"Open your mouth, here comes the plane!"

I'm having flashbacks to my young daughter and trying to bribe her with yoghurt to eat her dinner. Oh the things I tried.  Oh the stress I placed on myself! Oh the stress I placed on her!

Have you ever tried to coax your child to eat? It can be so STRESSFUL!

Have you ever had to stop your child from over-eating? It can be so STRESSFUL!

Join me this month in looking at meal times! I'm joined by my therapy blogger colleagues in the "Functional Skills for Kids Blog Series".  There are heaps of tips and tricks to help your little ones at meal times with the links below.

I wish I had read these articles as new parent. I wish I could tell first-time-parent-Cindy some of the things in this article! ​

​Here are 4 ways to modify meal times for your FUSSY eater!
​

 1. ALTERNATIVE CUTLERY

(a) Cutlery with built up hands allow for easier grip for those with fine motor difficulties. Bendable necks of cutlery can help to angle the metal part so that the child (or adult) has more success with independent eating.  Try Good Grips Utensils with built up handles. Read more about FM skills at meal times with Therapy Fun Zone's article  HERE.

(b) Shallower spoons are particularly good for kids with a strong gag reflex.  The spoon does not need to be inserted too far into the mouth and the food comes off more easily. Try Gerber Graduates Spoon. 

(c) Weighted cutlery can help those who are experiencing difficulties with body and spatial awareness as well as sensory registration.  Try Good Grips Utensils Weighted set of 4. 

(d) Chopsticks with training loops provide a guide for finger placement.  Try Edison Chopsticks with right hand Minnie or right hand Mickey or  left hand bunny.   Some kids enjoy the novelty of picking food up with chopsticks.  These are also great for working on hand strength and a tripod grasp too! I love using these chopsticks in OT (and not for meal times)! Read about thisHERE.  
​
(e) Novelty cutlery is everywhere on the market .  You can find planes, bulldozers, block figures andvarious characters, etc! Kids enjoy using novelty cutlery as it brings a playful element into an every day activity.
​
Read also how you can adapt regular cutlery withSugar Aunt's article here. 

2. DIVIDED PLATES, BOWLS AND LUNCH BOXES!

Divided plates, bowls and lunch boxes  are a great way to help fussy eaters.  They allow you to separate food into portions. You may still present the food that they refuse and gradually encourage mixing foods from different sections.  Remember that it often takes multiple presentations of the same food before a child will try something new. It is also okay if they don't eat it! Keep presenting it and don't worry!

​In a practical sense, divided plates, bowls and lunch boxes also keep wet foods separate from dry.  

There is a huge range of tableware on the market. You could try these:

• 3-Pack Recycled Milk Jugs, BPA-free Divided Plates, Blue/Aqua/Green
• Re Play Divided Plates for Babies and Toddlers 
• EZPZ Plates and Mats
• Stephen Joseph Melamine Plate, Dino
• Fred and Friends Dinner Winner Kids Dinner Tray

For lunch boxes, you could try these:

• ​WonderEsque  Bento Lunch Box - Leak Proof Lunch Container 
• Yum Box Leak Proof Bento Box Container for Kids
• Cool Bites Premium Bento Lunch Box
• Sistema Lunch Collection Lunch Cube
• Lunch Bento Box Iwotou Microwave and Dishwasher Safe Lunch Box with 5+1 Separated Containers (Blue)

​​For a comprehensive look at lunchboxes in Australia have a look at this article by my friend Kylie at Kidgredients!

Divided plates, bowls and lunch boxes can help kids who -

• don't like certain food touching other foods
• don't like certain textures
• don't like trying new foods 
• refuse to eat certain food
• don't like a chosen food colour (eg. any food that is green)
• don't like a particular coloured plates or bowl
• have difficulty with portion control.

​

3. REGULAR ROUTINE

​Establishing regular eating times and habits help children with meal times.  It doesn't have to be regimented, however if meals are always around the same time of day; then your child will develop a natural circadian rhythm (natural body clock).  They will begin to feel hungry at the same time of day.  This will also help kids to sleep better!

