Oral Motor and Feeding

Oral-Motor Delays and Disorders

A child with an oral-motor disorder has trouble controlling their lips, tongue, and jaw muscles, which makes mouth skills, from talking to eating to sipping from a straw, tough to master. While these are physical issues, there are also oral-motor disorders, and they often have a neurological component. 

A child with these disorders may:

  • have a droopy, or “long” face (their mouth frequently hangs open)

  • refuse to eat food that needs to be chewed

  • gag frequently when eating

  • weigh less and be shorter than other tots their age

  • have trouble sticking out their tongue or moving it from side to side

  • be hard to understand

  • drool past the age of 18 months

  • lisp excessively

  • take extra time to form words while speaking

  • use mostly vowel sounds after 18 months (“aah-aah” instead of “mama”)

  • leave out some consonants in words at age three ( “at” instead of “cat”)

  • add extra sounds to words (“animinal” instead of “animal”)

  • substitute certain sounds when speaking (“wittle” instead of “little”); note that this is common in young toddlers

  • have trouble stringing together syllables in the right order (“minacin” instead of “cinnamon”)

Oral - motor functioning is the area of assessment which looks at normal and abnormal patterns of the lips, tongue, jaw, cheeks, hard palate and soft palate for eating, drinking, facial expression and speech to determine which functional skills a client has to build on, and which abnormal patterns need to be inhibited or for which compensation is needed.  Structure (lip, tongue, jaw, cheek) affects oral motor control. Recognition of the patterns is essential to adequately attain baseline the individual's current skills, so that an appropriate plan of intervention can be developed. That plan will include mealtime interventions (positioning, handling techniques, adaptive equipment, etc.), as well as oral motor interventions to enhance control of the lips, cheeks, jaw and tongue. 

Oral-motor patterns must be directly observed. It's extremely important to do a thorough oral - peripheral examination on clients of all ages.  The individual presents many different patterns at once with varying degrees of severity and skill, making identification of baseline oral motor skills challenging for the therapist. Different patterns may be observed with different food types and in response to different types of stimuli. For example, a client may show good control and normal patterns with denser pureed foods, but then have great difficulty controlling fluids, showing abnormal patterns such as jaw and tongue retraction, and incoordination of suck/swallow/breathing, resulting in coughing and neck hyperextension. Be certain to assess oral-motor patterns by presenting a variety of food densities, such as thick liquids, thin liquids, semi-solids, crunchy and chewy solids (may be wrapped in thin fabric for safety) and observing the oral-motor patterns seen with each item.

Feeding Disorders (Motor- and Sensory-based)

Feeding and swallowing disorders may be due to difficulties with the motor and/or sensory systems. Motor difficulties stem from problems with the structures of the oral mechanism (i.e., mouth, lips, tongue, and jaw). Feeding difficulties may affect both children and adults but are most obvious as a child strives to acquire new feeding skills or as a child or adult experiences a medical insult to the brain or nervous system. Some pediatric examples include infants who have difficulty latching onto a nipple, children who have difficulty chewing and breaking down solid foods into manageable pieces, children who use a “reverse” swallow, or children who have difficulty removing food from a spoon because of insufficient lip closure.

Sensory processing difficulties can negatively effect eating processes (e.g., being picky eater, especially regarding food textures; having abnormal responses to taste and smell). Some children may be predisposed to sensory-based feeding disorders. For example, children with a history of Broncho Pulmonary Displasia (BPD), cardiac defects, drug exposure, gastrointestinal diseases, prolonged periods of intubation or suction, or prolonged NG tube feeds may be at risk. The population of children with sensory-based feeding disorders often includes but is not limited to medically involved or “medically fragile” children.