Oral Motor Deficits

How does a parent know if their child has low muscle tone of the oral mechanism?

The muscles of the oral mechanism include the muscles of the lip, tongue, and jaw.  Very often when these muscles are weak your child will present with an open mouth position with the tongue placed anteriorly. They might experience severe drooling and have difficulty eating, drinking and maintain a closed seal around the straw,  Weakness of the lips, tongue and jaw will most certainly impact your child’s ability to produce the precise articulation (movements of the tongue, lips and jaw) and will likely result in your child’s ability to produce understandable speech.   Additionally, low tone may result in difficulty chewing, swallowing and  can result in an inability to stick the tongue out, or move it from side to side.  Drooling can also be caused by weakness in the muscles of the mouth.  Strengthening these muscles can be very important in improving both feeding deficits and speech intelligibility.

During mealtime, weakness of the muscles of the lip, tongue, or jaw can have a negative impact on the ability to maneuver the food laterally and posteriorly in the mouth as well as efficiently removing the food from the spoon or fork, and swallowing.   A heightened gag reflex and frequent choking may be caused by weak oral motor muscles, which make feeding your child quite challenging.    

Are there any quick fixes?

When a child presents with oral motor weakness, I recommend a structured oral motor program designed to strengthen the lips, jaw, and tongue.  Parents are asked to participate in these routines several times a day before feeding and to increase the difficulty as the child’s strength, awareness and range of motion increases.  The following are some activities and tools that I recommend to increase your child’s strength and abilities to feed and produce intelligible speech.

Chew Tube:  (textured and not textured)

• ·         Place laterally along teeth.  Allow your child to bite on each side. 
• ·         Place centrally on your child’s lips/mouth and allow him/her to round his/her lips while creating as tight of seal as possible for as long as s/he can maintain it.
• ·         Place laterally in-between cheek and teeth so child can feel the ridges/bumps on chew toy.
• ·         Swipe his tongue so he can feel the texture and receive sensation orally.
•  

Jiggler:

• ·         Start on child’s hands and move to his shoulders so as to prepare him/her for the activity. 
• ·         Using slight pressure, move the jiggler from ear to corners of the mouth several times or as long as s/he will tolerate it.
• ·         Allow your child to bite on the jiggler so s/he can receive sensory input orally.

Probe and /or Z-vibe:

• ·         Place laterally and posteriorly towards molars. 
• ·         Apply slight pressure and encourage your child to bite down on each side. 
• ·         Place laterally in-between cheek and teeth so your child can feel the ridges/bumps and vibrations on probe.
• ·         Swipe his tongue so he can feel the texture and receive sensation orally.
• ·         Put slight pressure against your child’s tongue and encourage him/her to push back with their tongue.

Straws and Sippy Cups: (using a straw will help stabilize your child’s jaw and keep it from shifting; build his/her strength and musculature)

• ·         Encourage your child to suck through the straw while holding his/her chin stable with your thumb and forefinger.
• ·         Discourage him/her from biting on the straw while drinking.  Very often a child will attempt to bite on the drinking straw to stabilize their jaw and keep their head from moving.
• Horns and Whistles:
• ·         Allow your child to explore the tools/toys orally. 
• ·         Place in between lips.
• ·         Discourage your child from biting on the tools/toys.
• ·         Encourage lip rounding around the horn for as for as s/he can maintain the position while blowing.
• ·         Model blowing for your child.

Oral Motor Games and Activities:

• ·         Fish faces – Use tactile prompts to bring your child’s cheeks together
• ·         Massage – With firm touch using one or two fingers, massage from their ears to the     corner of his mouth in a circular motion (along his teeth)
• ·         Lip smacking
• ·         Blowing kisses and raspberries
• ·         Bubble blowing  and popping on your child’s cheeks
• ·         Tongue clicking
• ·         Place something sweet around your child’s lips so he can attempt to use his tongue to lick it off.

As with any concern you may have about your child’s development, please contact you pediatrician and or a qualified speech language pathologist.

Please see Oral Motor and Sensory Tools for information on recommended products available at Amazon.com's Diane's Picks.