Establishing a family routine of setting the table, sitting, eating, talking, packing away... help children who have difficulty with transitions, creating stability and order.  It can help children to understand the beginning and end of the "activity".   

Children also learn by example.  As they see you trying new food, they want to follow. Sometimes the food on your plate might be more appealing than what they are eating. Some children prefer to feed themselves, whether that be finger food or with cutlery. Encourage this! Although it can often be quicker to feed young children yourself, this will pay off in the long run. 
​

4. HIDDEN VEGGIES!

For or against? There are two philosophies around disguising vegetables in other food.

Some people stress the importance of teaching kids a knowledge of "farmyard to plate". Teaching kids where food comes from and how it grows.  Getting kids digging in the garden, planting seeds, watering and watching them grow!

Some people consider hidden veggies a brilliant idea! Genius! Sneak them in so at least kids are consuming veggies where they might otherwise refuse if they "see" them. 

You can try these recipes with hidden veggies!

• Hidden Vegetables Crockpot Marinara Sauce by Sugar Aunts
• Chocolate Zuchini Muffins by Picklebums
• Skinnymixers Macaroni and Cheese with a Twist
• The tastiest hidden veggie panko coated chicken nuggets ever! by Kidgredients

​
Why not try both philosophies simultaneously? 

As a new parent wrangling with my firstborn, I wish I had known of some of these ways to modify meal times. The main tip I would tell first-time-parent-Cindy... was that it was going to be okay if she didn't everything but to keep on presenting it to her anyway. ​ REALLY - it's okay if she doesn't eat it!

Do you have a fussy eater?  

​Have you tried hiding veggies? Does your child have a favourite lunch box or dinner ware?

​What is your best tip to help modify meal times?

This post is part of “Functional Skills for Kids: 12 month series by Paediatric Occupational and Physical Therapists”.  You can read all of the childhood functions HERE.  Read all Your Kids OT’s monthly posts HERE.

For more information about “meal times”, read what other Occupational and Physical Therapists participating in the “Functional Skills for Kids series” have written: ​

When Can Kids Feed Themselves? (and other mealtime milestones) | Mama OT
Fine Motor Skills For Mealtimes  | Therapy Fun Zone
Postural Control, Gross Motor Development and Mealtime  |Your Therapy Source
Attention, Behavior, and Meal Time Problems | Sugar Aunts
4 Ways to Modify Meal Times for Fussy Eaters  | Your Kids OT
Mealtime Skills, Rituals & Play - Nurturing a Love for Food | Kids Play Space
15 Tips for Picky Eaters | The Inspired Treehouse
Positioning, Motor Skills, and Table Manners: What the Connection? | Miss Jaime OT
Visual Perceptual Skills Needed for Independent Feeding | Growing Hands-On Kids

​

​Cindy is a registered Occupational Therapist practising in Sydney Australia.  She has two young children who are a constant source of inspiration and learning.  Cindy loves working creatively to help children to reach their potential, finding opportunities in everyday living and making learning fun. Cindy is the author of the occupational therapy blog Your Kids OT.

You may also find these affiliate links helpful...

Disclosure: Affiliate links are included in this article to promote products that I recommend.   Your Kids  OT is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Your Kids OT.  Reviews and endorsements of products will only be made based on my expertise and personal opinion; and deemed worthy of such endorsement. The opinions shared in sponsored content will always be my own and not that of the advertising company or brand.

As an occupational therapist and mum, I always have a mental checklist when I am buying toys for my own kids, my practice and as gifts for others.

1. Is the toy made well?
2. Does the toy promote skill development (motor, problem solving, pretend play, co-operation, sensory)?
3. Is the toy "open ended"? Can it be used in a few different ways?
4. Will the toy endure the test of time?
5. Is the toy appealing?

