Question:

I have a 2 year 6-month-old child who was NPO and G-tube dependent until he started feeding therapy again about 5 months ago. He is safely able to consume thin liquids and IDDSI level 4 solids like pudding with no issues. Recently, I’ve started to try textured foods with him. I’ve noticed that he will accept the food into his mouth and chew it up, however, starts gagging shortly thereafter and spits it out. I don’t believe it’s a swallowing issue, but rather a sensory issue and it seems the texture of chewed up food makes him uncomfortable. Does anybody have any advice/tips on how I can help him with consuming textured foods? TIA!

Catherine’s Answer:

To help problem-solve, can you round out the bigger picture, as that is likely key to first understanding the “why” behind what he is doing, to then figure out interventions. At 2 years 6 months, is there a history that will help explain some of this? For example, why was a G-Tube placed? Was he born at term? What are his diagnoses? GI issues? Sensory Processing Disorder? Does he have atypical motor and/or postural and/or sensory-motor issues? Cognitive/communicative status? TOTs? h/o “release” of TOTs? Clarity of connected speech? Was there ever swallow study and what did it reveal about physiology? Is he gaining weight? One of my colleagues wondered if there may be any tonsillar hypertrophy that could create challenges with textured foods; any apparent challenges with thicker purees that may suggest that etiology as well?  It’s very possible that his responses are adaptive behavior, i.e., purposeful, and due to reduced strength and motor control problems. If so, that will be your treatment focus. You are asking good questions. It’s ok to take the time to figure out the why and ask yourself more questions about what you are seeing and the possible reasons. Otherwise, you may select interventions that are not what his system needs, and more maladaptation could be inadvertently fostered.