Transcript Oral Motor Skills and Feeding

Debra Lauharn, M.A., OTR
Christin R. Dowd, M.A., CCC-SLP
AGENDA
1. Anatomy and physiology of the oral/pharyngeal structures for feeding skills
2. A sequential look at development related to feeding skills
3. Oral motor treatment and feeding
Anatomy
 Lips
 Teeth
 Tongue
 Palate/Velum
 Epiglottis
 Trachea
 Esophagus
Normal Development and
Feeding Skills
 Please refer to handout
Initial Observations
 Look at motor patterns and body stability; positioning
options
 Determine sensory needs: gravitational security,
tactile/auditory/olfactory/gustatory defensiveness
 Assess problems with function of individual oral
structures (jaw, kips, tongue, cheeks, palate)
 Type of food child is eating
 Behavioral issues: rule out medical, then determine if
it’s a sensory vs. behavioral issue
Medical Issues To Consider
 Reflux: The backward flow of food or liquids that have
already entered the stomach.
 Crying after eating
 Excessive burping
 Elongating of body (head to right and up)
 Projectile vomiting
 Not sleeping through the night
* medications
Nutrition
Approximate Formula Intake
Age in
months
Ounces
per day
1
2
3
4
5
6
7
8
9
10-12
20-29
23-35
27-35
29-40
32-44
28-36
32
28
24
16-24
Calories
Age
Calories
0-6 months
Lbs. x 52
6-12 months
Lbs. x 48
1-3 years
900-1230
4-6 years
1300-1715
7-10 years
1650-1970
Rules To Follow
1. 1 tbs. portion for each year of age (1tbs. for 1 year; 2 tbs. for 2 years)
2. Offer a protein, fruit or vegetable, and a starch for each meal including snacks
3. Make all food fun!
Positioning:
What happens in your hips passes to your lips!
 Mobility develops from proximal to distal; precise
interchange between stability and mobility that
influences oral motor skills.
 Oral stability is dependent upon the development of
neck and shoulder stability that is in turn dependent
on trunk and pelvic stability.
 Lips, cheeks, and tongue are dependent on jaw
stability.
 Position the child to support the head and trunk so
that the hands and mouth are free to work.
For Safety Sake











Children should always be fed in a highchair or the lap of their parent
No cracked or sticky/gummy nipples (replace them)
Children under the age of 3 should not be given hard candy
No chocolate of any kind before 1 year
No honey before age 1
Hot dogs, peanuts, peanut butter, whole grapes, and candy are choking
hazards.
Begin open cup drinking at 6 months
Never lay a baby down with a propped bottle
Never give a baby a bottle or sippy cup to keep in their bed to pacify
them. If you must, only fill it with water
No bottles after 15 months
No cereal in bottle!!!!!
Sensory Needs
How comfortable is the child in his/her feeding environment
 Change the noise, lighting and visual stimuli
 Prepare the body and mouth for eating (PRR/brushing,




swinging, proprioception, vibration, massage)
Changing food (temp, taste, texture) slowly
Hyposensitivity (ASD, low tone) prefer to drink and not eat
or prefer to eat soft/easy foods. *add spice to their life
Hypersensitivity (CP, high tone) use smooth bland food
Be social and engaging during meal times.
Techniques For Dysfunctional Oral Structures
(Lips, jaw tongue and cheeks)
 Jaw: slack/low muscle tone or jaw thrust
open/increased muscle tone and teeth grinding
 Check positioning of the hips/shoulders/chin (reduce





hip extension or posterior tilt and shoulder retraction,
and position the chin down)
Give jaw control/support as needed
Calm/organize the mouth with vibration
Ice/cold increases swallow reflex (ie ice straw)
Chew tubes
Bite tip on Z-Vibe (front to back on left and right)
Chewing Techniques
 The goal is to teach a graded, lateral chew with tongue-tip
dissociation and movement across midline.
 Graded lateral chew with tongue tip pointing: chew tube or Z-Vibe
perpendicular to the lateral molar ridge as you support jaw as
needed, encourage 2-3 bites. Alternate sides 4-5 times. Intro.
Veggie stix or ice straw
 Tongue tip Pointing and movement of bolus to lateral incisor and
molar ridge: place tube/stick food from molar ridge to lateral
incisor and alternate sides
 Tongue-tip pointing and tongue lateralization across midline:
present stick-shaped food or tube on lateral incisor and bit quickly
present bolus to opposite lateral incisor.
 5 point bite: present the stick shaped bolus perpendicular to the
lateral molar ridge, to the incisor, to the front, and move bolus
around midline to opposite molar ridge.
Tongue Retraction
 In tongue retraction the tongue pulls back into the
posterior ¾ of the mouth or in the pharyngeal airway.
Can be related to low or high muscle tone with neck
hyper extension or cleft palate
 Work on building tone by bouncing on a ball or lap
before positioning for eating
 Child is prone over lap then stroke tongue from middle
to tip toward lips
 When seated, keep child’s chin tucked down, gently
tap/hold under chin to increase tongue tone/stability,
vibrate from middle to tip and lateral to tip (Z-vibe)
Tongue Protrusion
 Low tone tongue moves forward beyond the border of the
gums and may stick out between the lips and may cause
food to be pushed out of the mouth
 Build tone in the trunk and provide proximal stability by