I have recently discovered the beautiful range of Click Clack Toys: "Designing for today's kids for tomorrow's world"!  Click Clack Toys is an Australian owned company which designs and makes handmade toys.  Click Clack Toys have sent me some of their toys for the purposes of review and have a given me an "Airport Starter Kit" and "Helicopter" to giveaway to one lucky Australian reader. More details to follow below.

Back to my checklist when choosing toys...

Is the toy well made?
I was really pleased to "feel" the Click Clack Toys.   The wood is really smooth and made from sustainably managed plantation timber forests. They use water-based non-toxic paint which add really great detail to the toys and won't scratch off easily. 

Does the toy promote skill development (motor, visual-motor, problem solving, pretend play, co-operation, sensory)?
A big tick here! The unique design and main feature of these toys are that they "click" together.  Children are encouraged to join parts of the toy together to make a whole.  From a simple animal "Critterz" that has two parts to a more complex vehicle and then to building a structure that houses the vehicle.   This promotes your child's busy fingers to match components using  fine motor skills, hand strength as well as their problem solving skills.  Younger kids will need help to match the right parts together. Once "clicked" into place, the toys are ready to be played with!

This is where imaginary and pretend play take over.  There are a wide range of vehicles in the range including a plane, helicopter, police car, postal van, fire truck and more.  Made at just the right size for little hands to move, these vehicles can be used to create their own stories of rescue, delivery and construction.  Children develop play themes from their experience with books, story telling and real life opportunities.  Visiting the local fire station may encourage "fire truck" play to rescue people or animals.  Watching a building site may encourage "diggers" and "cement mixers" to create their own work site.  Seeing a plane flying over the house may create intrigue about "plane" and "airport" play. 
​
The "Critterz" range are incredibly cute animals that "pull back" on wheels.  Hand skills are put into practise applying just enough pressure to activate the "pull back" mechanism before seeing these animals race away.  Great for racing with a friend or sibling.  We found the perfect spot on the trampoline!

​Is the toy "open ended"? Can it used in a few different ways?
These toys are definitely "open ended".  Although the nature of the vehicle, structure and animal may guide initial play ideas... there are no set rules.  Children may play with these toys and have a different "story" each time.  The "helicopter" might fly to rescue someone an accident in the snowy mountains one day and then fly on a sight-seeing tour over a volcano next time.  Some children will need help to think of new ideas as play is initially limited to personal experiences. 

To extend play, children may like to use existing toys or create their own extensions. For example, they may create a cardboard city for the people to visit.  They may use blocks to build a bridge or animal shelter. They may use playdough or kinetic sand as a "building material" for the construction toys. 

Changing "where" your child plays with their toys will also extend play.  We took our play set and critterz onto the trampoline! 

Will the toy endure the test of time?
These quality toys are "classics".  They do not follow the latest blockbuster movie or cartoon character.  These toys build on traditional play experiences.  These toys are built to last and can be passed onto the next generation!

Is the toy appealing?
When we opened the box, my children instantly found the toys appealing.  They are child-friendly in size and shape. The painted features and life-like resemblance of the toys will appeal to both kids and adults. The wheels work on the vehicles and "Critterz", moving these great distances on smooth surfaces. Both Mr 6 and Miss 10 found this very appealing as they raced their "Critterz". 
​​
For more information about Click Clack Toys, refer to their website.

Love the sound of Click Clack Toys? Thanks to the lovely people at Click Clack Toys, I am giving away an "Airport Starter Kit and Helicopter" to celebrate reaching 4000 Your Kids OT FB likers!  This set will make an excellent Christmas present for your child, niece, nephew or grand child! Open to Australian residents, enter now! 

Note: I have not received remuneration or compensation from Click Clack Toys.  I have been gifted an "Airport Starter Kit and Helicopter" and Critterz for this review.  All comments and opinions are my own.  Click Clack Toys will supply the winner of this giveaway an "Airport Starter Kit and Helicopter". 

