Chewing Cycles in
2- to 8-Year-Old
Normal Children: A
Developmental Profile
Erika G. Gisel
Key Words: child development. eating and
feeding evaluation. feeding behavior
Chewing movements of normal 5-, 6-, 7-, and 8year-old children were measured and compared
across age, food textures, and gender. Applesauce,
graham cracker, and raisins were used. Measures
were taken on 98 children: eighteen 5-year-olds (9
boys, 9 girls), thirty-five 6-year-olds (16 boys, 19
girls), twenty-six 7-year-olds (13 boys, 13 girls),- and
nineteen 8-year-olds (10 boys, 9 girls). Comparisons
were made with data of another twenty 5-year-olds
(10 boys, 10 girls) from a previous study. CheWing
movements were measured by time, number of
cycles, and a time/cycle ratio.
Food texture affected time, cycle, and the time/
cycle ratio. Age affected time and cycles. Data from
earlier studies are used to describe the development
of cheWing between the ages of 2 and 8 years Results indicate that eating skills for different fOOd textures mature at different rates. Skills for eating solid
fOOds mature before skills for eating viscous and
pureed foods mature. Thus, the consistent use of
fOOd textures is important when children's eating
skills are evaluated. The normative data presented
here may be used by clinicians evaluating children
within the given age group.
eeding may be the most difficult aspect in the
daily care of children with severe oral-motor
problems. A study by Johnson and Deitz
(1985) docu ments that a mother may spend an average of 35 ± 0.8 hr (range 0.7-77 hr) daily feeding her
disabled child, whereas it takes only 2.1 ± 0.9 hr
(range 00 ± 3.5 hr) to feed a normal child.
For the therapist, the assessment of these children is equally difficult because a standardized eating
scale is lacking. Evaluations developed by clinicians
(Stratwn, 1981) were shown to be only marginally
reliable (Ottenbacher, Dauk, Grahn, Gevelinger, &
Hasset, 1985) The difficulties in establishing valid
and reliable oral-motor assessments are well recognized (Schwaab, Niman, & Gisel, 1986; Gisel & Pollock, in press). Although therapists have responded to
the demands for treatment of the eating-impaired
child, there are to date no established norms against
which to judge abnormal oral-motor behaviors. Over
the past 4 years, my collaborators and I (Schwaab et
aI., 1986; Schwartz, Niman, & Gisel, 1984; Gisel,
Lange, & Niman, 1984) have established the reliability and usefulness of two parameters that can easily be
measured by the clinician. We have shown that the
time to chew a bite of food decreases consistently
with age (Schwaab et al.; Schwartz et al.) as does the
number of cycles a child chews on the same bite of
food. (A cycle was defined as one down-and-up movement of the mandible) In contrast to this normal progression, 4- and 5-year-old children with Down's syndrome manifest a significant increase in time needed,
although not of cycles, when cheWing food (Gisel et
al.). This phenomenon has now also been observed in
the severely feeding-impaired spastic child with cerebral palsy. I and my co-workers (Gisel et al.) have
proposed that the rate of cheWing varies only within
the narrow range allowed by the controls of the
human nervous system. In contrast, the duration of
cheWing is the variable used w compensate for eating
difficulties (Gisel et al.). It has further become clear
that the time and cycle parameters are significantly
influenced by different textures of food (Schwaab et
al.; Schwartz et ai.) Thus, when a child's eating performance is evaluated, consistency in the food texture
is of the utmost importance.
The purpose of the present study was to provide
further normative data on the cheWing behavior of
normal children 5, 6, 7, and 8 years of age by testing
the following three hypotheses:
F
1. The measures of time, number of cycles, and
Erika G. Gisel, PhD, OTR, is Associate Director of Occupational Therapy, School of Physical and Occupational
Therapy, McGill University, Montreal, Quebec H3G lY5,
Canada.
40
the time/cycle ratio will not differ with respect to food texture, age, and gender.
2. There will be no differences between the
measures taken by myself and two research
assistants.
