Understanding What is Pocketing When Eating
Pocketing food, also known as food holding, occurs when an individual stores food in the oral cavity, most commonly in the cheeks or between the gums and lips, without swallowing it. While it can be a temporary phase in infants or a behavioral issue in some children, it can also signal a more serious underlying medical condition, especially in the elderly or those with special needs. This article will delve into the various causes, associated risks, and effective management strategies for food pocketing in different populations.
Food Pocketing in Children
In pediatric populations, pocketing can be a fleeting phase or a symptom of a deeper issue. It is often linked to:
- Oral motor skill deficits: Young children may lack the coordination and strength in their tongue, jaw, and cheeks to properly chew and move food to the back of the mouth for swallowing. The food can get 'lost' in the cheeks as a result.
- Sensory processing differences: Children with heightened (hypersensitive) or lowered (hyposensitive) oral awareness might pocket food. For the hyposensitive child, stuffing food might be a way to get more oral input, while a hypersensitive child might avoid swallowing due to the texture.
- Texture aversion: A dislike of certain food textures can cause a child to hold the food in their mouth to avoid swallowing it.
- Avoidance behavior: If a child feels rushed or pressured to eat, they may pocket food as a way to control the pace of the meal or resist eating more.
- Painful swallowing: A sore throat, swollen tonsils, or chronic reflux can make swallowing painful, leading a child to hold food instead.
Food Pocketing in Adults and the Elderly
For older individuals, particularly those with degenerative conditions, food pocketing is often a symptom of dysphagia, or difficulty swallowing. Causes include:
- Neurological disorders: Diseases like Alzheimer's, other forms of dementia, Parkinson's disease, and post-stroke complications can impair the brain's signals that coordinate the chewing and swallowing process.
- Reduced oral strength: With age, there is a natural decline in the strength of the muscles in the mouth and tongue, making it harder to manipulate and swallow food effectively.
- Xerostomia (dry mouth): Decreased saliva production, often a side effect of medication, can make it difficult to form a food bolus and transport it down the throat.
- Fatigue: For those with advanced illness, the act of eating can be tiring, and they may forget to swallow or lack the energy to complete the process.
Risks Associated with Food Pocketing
Leaving food pocketed can lead to several serious complications:
- Choking: Food left in the mouth can be accidentally dislodged and obstruct the airway, posing a significant choking risk.
- Aspiration pneumonia: This is a severe risk, especially in the elderly and frail. Aspiration occurs when food or liquid enters the lungs instead of the stomach, potentially causing a dangerous infection.
- Dental decay: Prolonged contact between food particles and teeth provides a breeding ground for bacteria, increasing the risk of cavities and gum disease.
- Malnutrition and dehydration: If food is consistently pocketed and not swallowed, the individual is not receiving adequate nutrition or hydration, leading to weight loss and weakness.
How to Address and Manage Food Pocketing
Management strategies for food pocketing depend on the root cause and the individual's age. It is always best to consult a healthcare professional, like a Speech-Language Pathologist (SLP) or a pediatrician, for a proper assessment.
Environmental Modifications:
- Create a calm, quiet mealtime environment free of distractions like televisions or tablets.
- Ensure the individual is sitting upright with a supported posture, which promotes safer swallowing.
Food and Feeding Strategies:
- Offer smaller, more manageable bites of food. Presenting only a few bites at a time can prevent mouth-stuffing.
- Modify food textures to make them easier to chew and swallow. Consider softer, moist foods and use sauces or gravy.
- Incorporate strong flavors like sour or spicy tastes to increase oral sensory awareness.
- Encourage sips of water between bites to help wash down food and clear the mouth.
- Consider using specialized eating utensils or cups to aid in proper feeding.
Therapeutic Techniques:
- Provide verbal and visual prompts, such as gentle reminders to chew and swallow. A visual aid can show the process of eating.
- Practice oral exercises to strengthen mouth and tongue muscles, as guided by a feeding therapist.
- Use a vibrating toothbrush or chew tools to increase oral awareness and "map" the mouth.
- For caregivers of those with cognitive decline, checking the mouth for pocketed food after a meal is crucial.
When to Seek Help:
If pocketing is a persistent problem, impacts nutrition, or is accompanied by coughing and choking, a professional evaluation is necessary. A feeding therapist can provide a customized plan to address the specific challenges.
Food Pocketing vs. Tongue Thrust: A Comparison
It is important to differentiate between food pocketing and tongue thrust, another common oral motor issue. While both involve abnormal tongue movement, they have distinct characteristics:
| Feature | Food Pocketing | Tongue Thrust (Immature Swallow) |
|---|---|---|
| Mechanism | Holding or storing food in the oral cavity (cheeks, gums) instead of swallowing. | Pushing the tongue forward against or between the teeth during swallowing. |
| Appearance | Bulging cheeks or finding food long after a meal. | Lips and facial muscles may strain during swallowing. |
| Cause | Oral motor weakness, sensory issues, cognitive decline, or avoidance behavior. | Can be a developmental stage or a persistent learned habit. |
| Primary Risk | Choking, aspiration pneumonia, dental decay. | Dental misalignment (open bite), speech issues. |
Conclusion
Recognizing what is pocketing when eating is the first step toward managing this potentially serious feeding issue. By understanding the varied causes—from developmental and sensory challenges in children to neurological and strength-related issues in adults—caregivers can implement appropriate strategies. Modifying food, creating a supportive mealtime environment, and using therapeutic techniques can improve safety and nutrition. For persistent or complex cases, seeking professional help from a feeding specialist is essential to prevent severe complications like aspiration and ensure a better quality of life. For more detailed information on dysphagia and elderly care, please visit Open Arms Solutions.
