by Dr. Pamela Cooper, M.A., M.B.A., Ph.D.
As we work with children, they always seem to have something in their mouths. How many times have you said to the same child “take that out of your mouth” or “stop chewing on your pen” or “spit out that gum”? Perhaps you’ve asked a child to stop chewing on paper because it is dirty or that chewing the paper will make the child sick.
Chewing on an item is a physical need, not an act of defiance.
Some children continue to chew nonfood items well past the mouthing/teething stage. For some children, chewing is a passing phase while other children will always have a need to chew continuing into adulthood.
Because of a psychological or physical need, some children have a written medical diagnosis or a school plan to address these needs. School plans may include chewing accommodations in an individualized educational program (IEP), an individualized health plan (IHP), an intervention referral service plan (I&RS), or a Section 504 plan; much like when a child needs to carry and drink water during the school day.
The most common explanation for why some children chew is because of stress and/or anxiety. Chewing provides proprioceptive input to the jaw that is calming and self-organizing. Stress and anxiety are why some children may bite their fingernails when they are nervous, pace back and forth, do deep breathing, tap their feet, or suck their thumbs and fingers. Mouthing, chewing and sucking are self-soothing techniques. They are ways to cope with stress.
The stress children experience may be everyday stress, such as frustration, anger, the inability to perform a task, a change in routine, hunger, foster care placements, group home placements, homelessness, side-effects from a medication, sleepiness (often from playing games on their digital devices in place of sleeping), and other factors. Chewing will typically increase relative to the amount of stress and how well a child deals with stress.
Chewing is an easy way for children to calm themselves because:
• It is a known motor plan (i.e., the ability to organize the body’s actions, knowing what steps to take, and in what order to complete a task.)
• There is always something nearby that the child can chew on, whether it is safe or inappropriate. For example, some children are apt to chew on a piece of clothing, pencil, pen, gum, or something picked up off the floor.
• Children can control what goes in their mouths.
Chewing as a calming mechanism is especially true for children who have autism and/or sensory processing disorder (SPD). SPD is also known as sensory integration dysfunction; a condition where multisensory integration is not adequately processed to provide appropriate responses to the demands of the child’s environment.
Children with sensory issues process the world differently and that can often be overwhelming. Lights might be brighter, sounds louder, and touch can be painful. Being stared at might feel threatening to them. Some children wear hoods during class to meet a sensory need. Some children put their heads down within their arms to buffer light or sound and at times pull a clothing item over their mouth or ears.
Stimming is short for self-stimulation. Stimming is one way that children with sensory issues organize themselves and manage the extra sensory information bombarding their systems. Stimming is typically anything repetitive, such as flapping one’s hands, rocking back and forth, spinning things, repeating certain words, chewing, getting up to sharpen a pencil several times and other such behaviors.
We process the world around us through our senses, one of which is called proprioception. Proprioception is the ability to know where the body is in time and space and how to process input from joints and muscles to move and the position of the body. Children who are struggling with body awareness and position can appear heavy-handed and overly forceful. They may damage items unintentionally, walk into others while looking ahead, or trip over or fall from chairs. These children can display poor motor control, have the “wiggles,” be unable to sit still, lack focus, become easily distracted, and many other symptoms.
Children with poor proprioception would benefit from what is called a “sensory diet” of activities to regulate their systems. Sensory diet activities are developed to independently meet each child’s needs and typically include some sort of heavy work activities. Heavy work activities are any type of action that pushes or pulls against the body, such as:
• Cleaning tables
• Carrying supplies to and from the classroom
• Pushing a friend or sibling on a swing
• Passing out and collecting papers
• Lifting items from a shelf and stacking them at a different location
• Cleaning windows
• Vacuuming or sweeping
• Push-ups, swimming, playing sports
• Using weighted lap pads, vests, or blankets to improve body awareness and to promote a sense of calm.
If a sensory diet is not in place, or if the child is not getting the right amount of compensatory proprioceptive input at any point throughout the day, the child may try to self-regulate on their own. Often children may try to self-satisfy through chewing because it is something that they know, have access to, and can control. Moreover, it provides proprioceptive input to the jaw.
Some children have oral hyposensitivity, which is limited sensitivity or no sensation in the mouth. Imagine that you have decreased sensation in your fingers. To compensate for the decreased fingers sensation, you would probably press on things harder, grip things tighter, or seek out things that are textured that contain a lot of tactile information.
Children with limited oral hyposensitivity awareness may seek out activities that provide increased oral feedback, such as eating crunchy foods, stuffing their mouths with food, grinding their teeth, or chewing on nonfood items.
Chewing can be an effective way to increase focus and block out other distractions, especially since it is a repetitive movement. Chewing activates muscles in the jaw down into the neck, which provides added stability that is grounding, particularly for children with decreased motor planning. Have you ever chewed gum during a test? Or chewed on a pen cap or pencil while trying to concentrate on something? If not, then odds are you know someone who does.
Characterized by the need or craving not only to chew, but eat nonfood items (paper, clay, sand, etc.). If you suspect that a child is chewing nonfood items in excess, inform the parent, school nurse, counselor and/or child study team case manager to seek medical attention right away.
It is not uncommon to see children chew for relief when their six-year molars start to erupt. If this is the cause, it will likely pass when the teeth are done moving into place. The average age for loss of these primary molars is 10 to 12 years, with children having at least all their first and second permanent, or adult, molars by 13 to 15 years of age.
When children cannot eat by mouth, they may still crave or miss the act of chewing. These children are given alternatives to chewing food to help satisfy that need by chewing on a chew tool during tube feedings. A chew tool looks similar to dog chew toy. The school nurse generally changes feeding tubes during the school day.
When a child presents as being bored, there is always something nearby that could potentially be chewed on, safe or not—pencil erasers, paper clips, tissues, etc.
Document your observations and notify the parent, school nurse, support service provider and/or child study team case manager. Remember, it is not that children WANT to chew, it is that they NEED to chew.
Although biting or chewing can sometimes be behavioral, they are most often sensory-related. As a result, telling the child to stop chewing is not going to work. For one reason or another, children’s body are telling them that they need to chew, and their bodies are adeptly listening.
Dr. Pamela Cooper is a learning disabilities teacher-consultant in Winslow Township, Camden County. She can be reached at firstname.lastname@example.org.