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Table 1
Effect of Food on Chewing Cycles in 5-, 6-, 7-,
and 8-Year-Old Normal Children
Time
(sec)
Food
n"
R1
R2
GC
A
(96)
(96)
(98)
(89)
10.79
1054
13.22
2.49
±
±
±
±
258
289
250
146
T/C
Cycles - _(sec/cycle)
._-12.77 ± 3.10
086±016
084±0.14
1260 ± 2.99
1610 ± 336
0.83 ± 013
201 ± 1.49
131 ± 0.28
Note. Data represent mean ± 50. R1 = Raisin 1. R2 = Raisin 2. GC
= graham cracker; A = applesauce. T/C = time/cycle.
a Unequal numbers of subjects on different foods reflect some chil·
dren's refusals.
3. The measures of the 5-year-olds in this study
will not differ from those published earlier by
Schwartz et a1. (1984).
Additionally, the development of chewing between the ages of 2 and 8 years will be summarized
and discussed.
Material and Methods
Sample. The sample consisted of 98 children: 18
were 5 years ± 2.8 months old (9 boys, 9 girls), 35
were 6 years ± 2.5 months old (16 boys, 19 girls), 26
were 7 years ± 2.2 months old (13 boys, 13 girls), and
19 were 8 years ± 2.7 months old (10 boys, 9 girls).
These children also took part in a study on tongue
movement and oral stereognosis (Gisel & Schwab,
in press). Written institutional and parental consent
was obtained. In addition, verbal consent of the child
was obtained on the day of study. If children refused
any of the foods during the study, they were not persuaded against their will to eat them. All children
spoke French, and they were tested in two grade
schools in the city of Montreal. Subject selection criteria were the same as reported earlier (Schwartz et aI.,
1984).
Procedure. The sessions took place between 9:00
AM and 11 :30 AM. They were held in a well-lit
classroom used exclusively for testing. Each child was
seated on a chair with his or her feet flat on the floor.
The investigator sat in front of the child. The video
camera was pOSitioned 1.8 m to the right of the chair
to obtain a profile view of the child. The camera was
adjusted so that the lens was positioned level with the
child's face. Time was recorded with a digital clock
placed near the child.
Each child was observed eating the follOWing
foods: applesauce, graham cracker (GC), and raisins.
Raisins were presented in two modes: (a) the raisin
was placed behind the lower incisors to observe side
preference (Raisin 1) and (b) the raisin was placed on
the lower molars to observe how the raisin was moved
from one side of the mouth to the other (Raisin 2).
The child was presented with each food 10 times.
Food order was random. Time was measured from the
moment the food was placed into the mouth until the
final swallow. A cycle was defined as one downwardand-upward movement of the chin.
Videotape analysis. Videotape analysis was performed as described in an earlier study (Schwartz et
aI., 1984). I analyzed the data using an analysis of
variance with repeated measures via computer program SAS general linear models procedure. This provided me with one-way, two-way, and three-way associations of the data. Comparisons were made between
ages, gender, and food types. For interscorer reliability, I and two research assistants functioning as inde·
pendent observers scored all trials from the 98 subjects (Observer 1, 56 subjects; Observer 2, 42 subjects). Ebel's method (1951) for intraclass correlation
was used to analyzE' the data. For all measures an
alpha level of 0.05 was accepted as significant. This
allowed a comparison of the present data with earlier
work (Schwartz et a1.; Schwaab et aI., 1986)
Results
The first hypothesis was that there would be no difference in the measures of time, number of cycles,
and the time/cycle ratio between the differently textured foods, the two sexes, and the different age
groups. Data for the effects of food, gender, and age
on cheWing are proVided in Tables 1,2, and 3.
