Sensory chew necklace & other chew toys; Should I use them?

Sensory Chew Necklace, Chewlery, chewy tube, chewy toys …. And the list goes on! Should I use them or not? As an Occupational Therapist with 25 years experience, I have spent much of that time devoted to trying to understand the nervous system and behaviour in children and adolescents. In addition to this, my aim is to continue to gain meaningful education and certification in Ayres Sensory Integration. This being said, I still see the great misunderstanding and misconception when it comes to sensory chew items.

I am hoping that I can provide some clarity.

Will a sensory chew necklace, or sensory chew toy help my child?

When parents ask, “should, or would a sensory chew necklace, chew tube, chew toy help my child?” I wish the answer was simply “YES!”, but unfortunately it is not. I always ask therapists at OTFC (and students on placement) to understand what “drives” the BEHAVIOUR before offering a solution. In this instance “why is your child chewing or mouthing their clothing, hair, hands, nails, skin, pencils, objects from the ground….?”

For some, it can be as simple as, “sensory chew toys feel good.” For many others, it serves two main purposes:

1. To reduce anxiety or stress
2. To improve arousal level.
   

Considering that improving arousal level can also reduce stress (and vice versa), it is important to make the distinction that they are not one in the same thing. People can eat because they are hungry or because they are knowingly (or unknowingly) managing stress. It simply just makes them feel good. The ‘feel good’ factor is more aligned to arousal level, and ‘stress eating’ is sometimes aligned to emotional regulation.

With the above in mind, what is the science behind it all?

Sensory chew science

Well, it really comes down to the VAGUS nerve. This is the largest nerve of the body and it connects your brain to many important organs including the heart, lungs and stomach. It has a very important role in the parasympathetic nervous system, “rest and digest.” It is therefore linked to sensory regulation:

“The vagal response reduces stress. It reduces our heart rate and blood pressure. It changes the function of certain parts of the brain, stimulates digestion, all those things that happen when we are relaxed.” — Dr. Mladen Golubic, MD, Medical Director of the Cleveland Clinic

So, chewing quite simply improves your state of arousal. It doesn’t, for many of the young people we work with, alleviate the cause of stress or dysregulation, but it helps them cope and manage in environments or situations they can’t always control – like going to school or being at a shopping centre when there are lots of sensory inputs that can lead to overload.

For many young people diagnosed on the autism spectrum, being dysregulated, anxious and on-alert occurs the moment they wake up, and only increases when they leave the safety of their homes. Using a sensory chewy necklace or other chew tools can be effective (given the neuroscience described briefly above) to help them cope and manage. Over time, we would hope to be able to implement a ‘sensory diet’ that aims to consistently provide tailored and specific ‘sensory input.’ This would help maintain an optimal arousal level, rather than reacting to it. In addition, we endeavour to understand more about the “triggers” that lead individuals to seek oral stimulation to help manage arousal levels or stress.

Sensory diet options

So, what are the options with a ‘sensory diet’ which essentially stimulates the VAGUS nerve to promote parasympathetic “rest and digest” response?

 Well, here are a few options:

1. Oral Stimulation: This certainly includes chewing and chewy tubes, the sensory chew necklace, chewy bands etc. But there are other options as well – crunchy foods, sucking thick shakes or smoothies through a straw, sipping from a water bottle, blowing bubbles, making bubble monsters (see OTFC You tube video) humming, singing, gargling water, even having a small vibrating massager placed against the jaw promotes vagal stimulation. All these strategies work, but my personal favourite is – CHEWING GUM. Discreet so as not to draw attention to the individual and many children beyond the age of 7 can use this effectively in the class with a strict protocol. Yes, it can be misused by the student or child, but if it is taken away and they really benefit from having it, then my years of working with children see them using it correctly the second time (sometimes the third).

• Breathing – Ever heard the phrase, “Just take a deep breath?” well this also activates the Vagus nerve through the diaphragm, expanding the stomach. It is something we can learn to do instinctively, but young people often require some training and practice.
  
• Meditation – Same as the above, but an honourable mention for adults. Some schools focus on meditation to help ‘calm and concentrate.’ Why not? This is great early training for what many adults do to support their ability to perform their roles each day, whether this be parenting or other roles.

• Exercise – At OTFC Group, we train OT’s to work with young people in a dynamic Sensory practice. We understand the value of exercise throughout the lifespan. As an OT who started their journey in child and adolescent mental health, I cannot tell you the importance of “healthy body / healthy mind.” There is so much research invested in how being physically active helps the mental state; The release of dopamine is the body’s natural ‘happy.’ OT’s who are trained in Ayres Sensory Integration also see how certain types of exercise can really support improved arousal and reduce stress. Deep pressure touch and movement are just 2 examples of this.

There are other ways to help support arousal level and manage stress, but the key is always understanding the underlying reasons or triggers. In any case, consulting an occupational therapist who is trained and experienced is always recommended. What works for one person doesn’t mean it will work for another. Understanding the individual’s profile will always lead to the best approach to manage any issues or concerns.