As children approach the
age of 24 months, they discover the amazing size of their
mouth cavity. An endless amount of food fits in the
space, and their new ability to keep the lips tightly
closed against pressure from the inside seems like a
miracle. This leads parents to remind them to finish what
is in the mouth before taking another bite. Once the
sense of sensorimotor discovery and adventure has worn
off, children return to more reasonable sized mouthfuls.
Mouth stuffing can also be an important sign of
sensory or motor difficulties in oral-motor control. When
the mouth is fully stuffed with food, children obtain
more sensory information about the boundaries of their
mouths and the presence of food in the mouth. This often
happens when oral sensation is reduced. The child may
have a low level of awareness of the inside dimensions of
the mouth and the feeling of food. The stuffing wakes up
the mouth and helps the child know that there is still
food in the mouth. Some children deal with a condition
called oral defensiveness. These youngsters experience
highly distressful sensations from food taste or texture.
Unpredictable movement of the food can be very
uncomfortable. Many children with oral tactile
defensiveness also stuff the mouth because it reduces the
random tactile input to the cheeks when smaller pieces of
food are moved around.
Mouth stuffing is also present when a child has
difficulty using skillful tongue movements for chewing.
Movements may be uncoordinated or limited in direction or
strength. When there is a great deal of food in the
mouth, a very small amount of tongue movement will push
some food to the side for chewing. Smaller pieces require
much more control of movement.
It is important to distinguish between mouth stuffing
that is a normal developmental behavior and one that is a
compensation for sensorimotor difficulties. Typically
developing children have the sensory awareness and the
motor skill to remove all food from the mouth at the end
of the meal. Children with poor awareness or movement
limitations will often leave pieces of food in the mouth
after eating. Often parents will find pieces of food
pocketed between the gums and the cheeks when they brush
their child's teeth at night. Some children are sure that
their mouths are empty when there is still food on the
tongue or in the pockets. Many children with difficulties
in sensory awareness love foods with strong flavors.
Salsa, lemon juice, pickles, and barbecue sauce are often
favorites. There may be less mouth stuffing with these
high-awareness foods. This can be a clue that the child's
mouth stuffing is related to a sensory difficulty. The
child with motor difficulties may push food up into the
roof of the mouth where it becomes stuck. When the food
later falls down, the child may be surprised and gag or
choke on the unexpected mouthful.
Mouth stuffing can be an important diagnostic symptom
of a mild-to-moderate oral sensorimotor difficulty. When
children resolve their difficulties with oral sensation
and perception and improve tongue, lip, and cheek
movements in chewing, the mouth stuffing stops. Because
it is a compensation, the child no longer needs it as
sensorimotor processing improves. It is vitally important
to help children clear their mouths after each meal and
to become comfortable with regular toothbrushing. When
children keep food in their mouths for longer periods of
time, they are at a higher risk for tooth decay and
It is critically important to remember that mouth
stuffing is a child's way of compensating for sensory or
motor difficulties. By treating the underlying problem,
the child will no longer need to stuff the mouth.
Treatment does not address the mouth stuffing itself, but
the reasons why the child stuffs. The specifics of
treatment will depend upon why the child is stuffing. The
following strategies may be incorporated into a child's
program during therapy and at home.
When Stuffing is a Symptom of Poor Sensory
- Wake up the mouth before the meal, intermittently
during the meal, and after the meal with foods
that are spicy, crunchy, cold, or carbonated.
These 4 sensory inputs can help a child become
more aware of the mouth and organize oral
movement more effectively. Foods such as pickles,
raw carrots, and spicy dips can be included in
the meal. Spices can be added to other foods.
Cold carbonated mineral water can be sipped
between mouthfuls. Add lemon to the mineral water
for extra sensory input if the child will accept
it. Add ice to other liquids.
- Chew on ice before and during the meal. This
alerts the mouth, but simultaneously reduces
discomfort from oral sensory defensiveness.
- Use a small table mirror, and have the child
visually check the mouth at intervals before
taking another bite, and at the end of the meal.
Help the child learn what an empty mouth looks
like and feels like.
- Use a small vibrator massager before the meal to
help build more awareness and movement in the
tongue, lips, and cheeks before the meal.
When Stuffing is a Symptom of Poor Oral Movement
and Reduced Chewing Skills:
- Use a small vibrator/massager before the meal to
build up muscle tone in the cheeks and tongue if
the child has low tone in these areas.
- Brush the sides of the tongue when you brush the
teeth. This can help get more tongue
lateralization which is needed for chewing. Use
an electric toothbrush if the child will accept
- Provide strong or frequent sensory stimulation to
the insides of the cheeks. This can be done with
a toothbrush, or by pushing outward on the inside
of the cheeks with your fingers. Chewing is a
partnership between the tongue and the cheeks.
Often poor chewing coordination is caused by
cheeks that are inactive.
Evans Morris, Ph.D.
1124 Roberts Mountain Road
Faber, Virginia 22938
This paper is a working
draft and multiple copies may not be reproduced
without prior written permission of the author
© Suzanne Evans Morris, 1998 All Rights Reserved