks like, and let's figure out how it's either working or not working, lack of better terms. And just to make this super simple, now, of course I'm going to dive into this from a tethered oral tissue standpoint because we know that that is one of my specialties. And this is something that I see. I'm not saying that all children who stuff their mouths have tethered oral tissues. Let me just put that disclaimer out there. But I see this frequently in our tethered oral tissue kiddos. So let's talk about it. And then if you're watching this on YouTube when it gets posted, you'll see my new mouth shir that I'm wearing that I just rolled back to show you how appropriate for today's conversation. But ties and swallowing, right? Ties and overstuffing. Ties and, and, and, and, and, and, and, and. Right. What happens if your tongue is restricted? Let's talk about that for a minute. Maybe we'll better understand why these children are overstuffing their mouth. We know in infants we're not going to see them overstuffing per se, but let's say they're breastfeeding and mom has a very quick letdown and we see a baby dribbling out the corners of their mouth. Well, they might be able to hold a lot in their mouth, but it could be spilling over everywhere and dribbling out the side because they can't control it. These children give us some good insight into it from an anatomical and physiological standpoint. Well, what happens when our tongue is not functioning the way it should? What happens when our cheeks are not functioning the way they should? What happens when our mouth is not working together as a single unit to feed the way that it should? Right. We need to be looking back at our patient's history all the way back to birth, all the way back to infant feeding. And, you know, did they transition easily to solids? How did that transition go when they transitioned to solids? You know, were there any hiccups? Were there any. Did they eventually cut foods out? Like, you know, sometimes we see that in toddlerhood, and they can become a little picky, and that's still normal. But did they then cut foods back from, like, eating 30 foods to five foods? Did they dec. They were only going to eat one color or, you know, brown, yellow, and white foods. And they were mostly soft or easy to break down. And they weren't eating any, like, proteins, despite the fact that the family eats chicken and beef. You know, these are the things that we need to be looking at when it comes to children. You know, even if you just notice, hey, that kid stuffs their mouth like this, tells me, oh, hey, we need to be doing a. Either an oral motor feeding or myofunctional therapy evaluation, you know, depending on their age, and seeing what seem a little bit deeper, like, look a little bit deeper into what is going on. Okay, so from a mild standpoint, if we focus on that oral prep and oral phase of the swallow. Right. What happens if our tongue is restricted? Well, one we know it's generally tied literally to the floor of the mouth. Okay. The tongue is going to have trouble elevating. We might have trouble achieving that. Tongue to spot where we expect the tip of the tongue to touch the alveolar ridge, which sits about that bumpy ridge. It's about 2 to 3 millimeters behind your upper central incisors. They have a hard time getting the tip of their tongue up there. They have a hard time suctioning the tongue to their palate. Or sometimes we see that they can do a brief click or they can suction, but the suction kind of slides back because the tongue is restricted and they can't hold it in the proper position. This Is something I don't see a lot of people talk about very often. They just go, can you suction or not? Well, what's the quality of the suction? Is it decent? Is it sufficient? Is it staying up there? Can they hold it for 30 seconds? How about a minute? Does it stay up there at rest when their mouth is closed? If they have a closed mouth posture, is the tongue up on the palate or is that on the floor of the mouth? I think a lot of us assume that just because the lips are closed that the tongue is resting on the palate. Nope, we need to be checking for that because we might have a tongue that's resting down and then other lingual movements that are necessary during the oral phase. Especially from a, well, both feeding and myo standpoint, we need to be able to create a bowl shape to hold the bolus for that prepped food, the bottle prepped food, if you will, in the center of your tongue while suctioning your tongue to the roof of your mouth. And then our tongue starts to move in that peristaltic motion where that wave like motion to help push the food back and swallow that bolus. Now, when we initiate the swallow, our tongue is moving in so many different directions. It might be that the posterior portion of the tongue is elevated and the tip of the tongue dips down, drops down just slightly off of the alveolar ridge and then it comes back. The tip of the tongue comes back up as we swallow and the posterior portion of the tongue drops down so we can release the food. But when this happens, the tongue is maintaining contact with the palate that entire time. And that's important because if it doesn't, and it can't create that negative pressure needed in the mouth to swallow that food bolus, it's going to go push against the teeth or the gums in a different way or through the teeth or the gums to seal off the lips. If there's an open mouth posture, it's going to figure out how it can close up all the little tiny holes between the teeth. If this child has teeth and. Or if the mouth is open, it's just going to seal. It's going to seal the mouth right at the lips. Right. So we have to look at. And in that case, this child may also be swallowing air, which can cause digestive upset. Sometimes we see like a lot of constipation in some of these kiddos. And so we really need to be thinking more about, okay, this child is an overstuffer and we can't seem to change it behaviorally. So, like, let's, let's look more into what's going on, because if they're struggling with some of the things I just mentioned, they need oral motor feeding therapy if they're under the age of four with a twist of myo. Or they need maybe traditional myofunctional therapy if they're a cognitively intact child who's at least four years of age plus. Now let's also think about what happens if our tongue is restricted. Right? If our tongue is restricted. Let's talk about infants for a second. I know we're talking about over stuffing, but in infancy I mentioned before, so let's talk about