Conditions apply.
1. This is a game of skill.  Mandatory requirements include visiting Your Kids OT FB page and Click Clack Toys FB page.  Entries must answer the question "Complete Click Clack Toys slogan - Designing for today's kids for ........".  Additional entry points are given for following Your Kids OT and Click Clack Toys on Instagram. 
2. This game is open to Australian residents only.
3. This game of skill is open from Monday 26/09/2016 12am and closes Monday 17/10/2016 12am (Sydney time).
4. Eligible prize winners will be drawn randomly on the 17/10/2016 at 12:00PM. Prize winners will be notified via YOUR KIDS OT Facebook page and private message.  Prize winners must inform Your Kids OT of their mailing address within 48 hours of being notified as the winning entry. 
5. There will be 1 prize winner drawn with the winner receiving an airport starter pack and helicopter.  The prize will be delivered by Click Clack toys directly to the winner.  

Shuffle shuffle.  The 8 year old was shuffling along his chair and almost fell off.  Why was he doing this?
Left hand. Right hand. Together.  The 6 year old girl could not decide which hand to hold the crayon.
Snip snip. Hang on! This kid was just using a different hand when holding his pencil!
This child can't sit cross-legged on the floor! They either flop about or sit with the legs in a "w" position.

Have you seen any of these common issues in the classroom?

Hand preference, crossing the midline, bilateral coordination are all related concepts. Read on and let me explain how! 

Development of Bilateral Coordination
Bilateral coordination/integration is the ability to use both sides of the body at the same time in a coordinated way. 

Babies develop symmetrical bilateral coordinated movements at 3 months of age (Beery, 2010).  They bring objects to their midline (ie. the imaginary line running through the middle of a person separating left from right).  Both hands move simultaneously and symmetrically.  This skill continues to develop as a child matures, develops muscle tone and control. Examples of symmetrical bilateral coordination include clapping hands, holding onto a cup with two hands to drink, banging a pot with both hands together, using a rolling pin and banging two blocks together.

Reciprocal bilateral coordination can be seen when both sides of the body are performing the same actions in an alternating pattern (ie. reciprocal pattern).  This may include just the upper limbs or just the lower limbs or a combination of both.  Early signs of this include crawling, shaking percussion instruments with alternating hands and walking.

Assymetrical bilateral coordination can be seen when both sides of the body are used to perform one activity.  One hand acts as the "worker" (dominant) and one hand acts as the "helper" (non-dominant).  Both hands play important roles in a variety of bilateral tasks.

Handedness (the identification of a dominant hand) is important for the development of fine and gross motor skills. It enables more refined development of the "work" hand to be "skilled".  In the brain, this means that cerebral dominance is localized to one hemisphere (ie. lateralized brain).

Everyday examples of assymetrical bilateral coordination include using one hand to hold scissors to cut whilst the other hand manipulates the paper, turning a screw bottle top with one hand whilst the other hands holds the bottle, using a screwdriver to turn whilst holding the screw steady, squeezing toothpaste onto a toothbrush whilst holding the toothbrush steady, etc.

Through natural opportunities to explore and play, children develop a hand preference (one hand is preferred or chosen) and handedness (one hand is more reliable for use across a range of skillful acts). (Erhardt and Sava, 2008). The age which children demonstrate hand dominance has been quite varied in research stating development anywhere between 5 and 9 years of age (Kaufman, Zalma and Kaufman, 1978).

Erhardt (2008) describes the essential developmental components for acquiring hand preference includes postural control, eye-hand coordination and perceptual concepts such as body image. Therefore mixed dominance (where there is no clear choice) should be considered as a symptom of dysfunction (rather than a cause) in areas such as handwriting and cutting. Kaufman, Zalma and Kaufman (1978) also found that preference for the right or left hand is related to knowledge of right versus left with greater mastery or right-left discrimination displayed by youngsters with a consistent hand preference.
 
But wait!....  I hear you say!

My child can use both hands equally well. They are ambidextrous!
 
Research has shown that the percentage of true ambidextrous people in the community is quite small. Here is where you can choose your own adventure ( I used to love those books as a kid).