compression of spine through shoulders, bounce on lap or
ball
Position in feeding chair with increased support of the trunk
and feet
Feed to the sides of the mouth to improve tongue
lateralization
Thicken liquids
Present flat bowl spoon in horizontal position midway and
vibrate to tip (Z-Vibe)
Offer vibration with battery operated toothbrush or Z-Vibe
Lip retraction
 Lip retraction occurs with increase muscle tone pulling/drawing the
lips and cheeks backward to form a tight horizontal mouth, making it
difficult to suck from a bottle or remove food from a spoon. Lip pursing
occurs when the child attempts to counteract the effects of retraction.
Before each meal:
 Check sitting position for too much hip extension/shoulder






retraction/head extension
check for overstimulating environment and sensory properties of the food
given (spicy/bland)
Midline orientation/3 point massage (cheeks, facial folds, upper lip)
Reduce hypertonicity in cheeks with vibrating hands on each cheek forward
or vibrating bug/Z-vibe
Lip massage: rub infadent finger or roll cut down toothette from the R
corner to midline, the L corner to midline *DO NOT CROSS MIDLINE
Facial molding with towel or flat palms move the cheeks forward and
chin/lower lip upward
Straw drinking or cup drinking (with cut out cup)
Low tone cheeks/lips
 Hypotonia in the cheeks reduces the strength/skill of the
lips causing inefficient sucking and bolus collection,
excessive drooling and open mouth, decreased awareness
and overstuffing/food pocketing. Before each meal:
 Increase tone in body with bouncing and compressions
 Engage midline orientation with 3 point massage
 Play patty-cake and other games to the cheeks that provide firm






input to sides of the face
Lip massage: rub lips from midline out ward to sides (stretch)
Explore mouth with ice, spicy, tart/sour foods to increase pucker
“Hide” soft food/banana or cheese in cheek pockets and have child
squeeze side of cheek to push food to center
Vibrate to increase awareness
Straw drinking
Three Point massage…
Straw drinking/Cup use
 Use a squeeze box with short, thick straw *place straw at
corner of mouth and quickly move to midline (repeat on
each side).
 Use aquarium tubing in squeeze bottle
 Use cork or medium bead to adjust the length of straw in
the mouth. The portion that enters the mouth should be
very short at first.
 Use thick liquids (honey consistency) with straw or cup (ie.
milkshake, applesauce, baby food)
 Use cut out cup and push corner to corner to improve lip
closure and decrease tone *use jaw control as needed.
*Try club soda and juice to increase awareness of liquid
Incorporate solid foods in therapy
 Cheetos and other junk food are good starter foods
(they melt)
 Shave a carrot or potato for teething, texture, and
proprioception/biting
 Use veggie stix for chewing
Prevent Food Jags
 Food jags are when a child will only eat certain foods
and may demand that they are presented the same way
(ie.certain label food, on a stick, wrapped in paper
towel)
 The brain does not produce pathways to accept other
foods
 Steps to prevent food jags
Works Cited
(2010). Retrieved September 20, 2010, from Mealtime notions llc: http://www.mealtimenotions.com
C Drobek, C. M. (2005). Building Blocks of Pediatric Therapy. Detroit: Children's Hospital of Michigan Detroit Medical Center/Wayne State University.
Harrison, T. (1996). Feeding your 1 to 5 year old building good eating habits. Okemos, Michigan: United Dairy Council of Michigan.
K. Toomey, E. R. (2007). When Children Won't Eat The SOS Approach to Feeding. Farmington Hills, MI: Abilities Center.
Klein, S. M. (1987). Pre-Feeding Skills. Tucson: Therapy Skill Builders.
Logemann, J., (1993). Manual for the videofluorographic study of swallowing (2nd ed.) Austin, TX: Pro-Ed
Overland, L. (1996). Feeding Therapy: A Sensory Motor Approach. Talk Tools Inoovative Therapists International.
Winstock, A. (2005). Eating & Drinking Difficulties in Children. Oxen: Speechmark Publishing Ltd.