Dear Dr. Debbie,
My toddler walks around with food in his mouth. He’ll say, “All done,” so I get him out of the high chair and start cleaning up. He’s usually nearby happily playing. Then I notice that his cheeks are plump with food. At bedtime he still has bits of his dinner in his cheeks when it comes time to brush his teeth. This has been getting worse the past couple of days. Should I be concerned?
Alvin’s Mom
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Dear Alvin’s Mom,
Pocketing food in their cheeks, also known as pouching, is a common behavior in toddlers. It might occur in younger or older children, too, but is generally harmless and temporary.
The Way it Feels
A simple explanation for this behavior is that it feels good. At birth and through the first three years, a child’s mouth – lips, tongue, and palate – are very sensitive. This is nature’s built-in assurance that he will enjoy eating. He uses his mouth to explore the world and at the same time, to satisfy oral stimulation needs.
If he has his two-year-old molars, he may be enjoying practicing his grinding skills, a little at a time, while he plays. If the molars are just coming in, some packed mushy food may be soothing. Either way, playing around with his tongue with the squishy food in his mouth can be soothing, much like a pacifier when he was younger.
Constant Motion and Energy Supply
Calories count for a toddler. He is on the go and growing. Having to stay in one place for meals and snacks can really try his patience. He appears to have learned to signal that the meal is “over” so he can be on the loose again. His drawn-out intake of food, even after he’s toddled away from the table, may remind you of an earlier growth spurt a time when he seemed to need milk around the clock. The difference is that now he also needs the fuel for near constant movement.
So much the better if what he has stored in his cheeks is apple sauce, oatmeal, noodles, or anything high in carbohydrates which can supply him with physical energy. As he needs a blood sugar boost, the veritable chipmunk will release tiny amounts of the stored food. This is what real chipmunks do, to keep on the move away from predators, or just to transport a large find of food to their den to eat later. A slow and steady infusion of carbohydrates is similarly in effect when adults sip on soft drinks or sugared coffee while working.
Swallowing Discomfort
There’s a small chance that swallowing is or was uncomfortable for some reason. It could be that he scratched his throat with something sharp – a piece of pretzel, maybe – so he avoids swallowing until the food has soaked in his saliva long enough to be very mushy. The scratch may have healed, but the habit continued because it was soothing. Eventually, the soaked food is swallowed unconsciously.
Alternatively, a sore throat could be caused by a passing cold virus. Sore throat is one of the possible symptoms of Covid-19, so be on the lookout for a fever or other symptoms in him, as well as other members of the household, and proceed with testing and quarantining if warranted. (The Covid-19 vaccine for children under the age of five is still undergoing trials. The mass availability of vaccines for all little ones is expected this summer.)
Reducing the Cheekload
It may help to slow the pace at which your child eats to prevent cheek stuffing. Serve small amounts of bite size pieces of food at a time so he isn’t tempted to pack in too much at once. Have two-way conversation while you eat together to further slow the pace at which he shovels it in. By the way, watching television or other electronic devices while eating is a bad habit that can lead to mindless mouth stuffing at any age. Best to limit time at the table to only as long as your child is interested in eating. He may be less ravenous, and therefore less likely to want to hoard food in his cheeks, if you offer one or two snacks between meals.
If you include crunchy food such as apples in his meals and snacks this can encourage chewing and might help to move the mush along. But then again, maybe not.
Professional Help
There is a risk of gagging and choking any time a toddler is eating, just because they are still developing the coordination needed to deftly bite, chew, and swallow. Always stay close when your toddler may have food in his mouth. If he’s having a motor issue with properly chewing and swallowing, an occupational therapist, speech therapist, or feeding therapist can demonstrate exercises. He may need some lessons in getting his jaw and tongue to efficiently get the job done while at the table. A professional can guide him, or transfer this role to you, to scoop up the mushy food collecting in his cheeks so he can complete the chewing and swallowing process.
Your child’s dentist would agree that holding food in his mouth is not a good idea. Cavities are a concern when food stays long on the teeth, especially those beloved carbohydrates that fuel his toddling around. We all know how bad sugar (also known as simple carbohydrate) is for teeth. The complex carbohydrates of starches – flour, cereal, beans, potato, etc. quickly turn to sugar as mouth bacteria break down the molecules. If the food wasn’t being pocketed in his cheeks, it would be on its way to the stomach before getting a chance to cause damage. Offer plenty of water to help rinse off his teeth throughout the day.
Hopefully your child’s chipmunk phase will soon pass.
Dr. Debbie
Deborah Wood, Ph.D. is a child development specialist and founding director of Chesapeake Children’s Museum.
Dr. Wood will be presenting a workshop for parents and professional caregivers entitled: Effective Discipline Techniques for two- to five-year-olds, Tuesday, March 29, 7 pm – 9 pm on Zoom. Register online or by phone: 410-990-1993.
Read more of Dr. Wood’s Good Parenting columns by clicking here.