If your child is ambidextrous (ie. mixed dominance) and this is not affecting functional tasks, bilateral coordination or the classroom issues mentioned previously then GREAT! Please feel free to skip over this article.

If your child has not developed a hand dominance and it is affecting their functional skills then keep reading!

Crossing the midline 
The ability for one side of the body to “crossover” to the other side of the body. This requires good core stability, trunk rotation and body awareness. In the brain, this requires the left and right hemispheres of the brain to communicate across the corpus collosum (the connection between the two sides of the brain). 

The ability to "cross the midline" is an important skill for kids every day.  Examples include sitting cross-legged on the floor, cutting with scissors, reaching across to put on shoes, drawing a diagonal line, unzipping a school bag. 

Kids sometime compensate for difficulties with crossing the midline by demonstrating some of the problems I  listed earlier.  They may switch hands when the pencil reaches the midline.  They may adjust their work so it is always on the "writing side".  They may move themselves along the chair so that the work is kept on the "writing side" as they write along a line.  

Associated Problems with Bilateral Coordination.
When considering bilateral coordination, there are a number of associated problems that need to be considered as well. 

• Difficulty with trunk rotation. Rotation upper body at the trunk in either direction needed to reach across the body. 
  
• Poor spatial and body awareness.  Spatial awareness is a a child's ability to understand their  body position in relation to other body parts and the environment around them.  This is a fundamental skill to develop before children can then understand how other objects, shapes, other people, letters and words relate to each other and to themselves.  Information about spatial awareness and position in space is guided by the vestibular sensory system (organs in the inner ear) through the position of the head (Bundy, Lane, Murray, 2002). 
  
• Poor visual perceptual skills.  This is the process of assigning meaning to what is seen.  It includes movements of the eyes up/down and left/right (and vice versa). It also includes eye/hand coordination and discriminating visual information. Vision and the vestibular system are also closely related.   The importance of the visual system related to bilateral coordination is described by Rutkowska, et al (2016). 
• Weak core muscle strength.  Core strength helps with balance and stability to perform fine and gross motor tasks. 
• Difficulty with left and right discrimination. This includes identifying left and right sides as well as tracking from left to right across the midline.  As mentioned previously, Kaufman et al (1978) found links between discrimination left and right with bilateral coordination. 

INTRODUCING MY NEWEST REFERENCE SHEET! 
The "Bilateral Integration and Laterality" reference sheet is a comprehensive guide to bilateral integration! It covers everything in this article as well as over 50 activities to help your child with bilateral coordination skills.  

This reference sheet has been kindly reviewed by some wonderful therapy bloggers! A big thanks to my colleagues for reading, commenting and reviewing! Read what they are saying about it!

"It is incredibly thorough and the checklist is a thoughtful way to provide reasoning for activity use during treatment or education."Becca @ OT Mommy Needs Her Coffee

"It is very visually laid out for ease of reading".Laura @ Easter Seals DuPage & Fox Valley

"I love how easy it is to follow and understand, especially for parents. But it is also a great refresher for therapists too!" Heather @ Growing Hands On Kids  

Purchase your copy of the "Bilateral Integration and Laterality Reference Sheet" HERE!

As a special introductory offer, you can purchase the BI reference sheet as a bundle with my other popular reference sheets: pencil grasp, sensory, visual perception skills.  Purchase your bundle HERE! 
 

Do you know a child with difficulties with bilateral coordination? 