Table 1 presents mean time, cycles, and time/
cycle ratios with all ages combined. Note that values
of time and cycles are slightly lower in this age group
Table 2
Effect of Gender on Chewing Cycles in 5- to 8-Year-Old Normal Children
Girls (n
Boys (n=48)
Food
n'
Time
(sec)
R1
R2
GC
(43)
(48)
(48)
(48)
10.68 ± 2.43
1059±237
1287 ± 234
2.13±0.91
A
Cycles
1294
13.08
1652
1.71
±
±
±
±
269
292
352
078
T/C
(sec/cycle)
n'J
0.83±012
082±012
079±010
127 ± 029
(46)
(50)
(48)
(48)
Time
(sec)
10.90
1049
1356
2.84
±
±
±
±
275
335
263
1.78
=
50)
Cycles
T/C
(sec/cycle)
1261 ± 3.69
1213 ± 3.02
1570±318
229 ± 1.90
089 ± 0.18
0.87 ± 0.16
0.88±015
134 ± 026
Note. Data represent mean ± 5D. R1 = Raisin 1. R2 = Raisin 2. GC = graham cracker. A = applesauce; T/C = time/cycle.
, Unequal numbers of subjects on uifferent fooels reflect some children's refusals.
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41
Table 3
Effect of Age on Chewing Cycles in 5-, 6-, 7-, and 8-Year-Old Normal Children
Food
Time
Cycles
T/C
(sec/cycle)
Time
A
12.26
12.00
14.47
3.39
±
±
±
±
2.16
3.69
2.22
2.52
1407 ± 337
1364±289
1668 ± 199
300 ± 2.67
0.88 ± 0.17
089 ± 0.22
087±0.13
1.20 ± 0.33
1091 ± 266
1086±315
12.86 ± 2.77
2.27 ± 100
7·Year·Olds
1006 ± 181
9.56±182
1331 ± 2.25
2_3_2_±_1_3_2
Note, Data represent mean ±
1183 ± 2.42
1130±238
16.19 ± 3.40
1_79_±_1_2_6
±
±
±
±
3.44
3.14
3.69
0.89
086 ± 0.20
0.84±014
083 ± 0.14
1.27 ± 0.26
(n=19)
086 ± 012
086±0.12
0.84 ± 016
1_30 ± 0.21
10.20 ± 2.29
9.92±2.18
1260 ± 235
2...c.3_2_±_0,_67
12.41 ± 2.74
12.64±313
1595 ± 3.84
1_75_±_0_.7_2
0.82 ± 0.05
0.79±0.06
080 ± 0,09
1_.4_0_±_0_,.:....31_ _
so. R1 = Raisin 1 R2 = Raisin 2. GC = graham cracker. T/C = time/cycle. A = applesauce.
of 5- to 8-year-olds than the values reported by
Schwartz et al. (1984) for 4- and 5-year-olds. Consequently, time/cycle values are very similar in both age
groups. The effect of food on time (see Table 4) can
be attributed to the pureed texture of applesauce (p
< .006). The effect of the solid texture of the graham
cracker (p < .08) and the viscous texture of the raisins
(Raisin 1, p < .06; Raisin 2, p < ,07) did not reach
significance, Thus, the hypothesis that there would be
no difference in chewing time for food textures was
rejected for applesauce, but not for graham cracker,
Raisin 1, and Raisin 2. Similarly, pureed food accounted for the effect of food on cycles (applesauce, p
< ,009), and there was also a significant effect of Raisin 2 (p < .05).
A significant effect of food on the time/cycle ratio
was noted for graham cracker (p < .009). It was also
shown (see Table 1) that the pureed food (applesauce) had a short time and a very low number of
cycles and, hence, a higher time/cycle ratio than did
all other foods, These findings are in agreement with
the findings by Schwaab et al. (1986) and Schwartz et
a!. (1984)
Three food-gender interactions were noted (see
Tables 2 and 4). Girls savored applesauce significantly longer (p < ,009) and used more cycles (p
< .03) than did boys Therefore, the hypothesis that
there would be no difference in time and cycles for
food textures between the sexes was rejected with
respect to applesauce, but not with respect to graham
crackers and raisins. The time/cycle ratio for applesauce was not significantly different between the
sexes. However, for graham crackers, girls had a significantly higher time/cycle ratio (p < .001) than did
boys,
Several food-age interactions were noted (see
Tables 3 and 4), These may be attributed to a major
42
1300
12.97
15.81
1.82
8·Year-Olds
(n=26)
R1
R2
GC
__
A
T/C
(sec/cycle)
6·Year·Olds
(n = 35)
5·Year·Olds
(n = 18)
Rl
R2
GC
Cycles
decrease of chewing time from age 5 to age 6 years
and a smaller decrease of chewing time from age 6 to
age 7 years, Thus, mean decreases for Raisin 1 were
1.35 sec (11 %) from age 5 to age 6 years and 0.85 sec
(7,8%) from age 6 to age 7 years (p < ,03), For Raisin
2, the same values were 1.14 sec (95%) from age 5 to
age 6 years and 1.30 sec (12.0%) from age 6 to age 7
years (p < ,04). The time decreases for graham
cracker were not significant (p < .08). The first was a
decrease of 1.61 sec (11 %) from age 5 to age 6 years,
and the second was a decrease of 0.71 sec (5,3%) from
age 7 to age 8 years. The decrease for applesauce was
1.12 sec 03%) from age 5 to age 6 years (p <05).
