So Ava continues to do well with her feeding hierarchy. She's pretty much just accepted that she has to take a bite of the food she doesn't like in order to receive more of the food she wants.
Her technique so far has been to pop that food in her mouth and let it sit front and center on her tongue as if I had put something horrendously nasty in there. She grabs her milk and swallows it down as if it were a pill-tasting it as little as possible. In the name of substantial progress, I was letting the fact that she was treating perfectly yummy food like dirt go.
Well, yesterday morning, in the middle of our weekly OT session I had set her plate up with small pieces of sausage. They were the size of large blueberries. A bowl of cheerios to use as a reward had been set to the side. She asked for cheerios. I told her she'd need to eat a small bite of sausage first and I stepped away from the table to grab a knife. Usually I cut a tiny sliver off the larger piece of sausage for her to try.
Well, when my back was turned she popped the entire piece of sausage in her mouth and tried to swallow it whole by gulping several large gulps of milk. I turned around to see her choking back up all the milk and finally (thankfully) the piece of sausage too right back into her lap.
I calmed her down, cleaned her up, and told her I was proud of her for trying such a big piece. I then tried to explain that we can't swallow such big pieces without chewing them first. I'm pretty sure she didn't really get it.
So now we're working on teaching her to put food in the side of her mouth and to chew it up in an exaggerated way. We're teaching the technique with foods she likes first. Once she's really good at it, I'll have to insist she actually chew the things she doesn't like before swallowing them and getting a reward.
I'm pretty sure that this next step forward is going to be a big struggle.