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Q&A Mouthing, Toe-walking and Biting Help. Autism Parenting Magazine

October 13, 2023

Anna from the Philippines asks: My son always puts any objects he is holding into his mouth. He also walks on his tip-toes. When he is angry he bites himself or his family. Recently he also started playing with his saliva. As a mother I just want my son to live a normal life. What should I do?

QA Toe Walk Biting

Dear Anna, that’s a great question and I’m so glad you asked. It sounds like your son is exhibiting these behaviors for a couple of reasons. Putting items into his mouth, playing with his saliva, and walking on his toes most likely gives him sensory input. In other words, these behaviors feel good.

Sandy Horna, Physical Therapist, explains that your son is most likely mouthing items because he is seeking sensation that his central nervous system is not providing to his mouth. She suggests giving your son a vibrating toothbrush. You can rub it on his gums and on his tongue, and also let him suck or chew on it. She adds that you can even spread something like yummy onto it so that the toothbrush tastes good. You may also massage his gums with your thumbs in a circular motion to provide additional sensory input to his mouth. Sandy states that the vibration from the toothbrush, or the pressure from the massage, will help connect his nerves, and thereby decrease his need for other sensory seeking behaviors (like mouthing items).

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Here are some other ideas I’ve learned about to provide alternatives for his sensory seeking behaviors:
• Putting items in his mouth: Chewy Tubes, Knobby Q, Grabber XT, or Chewlery. It’s also a good idea to move any small items out of his reach to reduce risk of choking.
• Playing with saliva: Activities like finger-painting, water play, or shaving cream.
• Toe-walking: Stretches and exercises (ie: stretching his calf muscles, rolling his ankle, squatting while he’s playing). Also, you can try putting him in flat shoes with a high back to make it more difficult to stand on his toes.

Now, onto the biting behaviors… these are more serious as it can cause injury to himself or others. It’s great that you are seeking help for this problem. When he bites himself or others, try to examine what happens just before that. Why is he mad? Does he want an item? Is it because you told him to do something he doesn’t want to do?

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Knowing WHY he is biting will help you know what to do about it.

For example, if he bites himself because you take an item away from him or tell him, “No, you can’t have that,” you may want to try these strategies:
• Priming him before the transition or before taking something away by telling him what is going to happen (“Okay, you have 1 more minute and then all done iPad”). This will help him prepare for what is about to happen.
• Providing choices if you have to deny something he wants (“All done iPad, now you can have book or puzzle instead,” or “No juice right now, but you may have milk or water instead”). Make sure the alternative choices are things he likes.
• Withholding the item he wants if he engages in biting. No matter how upset he gets, do not give him the item if he bites. We want to teach him that biting does not get him what he wants.
• Reinforcing appropriate behavior. If he asks for an item appropriately, without biting himself or others, reward that! He may communicate through signs, icons, or using speech.

If he bites himself to escape demands or get out of doing what you tell him, you may want to try these strategies:

• First/Then arrangements will make him more likely to complete a task you want because he knows he will get what he wants right after. (“First brush your teeth, then Elmo” or “First 1 bite of chicken, then a candy”) You can verbally tell him, or even make a visual with pictures to show him. Keep it simple with as few words as possible. “First bath, then TV” is all you need to say. Leave out extraneous words and explanations. Be sure that he completes the task before getting the reward and once he has done what you asked, immediately give him what he earned.
• Following through with demands will teach him that biting people does not work to get him out of doing things. It’s so important to send the message that MOM makes the rules, and his behaviors are not in charge.
• Withholding a big reaction (such as a loud or lengthy reprimand) will help ensure that he does not begin biting to get attention. While the behavior may not initially be to get your attention, it may become attention seeking if he learns that every time he bites he gets a big reaction.

I also recommend that you work with your son on a way to communicate his needs. Research shows that functional communication can greatly reduce maladaptive behaviors. If he does not have any speech, you can try using picture icons. Teach him to touch or give you the picture of what he wants. You can even create a “break” or “all done” icon so that when he wants to get out of doing something he can express it appropriately. Giving him a way to communicate with you will help him navigate his environment and reduce his need for acting out by biting others.

Most importantly, consult with a Physical Therapist and a Behavior Analyst in your area who could give you more ideas on how to help your son. If none are available, check online for resources, articles, websites, message boards, or online groups who could provide you with support. We hope this information is helpful for you and your son.

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