References

• Adamo, D. E., & Taufiq, A. (2011). Establishing hand preference: Why does it matter? Hand, 6(3), 295-303. doi:10.1007/s11552-011-9324-x
• Bundy, A, Lane, S.J., Murray, E.A. (2002) Sensory Integration Theory and Practice (2nd Edition)
• Beery, K. E., Buktenica, N. A., & Beery, N. A. (2010). The Beery-Buktenica developmental test of visual-motor integration: Administration, scoring, and teaching manual (6th ed.). Minneapolis, MN: NSC Pearson. 
• Erhardt, R. & Sava, D. I. (2008). Scissors Skills and Hand Preference: A Pilot Study. Journal of Occupational Therapy, Schools, & Early Intervention, 1(3), 215-230. doi:10.1080/19411240802589163
• Garcia, L.A. (2016) Bilateral Integration.  Retrieved on 23/09/2016 at http://www.wholechildlearningsolutions.com/bilateral-integration.html
• Kaufman, A. S., Zalma, R., & Kaufman, N. L. (1978). The Relationship of Hand Dominance to the Motor Coordination, Mental Ability, and Right-Left Awareness of Young Normal Children. Child Development, 49(3), 885. doi:10.2307/1128263
• Lin, C., Wu, H., Lin, C., Wu, Y., Wu, P., Kuo, B., & Yeung, K. (2012). A Small Sample Test Of The Factor Structure Of Postural Movement And Bilateral Motor Integration Using Structural Equation Modeling1,2. Perceptual and Motor Skills, 115(2), 544-557. doi:10.2466/25.03.10.pms.115.5.544-557
• Mason, A. H., Bruyn, J. L. & Lazarus, J. C. (2013), Bimanual coordination in children: Manipulation of object distance. Experimental Brain Research, 231 (2), 153-164. Doi:10.1007/s00221-013-3678-y
• Rutkowska, I. Lieberman, L.J., Bednarczuk, G. Molik, B., Kazimierska-Kowalewska, K., Marsza Ek, J., & Gomez-Ruano, M. (2016). Bilateral Coordination of Children who are Blind. 
• Perceptual and Motor Skills, 122 (2), 595-609. Doi: 10.1177/0031512516636527

Tooth brushing is an important aspect of personal hygiene! This post is part of the "Functional Skills for Kids Blog Series" with a look at different forms of personal care.  Make sure you check out all the great tips for hand washing, bathing, showering, nose blowing, hair cuts, sleep, screen-free quiet times as well as adolescent hygiene ..... at the end of this article!
​~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Dentists worldwide including the America Dental Association and theAustralian Dental Association recommend that children brush their twice a day for two minutes at a time. They also recommend regular visits to the dentist, use of fluoride tooth paste  and daily flossing.  Both of these sites have great resources to encourage your kids to brush and floss! 

Occupational therapists help people to become independent in activities of daily living (ADL). We consider aspects of the activity as well as environmental demands to determine why a child might have difficulty achieving independence in a task. For babies and toddlers, we also consider why they may not want to participate in the task!

​Firstly we may consider the developmental expectations for tooth brushing and some tips to help with these stages. 

Babies  
Aim: Tolerating oral sensation of something in the mouth  and tongue movement.

Tips for helping babies:

• Provide opportunities to mouth safe toys and objects (eg. small spoon).
• Allow your child to play with a child friendly toothbrush - allow exploration.
• Use an adult finger tip tooth brush (eg. made from silicon or rubber) to provide gentle pressure on gums, tongue and lips.
• Toothpaste is not necessary.

Toddlers/preschoolers  
Aim: Tooth brushing and flossing by an adult  and beginning to brush parts themselves

Tips for Toddlers and Preschoolers:

• Use a soft bristle toothbrush and a small amount of fluoride tooth paste (rice grain size for under 3 years and pea-size for 3-6 years) .  
• Allow child to play with the toothbrush and attempt some brushing independently.
• Role play on a doll or teddy.
• Use novelty tooth brushes with your child's favourite character (or ones that light up). Let them choose the tooth brush. 
• Lead by example and demonstrate that you brush your teeth (and care about your teeth).
• Read books about tooth brushing.
• Sing songs about tooth brushing. 
• Provide a mirror so the child can see their mouth during brushing. 
• Whilst it is ok for young children to swallow small amounts of toothpaste, you can practise spitting out small amounts of water. 

​School Age Children
Aim: Independent brushing and flossing teeth. 

