He is 15, he was malnutrition, he has multiple feeding issues, he struggles to hold a fork and you want to teach table manners like chewing with his mouth closed, when he barely had the ability to use his tongue? This just doesn’t seem right

Anonymous wrote:OP here - Thanks for the helpful replies. To answer the question about what he understands the problem to be, he says it's just a habit. He eats with his mouth open and is extremely loud, but he says he can control it when prompted.

For context, he used to not be able to control it at all... so all the SLP and OT and PT since the age of 12 months seemed to have worked to help him move his tongue and facial muscles. A couple of years ago, he could not control his tongue at all and it just flailed about if he tried to stick it out.

So... he seems to have the ability right now. I think it's the ADHD that makes him lose focus on it (it's obviously pretty boring to think about how you're chewing) and habit formation.

It also likely takes him more effort than it takes someone else. Most of us don't have to consciously think about controlling our mouth and tongue, but it sounds like it's still effortful for him, even if now it's possible. I would give him only one thing to focus on -- chewing with his mouth closed is probably the biggest priority -- and ask him what support he thinks would be helpful.

OP here - Thanks for the helpful replies. To answer the question about what he understands the problem to be, he says it's just a habit. He eats with his mouth open and is extremely loud, but he says he can control it when prompted.

For context, he used to not be able to control it at all... so all the SLP and OT and PT since the age of 12 months seemed to have worked to help him move his tongue and facial muscles. A couple of years ago, he could not control his tongue at all and it just flailed about if he tried to stick it out.

So... he seems to have the ability right now. I think it's the ADHD that makes him lose focus on it (it's obviously pretty boring to think about how you're chewing) and habit formation.

Is there table manner class in dmv area on weekend?

Reward charts only work when the issue is motivation and nothing you've said suggests that's the problem. I agree with targeting one issue at a time and asking him what is difficult about it/what support he needs.

Anonymous wrote:He has ADHD and hypotonia and some other issues that have caused malnutrition for years.

OP what is your son's understanding of these issues? What have the OT, nutritionist and feeding therapist said to him and what was his reaction? What is he telling you?

I’d focus on one table manner goal. Maybe chew with mouth closed. Cook lots of foods that he can eat with his hands, such as sandwiches, so you only need to give one type of feedback. Just make it your goal for the month of June to get him to chew with his mouth closed.

I think I would ignore the advice of the feeding therapist.

My son who has had all sorts of feeding issues since infancy is 15 and still struggling to hold a fork and chew with his mouth closed. He has ADHD and hypotonia and some other issues that have caused malnutrition for years. Working with a nutritionist I’ve gotten the malnutrition basically under control and he has been able to eat more foods in a more reasonable amount of time (it used to be dinner was 2.5 hours. It’s now a lot shorter). A feeding therapist said it was time to teach him table manners, and summer was the time to do it. The problem is I don’t know what to try. In the past I’ve tried everything I can think of (rewards charts, stickers, constant reminders, etc). The PT gave him exercises to strengthen all of the muscles involved in holding a fork. The OT had him eat in front of a mirror. Nothing has made a difference. One therapist just recommended that I sit alone with him at every meal and monitor each bite. I don’t think that’s feasible while also trying to take care of my SN daughter. Does anyone have any recommendations?