Several months ago I got a call from a mom who was looking for some help for her 14-year-old son “S.” She mentioned that he only eats “a few foods” and that it was challenging at meal times at home because he was unwilling to try new foods and she was concerned nutritionally. He ate chicken nuggets, french fries, and a few other foods. Her next comment really resonated with me though.
She said he was “struggling socially because when friends wanted to get together at local restaurants to hang out, he had to plan ahead and look at the menu to pick foods he could eat, often ordering ahead to save being embarrassed”
In cases like this, there are layers that have to be peeled away. I knew I had to figure out why kiddo maintained such a limited diet for so many years, especially knowing he wanted to “eat what his friends were eating.”
Initial Assessment and Referral
The first step was to look at his oral structures and learn more about their functionality. During the myofunctional assessment, I noticed struggles with activating muscles for chewing, poor bolus formation, and recruitment of accessory muscles to initiate and complete swallows. We had work to do.
Next, I referred the family to an ENT that I work closely with. I wanted to rule out any airway inflammation or obstruction.
Orthodontic Treatment or Myofunctional Therapy?
Once the ENT determined his airway was patent, I turned to Esther, to come in and take a look at his bite. Esther is a Registered Dental Hygienist and Myofunctional Therapist who works with me. Her knowledge fills the gaps and helps me get a better understanding of what her trained eyes are seeing. She helped me understand his occlusion and why his masseters weren’t engaging when he chewed foods.
I reached out to his orthodontist. S never had braces and I wanted him to look at the occlusion to see if there was anything he could do for my patient.
In the end, the decision was for no orthodontic treatment. So, we did lots of myofunctional therapy to address the soft tissue dysfunction and swallow mechanics. S was committed and practiced everything I suggested no matter how “weird” it seemed!
Behavioral Feeding Therapy
Last but not least, it was time to start working with Sandy. She had been following his journey and as a speech pathologist and experienced feeding specialist, she would look for patterns in food choices and help him expand his menu knowing his function had been maximized. She looked at both the sensory experiences and behavioral components of S and his eating.
Sandy is also a highly trained yoga therapist and added some postural suggestions to further improve function and week after week he added new foods. She shared his victories each week and talked about ordering at restaurants and having more food freedom on vacation.
Smelling Calamari and the Fruits of Therapy
Recently, I was sitting at my desk and thought I smelled calamari. Not a familiar occurrence in the office so I stuck my head into Sandy’s room to see if she was the culprit!
There, on the table was a plate of calamari. Steaming hot deliciousness. But, the calamari wasn’t Sandy’s. S had a big smile on his face when he saw my reaction to his food choice. He shared with me that he was almost done with therapy because he was eating in all kinds of restaurants, enjoying family meals at home and most excitedly with friends. He warned me that next week was shrimp scampi.
Collaboration and Calamari. This is what it's all about.