Significant decreases in cycles with age were
only observed in applesauce (p < .03; see Tables 3
and 4). None of the other food textures reached significance, There were no significant food-age interactions in the time/cycle ratio (see Tables 3 and 4).
The second hypothesis was that there would be
no differences between any of the measures taken by
myself as the investigator and those taken by the research assistants as observers. Reliability ratings for
the average of all four foods ranged from .91 to .97 for
Observer 1 and the investigator (N = 56) and from
0,90 to 0.88 for Observer 2 and the investigator (N =
42), (Numbers represent time and cycles, in that
order.)
Table 5 shows that there were indeed no differences between time and cycles in any of the food
textures between the measures of myself and the two
research assistants, Thus, the second hypothesis was
accepted, meaning that video analysis provided a reliable measure of chewing performance.
The third hypothesis was that the measures of the
5-year·olds in this study would not differ from the
measures published earlier by Schwartz et al. (1984).
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Table 4
Summary Analyses for Time, Cycles, and Time/Cycle
for Normal Children 5 to 8 Years Old
(N = 98: 50 Girls, 48 Boys)
SOURCE
55
M5
F
5823
1.16
57.07
14.56
2.31
0.18
3.02
Food-R2
Food-Sex
Food-Age
70.83
036
70.47
17.71
223
0.05
2.96
Food-GC
Food-Sex
Food-Age
Food-A
food-Sex
food-Age
52.38
11.71
40.67
13.09
219
196
227
2908
13.39
2.77
7.27
385
710
2.77
Food-R1
Food-Sex
food-Age
Food-R2
Food-Sex
Food-Age
56.75
2.61
5414
85.17
2158
63.59
25.57
16.06
951
28.72
9.51
19.21
Source
55
P
TIME
Food-R1
Food-Sex
Food-Age
Table 5
Reliability of Measures Between Investigators
of the Present Study·
0060
0669
0033
0.071
0.832
0036
0.076
0165
0.084
0.006
0.009
0.046
M5
F
P
6
0.00
034
0.07
0.07
0.979
0.559
0799
0.791
100
0.74
094
0.93
1.03
024
277
2.51
0314
0625
0.101
0.118
0.49
0.81
0.27
0.28
TIME
R1
R2
GC
A
45202
61830
51622
4457
7.410
10136
8.463
0.781
R1
R2
GC
A
522.39
661.65
67789
3126
8564
10.847
11.113
0549
CYCLES
Note. Data represent mean ± SD. R1 = Raisin 1 R2 = Raisin 2. GC
= graham cracker. A = applesauce.
a Author and twO research assistants.
CYCLE
Food-GC
Food-Sex
Food-Age
Food-A
food-Sex
Food-Age
14.48
2129
639
7.18
150
028
191
254
257
253
0.56
140
0.28
0208
0600
0132
0045
0.112
0061
3.63
4.81
324
0009
0031
0.026
115
313
050
176
2.55
1.49
0336
0.080
0690
0145
0.114
0.221
0009
0.001
0.374
0219
0284
0.201
0695
0240
0844
TIME/CYCLE
Food-R1
Food-Sex
Food-Age
Food-R2
Food-Sex
food-Age
Food-GC
Food-Sex
Food-Age
Food-A
Food-Sex
Food-Age
0.11
0.08
004
0.14
005
0.09
0.23
0.18
0.05
0.44
0.09
036
003
0.04
006
011
359
1119
105
147
116
l.57
Note. R1 = Raisin 1. R2 = Raisin 2. GC = graham cracker. A = applesauce.
