Pediatric Speech Therapy Case Studies: Examining The Side Biter™ for Phagophobia/Oral Dysphagia and Restricted Food Intake

CASE 1 – Phagophobia/Oral Dysphagia

Summary of Evaluation and Care for Pediatric Male with Cerebral Palsy presenting with Phagophobia/Oral Dysphagia

Diagnosis Definitions

• Cerebral Palsy: A group of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination (National Institute of Neurological Disorders and Stroke).
• Phagophobia: The avoidance of swallowing foods, liquids, or pills, usually based on a fear of choking (National Library of Medicine).
• Oral Dysphagia: A swallowing disorder characterized by difficulty moving food or liquid from the mouth, throat, or esophagus to the stomach (American Speech-Language-Hearing Association).

Background of Medical and Speech-Language Pathologist Diagnosis

• Client presented with phagophobia from a choking incident as well as mild oral phase dysphagia secondary to mild cerebral palsy.
• Client came into therapy with a diet that consisted of PediaSure® and smooth puree smoothies through a modified sippy cup.
• Client has been using The Side Biter in therapy sessions to explore new foods safely and is also using the tool at home for carryover exploration.

Treatment Tool Outcome

• During therapy, the client started with phase 0 (no holes) and worked his way up [all three levels].
• Client is now able to use The Side Biter to effectively consume and safely manage small amounts of food, such as birthday cake, potato, and stuffing on Thanksgiving.
• Client is no longer afraid to try new foods and is motivated by emptying the clear tube of The Side Biter.
• As side biting skills can be generalized to food outside of The Side Biter, the treating clinician systematically started coating the outside of The Side Biter with foods such as pudding and cookie crumbs. As a result, the client is now able to manage controlled boluses with familiar soft/semi-soft foods outside of The Side Biter (i.e., stick-shaped sandwich/stick-shaped coffee cake).

Treatment Tool Recommendation

• The family has loved using this easy-to-use tool. They have found it is great for consistent carryover from therapy and controlled measurement of progress without fear.
• Treating clinician comments:
  • This is an ideal tool because it allows for controlled exposure to food and measured intake, and the shape allows for teaching of molar mastication and tongue lateralization (this client loved to “bite, bite, bite” and find flavors with his tongue).
  • The handle is such that it is easily gripped and readily adapted by occupational therapists (OT) (built up, weighted).
  • It has been so great watching the family progress through the [Side Biter] levels.

CASE 2 – Rigid and Restricted Food Intake

Summary of Evaluation and Care for Pediatric Male with ASD presenting with rigid, restricted food intake

Diagnosis Definitions

• Autism Spectrum Disorder (ASD): A neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave (National Institute of Mental Health).
• Rigid and Restricted Food Intake: Most common in children and described as having extremely selective eating preferences with aversion to or avoidance of foods based on certain sensory characteristics (i.e., taste, texture, smell, or color), and with little interest in eating or food (American Speech-Language-Hearing Association, Child Mind Institute).

Background of Medical and Speech-Language Pathologist Diagnosis

• Client presented with rigid and restricted food intake, including distress (gagging, refusals, swiping, hitting) upon touching novel foods, even within the same texture category.
• Client would not tolerate novel foods even when presented at the table.
• Client’s diet before therapy consisted of milk through a bottle and goldfish crackers.

Treatment Tool Outcome

• During food play, treating clinician started crunching novel foods using fingers within the "no holes" phase [of The Side Biter] (graham cracker, cookie, cracker, fig newton).
• Client then graduated to biting and hearing the crunch of the silicone with food inside [The Side Biter] without direct oral exposure.
• Slowly, the client graduated to crunching foods and shaking the dust out of The Side Biter holes. Client was motivated by putting circular foods such as cereal, puffs, or Cheerios into The Side Biter, crunching it with his teeth, and then showing off "the work" that his teeth did.
• Client practiced in structured trials with parents and applied behavior analysis (ABA) outside of speech-language therapy sessions.
• Client is now able to successfully tolerate biting, crunchy foods, or mixed texture with crunchy foods (such as peanut butter on a Ritz cracker), first within The Side Biter and then outside of it.
• Client has graduated from using The Side Biter and now is able to tolerate novel foods using multi-sensory exploration (touch, kiss, pinch, crunch, bite, side bite).

Treatment Tool Recommendation

• Treating clinician comments: The Side Biter was a key step in our process because it allowed for systematic and routine food exposure. The soft silicone allowed him to feel the food and textures, and the clear silicone allowed him to visualize the crunching of a novel food.

Overall clinician feedback for The Side Biter: The side biter has been an integral part of feeding therapy and home carryover for some of my patients who present with a variety of barriers to feeding, from oral motor dysphagia to sensory rigidity and restricted eating.

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Case Study Disclaimer: The information and data contained in this case study was voluntarily provided by a licensed clinician and is not a representative of AliMed, Inc. Individual methods of treatment and results using any represented speech therapy tool or product may vary. Images are for illustrative purposes only and are not a representation of actual client use.