Tips for School Age Children

• An electric toothbrush may be motivating for older children.
• Use a kitchen timer, tooth brushing video orapp to encourage 2 minutes of brushing.
• Use a reward chart if necessary. (Download your FREE reward chart here!)
• Practise squeezing the adequate amount of toothpaste.  
• Use a small tube of toothpaste (eg. travel size) to encourage smaller squeezes of paste.
• Use a checklist to mark off each aspect of the tooth brushing routine. (Download your FREE checklist here!)
• Discuss the importance of good dental hygiene and foods to avoid to prevent decay.
• Listen to your dentist's recommendations for  the correct techniques for brushing and flossing. 

Children with special needs may have difficulty with specific aspects of brushing their teeth.  Here are some further considerations for tooth brushing! 

Fine Motor Considerations 

1. Ability to grasp the tooth brush 
2. Unscrew and screw back tooth paste lid 
3. Adequate pressure to squeeze toothpaste
4. Bilateral coordination to  hold tooth brush whilst squeezing tooth paste 
5. ​​Hand control to reach all teeth and gums with the tooth brush 
6. Adequate pressure of the toothbrush on the teeth and gums
7. Manipulation of dental floss to cut a piece 
8. Manipulation of dental floss to wind around fingers 
9. Manipulation of dental floss to floss between teeth 
10. Turning on and off taps  

Tips to Help with Fine Motor Skills

• Use toothpaste in a pump rather than a tube. 
• Use a floss pick rather than dental floss string. You may choose to wash the floss pick as you progress in the mouth and continue to practise using dental floss.
• Use a mirror so your child can see their teeth whilst brushing.

Gross Motor Considerations

1. ​Shoulder stability whilst brushing
2. Core muscle strength to perform task whilst standing
3. Standing to reach the sink and look in the bathroom mirror

Tips to Help with Gross Motor Skills

• Use a stool to help reach the sink.
• Sit down to brush and spit into a bucket or bath. 
• Brush teeth whilst sitting in the bath.

Sensory Considerations
Touch/Proprioception:

• Sensation of the toothbrush bristles on the gums, tongue, lips and inside cheeks
• Texture of the tooth paste
• Pressure applied whilst brushing
• Sensation of foaming from the tooth paste during brushing
• Sensitive gag reflex from toothbrush in mouth
• Desire to bite the toothbrush
• Soft/hard toothbrush bristles
• Alternate toothbrush bristle sensations (eg. silicon, electric toothbrush)
• Awareness (or non-awareness) of toothpaste on chin or face

Some children are hypo-sensitive (under responsive) and others are hyper-sensitive (over responsive) to touch around their mouths and face.  Children who are hypo-sensitive may have low tone and poor awareness of their oral motor muscles.  They may dribble constantly and have difficulty keeping their mouth closed.   Children who are hyper-sensitive may have a pain response to touch around their face and mouth.   Both groups of children may have difficulty with brushing their teeth. 

Smell

• Smell of the tooth paste
• Smell of the bathroom (ie. from the toilet, cleaning disinfectant, air freshener, etc)

Vestibular

• Unable to stand still for two minutes needed to brush teeth
• Constantly changing positions
• Poor body awareness and tooth brush misses mouth during brushing 
• Poor balance with child falling over during tooth brushing

Auditory

• The sound of the toothbrush

Oral/Taste

• The taste of the tooth paste (often mint flavoured)
• Difficulty closing mouth during brushing (so tooth paste dribbles down chin)
• Difficulty with keeping tooth paste in mouth without swallowing
• Refusing to place tooth brush in mouth
• Constant tongue movement during  brushing
• Desiring to brush areas external to mouth (eg. lips, cheeks, jawline)

Tips to Help With Sensory Processing Skills
Your child may benefit from an oral desensitization program as part of a sensory diet.   This might involve increasing deep pressure to the jaw, lips, cheeks, tongue and mouth.  

Bundy, Lane and Murray (2002) recommend providing infants and young children with deep pressure to the roof of the mouth or gums with the therapist's fingers or other soft rounded object (eg. Nuk toothbrush).  They also suggest that older children and adults may be taught to provide deep pressure to their own mouths using a variety of oral motor toys (eg. using whistle, biting on knotted rubber tubing, blowing on a rubber strip).   

