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A Pediatric Perspective

Tuesday Tidbit - The Spit Cup

Published October 19, 2009 11:42 PM by Wendy Hof

When it comes to picky eaters one of the biggest challenges we have as therapists is getting the child to even taste something.  There is, of course, an entire protocol to getting a sensory defensive child to allow food to be 1) in the room, 2) on the table, 3) on their plate, 4) on their spoon/fork, 5) near their mouth, 6) in their mouth.  In a later blog I will list some helpful seminars that will go into how to get a child from 1 to 6.  Today though, I would like to talk about a method that I have found to be very successful when it comes to working with older children.

If a child is old enough and cognitively aware enough to be reasoned with a "spit cup" is a good way to get them to try new foods.  Take a moment and think about the one food that you will just not eat.  Think about what you don't like about it.  Is it the texture, is it the smell, the taste?  Now think about how you would feel if someone was making you place that food into your mouth and swallow a piece of it.  Did you just shudder?  I did.  I don't like olives.  The mere thought of having to have them in mouth and swallow them makes me gag.  Now think about the children you are working with..  this is the same thing they go through if they are being encouraged to swallow a food they are not comfortable with or having sensory issues with.  But wait!  There is away to get around this...

Take a cup, any cup.  It can be as plain as a Dixie paper cup or as fancy as you want to make it.  It can be big or small.  It can be a "big boy" cup or a small toddler cup.  The actual size, shape, color of the cup doesn't matter.  What is going to matter is that you are going to encourage the parents to allow their child to spit out any food they don't like into this cup during meals.  What!  Spit out food?!  I know it doesn't sound like a pleasant thing to encourage but the most difficult part of eating something that you don't like is the moment you realize you have to swallow it.  More often than not you can keep that food in your mouth, move it around, store it in your cheek but when it comes to swallowing .. that is when the gagging and the struggle comes in.  This is also where a "spit cup" can come to the rescue.

A child who feels safe enough to be able to spit out and not have to swallow the food you are asking them to try, is a child who will be more willing to try new foods.  It has been my experience that a child is more willing to try new foods, to take bites of different foods, if they don't have to swallow it.  If a child can be encouraged to "just take a bite and then spit it into the cup", they are more willing to take that bite.  If a child is encouraged to have to swallow the bite they just took they will be less likely to want to take a bite again in the future.  What you will see is that at first the bites are quick and the child almost immediately spits out the food but they are still getting a taste of it.  The more they are encouraged to take bites and spit, the more tastes they will be willing to try.  As they feel safe that they don't have to swallow, they'll start to even do a few chews before they spit out.  As they are now taking a few chews they are swallowing little pieces of the food.  This can be a slow process and patience is important but the results are well worth the time that goes into using the "spit cup" properly.  After a while you will see that the child is taking more bites and swallowing occasionally - and spitting out less and less.

This procedure does work best, as I mentioned, with the older child who can be reasoned with.  Younger children may not understand the concept of taking a bite and spitting out but the older children will.  I will never forget the time I used this with a young boy of 8 years old whose mother told me that he only eats chicken nuggets and cereal but will not try anything else.  I suggested she try the "spit cup" and she was hesitant at first, not really liking the idea of spitting at the table, but I was able to convince her and her husband to at least try it for a couple weeks.  They agreed and when I returned two weeks later I was greeted by the eight year old at the door.  He was very excited and said "guess what! guess what my favorite food is now!!".  I smiled and asked him what it was and he replied " I tried meatloaf and I tried steak and I like the steak better!".  His mom was standing behind him with a big smile on her face.  Once he got the hang of being allowed to spit out the food he started to try more and more foods during their meals.  When I left a couple months later he was not evening using a spit cup any more but was using a napkin.  He tried almost everything on his plate but if he took a bite of something he didn't like he would pull out his paper napkin and discretely "spit" into it. 

The "spit cup" may not sound like a glamorous or high tech feeding strategy but it does work.  Give it a try, you have nothing to lose and your children have everything to gain! 

Thanks again for stopping by - hope to see you back here again on Friday.

~Wendy~

1 comments

Wendy,

Thank you for your delightful post suggesting the use of a “spit cup” to treat sensory defensive children. Specifically, you are writing regarding children with oral tactile defensiveness, which is an extremely imperative issue to address due to its deleterious effects on a child’s health. There is almost no other problem as principle to deal with as a child’s inability to ingest and assimilate the necessary nutrients for healthy development. The steps you proposed for treating this sensory integration disorder calls to mind the Russian social psychologist, Lev Vygotsky’s, theory of the zone of proximal development. In this case, the “spit cup” is a necessary intermediate between what a child is able to accomplish without assistance, and what he or she can accomplish with assistance. The “spit cup” is able to bridge the gap between the child’s ability to put food into their mouth and the actual act of ingesting the food. It even becomes the motivation for them to try new varieties of foods by being the safety net on which they can fall back when the tactile stimulation of a certain food becomes unbearable. This is extremely important to note because the “spit cup” can only work by banking on the fact that the children will put food into their mouths in the first place. The option of spitting out the food if desired definitely increases the likelihood and frequency of food ingestion and thus, assimilation.

I am under the assumption that sensory defensiveness is not an issue of merely one of the seven acknowledged senses by occupational therapists but of multiple senses. In light of this, I cannot help but wonder how an OT would then approach a child with both oral tactile and olfactory defensiveness with regards to improving eating behavior. The “spit cup” does an excellent job of alleviating the oral tactile aspect but seems to be unable to address the olfactory defensiveness issue, as smells tend to be more pervading and lasting, even after food ejection. After reading your post, I am much more intrigued about the matter of sensory integration disorders, specifically regarding oral tactile defensiveness, and look forward to your future posts on how to treat younger children with similar diagnoses.

Christina Chen, Student October 20, 2009 4:42 PM
Los Angeles CA

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