for solid food (graham cracker, 23%) from age 2 to
age 3 years and a further drop from age 3 to age 4 years
(12%). Although there are slight fluctuations from age
5 to age 8 years (see Table 3), these were not statistically significant (p < .084). The chewing of viscous
food (Raisin 1 and Raisin 2) showed a different developmental progression (see Figure 1). The decrease in
cheWing time from age 2 to age 3 years was 18%; from
age 3 to age 4 years, 14%; and from age 4 to age 7
years, 9% for each subsequent year. For pureed food
the major decreases in time occurred between age 2
and age 3 years (14.3%), age 3 and age 4 years
(27.8%), and age 5 and age 6 years (343%). Time
remained constant after age 6 years.
The changes in cycles with age were very similar
to those with time, except that the percent decreases
were smaller with age than with time. Consequently,
the most notable drop in the time/cycle ratio was
observed from age 2 to age 3 years for graham cracker
and raisin, but from age 3 to age 4 years for appleTable 6
Reliability of Measures Between the Investigator of the
Present Study and Investigators of an Earlier Study·
Source
Table 6 illustrates that none of the measures differed
between the 5-year-olds of this study and the 5-yearolds of the study by Schwanz et al. (1984); thus, the
third hypothesis was accepted with the exception of
time for graham cracker (p < .003).
On the basis of the above comparison and an
earlier comparison by Schwaab et al. (1986) showing
that the 4-year-old children of their study did not
differ from those in the study by Schwanz et al.
(1984), a developmental curve was established for
time, cycles, and the time/cycle ratio for all foods
(see Figure 1). There was an abrupt decrease in time
SS
MS
R1
R2
GC
A
77657
564.39
282.12
15467
TIME
2219
1613
7.84
455
R1
R2
GC
A
1518.92
82025
45113
21128
CYCLES
43.40
23.44
12.53
6.21
F
P
6
0.13
0.34
1039
006
0.719
0565
0.003
0.811
0.88
075
0.09
095
086
124
167
0.07
0361
0273
0.204
0.790
054
0.45
0.37
093
Note. Data represent mean ± So. R1 = Raisin 1. R2 = Raisin 2. GC
= graham cracker. A = applesauce.
a Comparison between Gisel (this study) and Schwartz, Niman &
Gisel (1984).
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43
Figure 1
Normative Data of Time, Cycles, and Time/Cycle Ratio
for Normal Children 2 to 8 Years of Age
18
~ Solid food
16
o
14
Viscous food
[22 Pureed food
12
U
IV
lJl
10
W
8
i=
6
~
4
2
0
2345678
2345678
20
~ Solid food
18
16
o
..r::
14
[22 Pureed food
lJl
12
\J
IV
3
IV
Viscous food
U
IV
U
( ; 10
'+-
0
8
~
IV
.D
E
:J
Z
6
4
2
0
2345676
2345676
I,B
WJ
1.6
o Viscous food
I~
2345676
Solid food
[22 Pureed food
12
U IP
~
.6
.6
.4
,2
o
2 3 4 5 6 7 6 '-----L2.l.--L
L6.l.7--LB..L.-~2aL.3.!.<4:.d.L<51:C6aL.7~8
3 4.l.....J
5
AGE (YEARS)
Note. Data represent means ± Sf. T /e = time/cycle ratio.
sauce. The possible clinical significance with respect
to the handling of food textures by a child is discussed
below.
44
Discussion
The findings of the present study expand on the earlier findings by Schwartz et a!. (1984) and Schwaab et
al. (1986) that food texture contributes significantly
to time, cycles, and the time/cycle ratio. In the
present study, the significant contribution of food
texture to time and cycles, but not to the time/cycle
ratio, continues with the exception of graham cracker.