it again. We might see a slow, it might slow down the flow of milk that's pulled from a breast or bottle nipple. It's a safety mechanism. Unless that nipple or both breast nipple or bottle nipple have too fast of a flow. And then they may not be able to control it. And we may see popping off the bottle, refusal of bottle, coughing, liquid falling out of the side of the corners of the mouth, and so on and so forth. But as the child gets older. Now let's fast forward back to starting to eat. We're going to start to see that initially we'll see a munch pattern of chewing, which is good, but we don't see these kids develop beyond that. They don't develop into that diagonal and rotary chew. We often also see that they have a hard time lateralizing their tongue. So they oftentimes can't get that tongue to move to the left molars or to that where the future molars will be or the right molars. Right. They can't get the food there in order to break it down. So they're munching with the food on their tongue. And that's again why some of these kids, these toddlers on up, are going to prefer softer foods. Because one, it feels much better when you're mashing your tongue against your palate. But two, they can't break it down otherwise, if they can't get it over to their, their molar area or their future molar area, their gums. So wouldn't it make sense that these children might overstuff their mouth or take larger bites? Because while it seems counterintuitive to us, these children need to do that in order to better control the food in their mouth. Right? So we see these large bites of food, we see overstuffing. And yes, it can be sensory. Maybe they're not feeling it. And they need more in order to feel it. That's definitely a possibility. There could be other sensory things going on as well. But I urge everybody to take a large bite of a sandwich, take a large bite of food, and see where you start to feel it in your mouth. It becomes harder because you can't really chew it as easily, right? Actually, it's harder to chew it and try to prep it. But a lot of these kids are not always prepping their food properly. Some of them are swallowing food that's not been broken down enough, maybe some larger pieces. And that also adds to digestive issues and constipation. And so, again, it's all interconnected. And we really need to be asking, why is this child taking large bites of food or overstuffing their mouth? Why? If we say, hey, take smaller bites, and it's just not something that they've been able to change over time just through reminders and some behavioral intervention outside of the mouth. We need to be going in the mouth and looking at why they're doing this. We do see in a lot of these kiddos that food might get trapped in the lateral sulcus. They might use their fingers if they can't use their tongue. I've had kiddos go into their mouth and clear their cheeks, clear that lateral sulci with their finger because the tongue just can't lateralize and do it. Then there are these kids who take these large bites and overstuff their mouths. They use utensils, fingers. And so that's another key factor. If you see a kid doing that frequently, or they keep their hand near their mouth, almost like that hand is a utensil or an assistant to them. That might be another good indicator that we need to look at what's going on inside the mouth. These kiddos also tend to tongue dump or hump tongue dumping and humping occurs. And so what I mean by this is like think of a dump truck, right? A dump truck literally just kind of like the backside of the dump truck just lifts up and dumps everything out. Well, the tongue does that to the side. When it can't lateralize nicely sideways, it just kind of lifts up from one side and dumps to the other. We might see that going on. We might see them kind of like bunching their tongues. We might see it, the tongue thrusting forward. And actually, we will frequently see the tongue come forward to either greet their cup or their utensil or their straw. And what I mean by that, when I say greet, the tongue comes out to at least the Lip or past the lip. And that's not what we want. We want the tongue back so that it can receive the spoon or the straw or our lips are supposed to greet that cup or that utensil or that straw, not our tongue. That's the lips job. And so if their tongue is there, their tongue is going to basically be functioning as one unit with their jaw and their lip or lips that really, by 18 months of age, we shouldn't be seeing any of that. We see babies bring their tongue to their lower lip when they're feeding. And that's totally normal. I'm talking about once we are beyond breast or bottle and we're onto solids, we should no longer be seeing that. They should be retracting the tongue so that it should not be coming forward to greet, quote, unquote, greet the cup, the utensil, the straw. It should be retracting. Okay? And you know, we also, and I mentioned this before, but we frequently see these kiddos have that tongue thrust, that tongue pushes up against the teeth or between the teeth, between the lips when swallowing to create that negative pressure that I mentioned before. So I wanted to record this because this was a really great question that came through when somebody said, hey, I'd really love for you to talk about these kids who overstuff. Well, I really want you guys to go back and look at your overstuffers, look at your kiddos who take large bites of food, and your task is to either do an oral motor feeding eval, I would say, with a twist of myo, if they're under the age of four, or do a myofunctional evaluation if they're over the age of four. So do that report back, let me know how it goes. And I'm curious to know your findings because I'm going to venture to guess that you're going to find a lot of the same things that I did here today because this is a very common profile that we observe in these kiddos. As always, if you guys have any requests or anything you would love to hear on the podcast, reach out to me. I would be more than happy to record, you know, cases, case studies on things that you're seeing that you're curious to know what I'm seeing in my practice. But this is a quick episode on the profile of an overstuffer, so I hope you all enjoyed it. Thanks for listening to this podcast. If you want to hear more of these MYO tots, airway and feeding related episodes, be sure to leave a review on Apple podcasts or pledge a small amount on Patreon. And if you found value, others you know in this space will too. 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