The Paediatric Occupational Therapy Department from Abertawe Bro Morgannwg University Health Board (2014) describe a protocol of oral desensitisation. This includes the following progressive steps:

1. ​​Apply firm pressure symmetrically to the area outside the child's mouth (from the forehead to the chin and mouth) using hands or different materials. 
2. Encourage your child to apply pressure (massage) to the roof of their mouth and gums (with their finger or a soft, round object).  This may begin with placing the child's finger on their lips and then  by rolling the finger inside the lip.
3. Encourage the child to dip the end of the toothbrush into a small cup of water and brush their tongue, teeth, inside of the cheeks and roof of the mouth.   Additional input with an electric toothbrush may provided. 
4. When the child is coping well with touch to their face and inside of their mouth, further oral motor activities may be introduced involving sucking, blowing, biting, crunching, chewing or licking. 

Further information about this protocol may be found here. 

You may also like to try...

• "Chewlery" or chewable jewellery to provide self regulating oral input. 
• A DIY "oral motor toy" to encourage blowing .
• Breakfast smoothies to awaken oral senses!

Attention and Behavior Considerations 

• ​Remembering the sequence of the task prior to brushing (ie. putting tooth paste on, wetting the brush, etc)
• Remembering the brushing sequence within the mouth and reaching all teeth.
• Attention to brush for 2 minutes
• Remembering the sequence of the task after brushing (eg. spitting out the paste, washing the brush).

Tips to Help with Attention and Behaviour skills

• Use a kitchen timer, tooth brushing video or app to encourage 2 minutes of brushing.
• Use a reward chart if necessary.
• Use a checklist to mark off each aspect of the tooth brushing routine. 

                                                 Download your FREE checklist and reward chart here!

Additional Considerations

• Sore gums from teething
• Loose teeth
• Tooth decay and pain
• Dominant hand not established so brush is held with either hand

Tips to Help with these additional considerations

• Seek professional advice from a dentist about your child's tooth development and oral motor hygiene.
• Use baby teething gel such as  "Bonjela".
• Consider  bilateral coordination activities.  

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Do your kids like brushing their teeth? Have you downloaded your FREE tips sheet, checklist and reward chart? ​

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I can brush my teeth! Tips for Tooth Brushing and Oral Care!  | Your Kids OT
Screen Free Quiet Time When Daytime Naps are History  | Kids Play Space
Tips to Help Kids Learn How to Blow Their Nose | Sugar Aunts
Tips to Help Kids Who Hate Haircuts | Mama OT
Sensory Friendly Tips for Kids Who Have Trouble Sleeping  |  The Inspired Treehouse
​Your Child With Special Needs: How to Conquer Showering Independently | Miss Jaime OT
Adolescent Hygiene Challenges  | Therapy Fun Zone

Disclosure: The information on this site is general in nature. The activities are safe for most children, however, 
​you should consult an Occupational Therapist or health professional to address specific movement, sensory or other medical conditions.  This article does not contain any affiliate links. 

​References:

• Bundy, A, Lane, S.J., Murray, E.A. (2002) Sensory Integration Theory and Practice (2nd Edition)
  
• ​Paediatric Occupational Therapy at Abertawe Bro Morgannwg University Health Board (2014) Oral Desensitisation. Retrieved on 20/09/2016 at  http://www.wales.nhs.uk/sitesplus/documents/863/Oral%20Desensitisation.pdf​

Ever sound like a broken record?  

"What does a sentence start with?"
"How do you hold the pencil?"
"Remember to put a space between your words."
"What do we put at the end of the sentence?"

Are you encouraging your students to self-evaluate their work?  

​This checklist comes in a set of 3.  The perfect prompt for the classroom, home and OT sessions! 

​Download your FREE copy here today! (FREE FOR A LIMITED TIME)

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