As was done in previous studies (Schwartz et al.;
Schwaab et al.) this effect is attributed to the pureed
texture of applesauce. The results suggest that it is
easier to eat food with viscous or solid textures than it
is to eat pureed food. The significant interaction of
Raisin 2 with cycles may be influenced by the added
task of haVing to move the raisin from one side of the
mouth to the other before cheWing and swallOWing it.
The reason for the significant contribution of graham
cracker to the time/cycle ratio is not readily apparent;
however, the measure may interact with sex because a
significantly lower time/cycle ratio was observed
among boys than among girls.
A factor contributing to the increase in eating efficiency with age may be the change from primary to
secondary dentition. While 5-year-olds had only their
primary teeth, 9 of 36 children (25%) in the 6-year-old
group already had some secondary teeth. This age
group, more than any other, refused some of the
foods. Five children (2 boys, 3 girls) refused applesauce and 1 boy refused raisins. Since these are the
soft foods, these refusals are probably idiosyncratic
rather than related to an inability to chew because of
changes in dentition. The 7-year-old group showed
the most changes in dentition. Thirteen of the 26
children (50%) were either missing one or two teeth
or were in the growth phase of their secondary teeth.
Among 8-year-olds, 6 of 21 children (28.5%) were
changing their dentition.
The strong effect of food texture on cheWing efficacy is of great importance for clinical practice. Our
observation has been that Down's syndrome children
(Gisel et al., 1984) and some children with cerebral
palsy (spastic quadruparesis) eat solid foods more efficiently than they eat either viscous or pureed foods.
This is apparent in the lowest increase in time among
the three food textures anel no increase in cycles
(Gisel et a!.). Therefore, children with Down's syndrome or cerebral palsy can be offered solid foods in
their daily diet. However, children with oral-motor
problems often resist the introduction of solid foods.
This is particularly the case with children who do not
wean successfully, that is, do not fully make the transition from nursing to the feeding of solids (Sleight &
Niman, 1984). Such children may retain sucking and
biting reflexes into adulthood, or develop aberrant
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oral-motor patterns. Some authors suggest that therapeutic intervention should be initiated before aberrant behaviors are established (Williamson, 1981) and
that early intervention may playa critical role in minimizing dysfunction (Largo, Molinari, Weber, Comenale-Pinto, & Duc, 1985)
To deal with solid food resistances, occupational
therapists often suggest the use of whole-wheat bread
sticks, wafers, and crackers. These are transition
foods; the child can chew them or to let them melt in
the mouth. Similarly, vegetables cooked to a soft consistency can be mashed in the mouth. The tacky consistency of solid foods seems to make it much easier
to retain these foods in the mouth so that less food
spilling occurs than with pureed foods. Therefore,
Sleight and Niman (1984) suggest that solid foods
elicit age-appropriate eating behaviors and they regard the use of appropriate textures as therapeutic.
Additionally, the experienced therapist positions the
patient properly, uses digital oral stimulation and jaw
control, and places the food over the molars. However, the efficacy of these maneuvers has not yet been
systematically investigated.
Significant effects of age on the time variable
were shown for all food textures except for graham
cracker. This may indicate that cheWing skills mature
earlier with respect to the solid food texture than with
respect to the pureed and viscous textures. Such an
interpretation suppOrts our proposition that a feed
ing-impaired child may respond more successfully if
given a food texture that can be eaten in a more mature way early than if given textures that can be handled in a mature way only much later.
The effect of age was also seen in the decrease of
cycles for applesauce but not for the other textures.
Age did not interact with the time/cycle ratio. These
findings differ from earlier studies (Schwartz et al.,
1984; Schwaab et al., 1986) where no effects of age
were shown on any of the three variables. The lack of
effect of age on the time variable in the earlier studies
may be due to the narrower age ranges studied, that is,
a range of age 2 years to age 4 years by Schwaab et al.
and a range of age 4 years to age 5 years by Schwartz et
at. A more plausible explanation for significant
changes in cheWing time from age 5 years to age 8
years may be that there is a maturational spurt in eating efficacy. Children change their dentition during
this period and therefore have a stronger anatomical
eating apparatus available for the task. Although the
absolute decreases in cheWing time between the ages
of 5 and 8 years seem small, their percent contribution ranged from 8% to 33%. These values represent
changes in normal development from one year to the
next and place the magnitude of eating impairments
among children with Down's syndrome or cerebral
palsy into proper perspective. Durations twice as long
as those of normal age mates have been observed
(Gisel et al., 1984) in eating-impaired children.
Finally, both Schwartz et a1. (1984) and Schwaab
et al. (1986) found no significant differences in sex
for either time, cycle, or the time/cycle ratio. Both
authors had slightly higher values for boys than for
girls in the categories of raisins and graham cracker,
but not in the category of applesauce. Our data in
general reflect higher values for girls than for boys
and show a significant food-sex interaction for applesauce for both time and cycles but not for time/cycle.
A closer inspection of the data revealed that this difference could be attributed to the prolonged time and
cycles of girls in the 5-year-old group, but not to girls
in the other age groups. Since these are cross-sectional data, this finding may well be spurious. Similarly, the significant difference between the data of
Schwartz et al. and myself in this stLldy in chewing
time of graham cracker must be attributed to the unusually low variation in cheWing time found in the
5-year-old group of this study, which may be unique
to the sample studied and not representative of all
5-year-olds.
In summary, the consistent use of food texture
will allow the clinicians to establish a reliable baseline for feeding evaluations. The data presented here
may be used as a basis of comparison between normal
and eating-impaired children How strongly different
food textures influence the therapeutic process remains to be determined
Acknowledgments
I thank Lucie Germain and Hannah Schwob for many hours
of Videotape analysis. The financial assistance through a
gram by AOTF is gratefully acknowledged.
References
Ebel, R L (1951) Estimation of reliability ratings.
Psychometrika, 16, 407-424.
Gisel, E. G, Lange, L J., & Niman, C. W (984).
CheWing cycles in 4 and 5-year-old Down's syndrome children: A comparison of eating efficacy with normals. American journal of Occupational Therapy, 38, 666-670.
Gisel, E. G., & Pollock, N. (in press). Assessmenr of
oral-motor deve!opmenr: Review of the literature. Occupa-
tional Therapy journal of Research.
Gisel, E. G, & Schwob, H. (in press). Relation of a
form-discrimination task and chewing behavior in normal 5
to 8-year-old children Occupational Therapy journal of
Research.
Johnson, C. B, & De itz, J C. (1985) Time use of
mothers with preschool children: A pilot study. American
journal of Occupational Therapy, 39, 578-583
Largo, R. H., Molinari, L., Weber, M., Comenale-Pinro,
L C, & Due, G (985) Early development of locomotion
The American journal of Occupational Therapy
Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/930354/ on 06/15/2017 Terms of Use: http://AOTA.org/terms
45
Significance of prematurity, cerebral palsy and sex. Developmental Medicine and Child Neurology, 27, 183-191.
Ottenbacher, K., Dauk, B.S., Grahn, V., Gevelinger,
M., & Hasset, C. (1985). Reliability of the behavioral assessment scale of oral funcrions in feeding. Americanjournal oj
Occupational Therapy, 39,436-440.
Schwaab, L. M., Niman, C. W., & Gisel, E. G. (1986).
Comparison of chewing cycles in 2-, 3-, and 4-year-old normal children. American journal ojOccupational Therapy.
40,40-43
Schwartz, ]. L., Niman, C. W, & Gisel, E G. (1984)
Chewing cycles in 4- and 5-year-old normal children: An
46
index of eating efficacy. Americanjournal ojOccupational
Therapy, 38, 171-175.
Sleight, D., & Niman, C. (1984). Gross motor and oral
motor development in children with Down syndrome: Birth
through three years. St. Louis, St. Louis Association for Retarded Citizens Inc
Stratton, M. (1981) Behavioral Assessment Scale of
oral functions in feeding. American journal oj Occupational Therapy, 35, 719-721.
Williamson, G G. (981) Pediatric Overview. In B. C.
Abreu (Ed.), Physical Disabilities Manual (pp. 77-98). New
York: Raven Press.
January 1988, Volume 42, Number 1
Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/930354/ on 06/15/2017 Terms of Use: http://AOTA.org/terms