Oral Motor Development Issues

A young boy mouths a ball with holes.
A young boy mouths a ball with holes.

Prior to creating any intervention strategy, you must first complete an assessment.  There are three main components to oral motor deficiencies that we will be discussing today. They are sensory, motor, and behavioral.  A child can have deficits in one, two or all three of these areas. 

For additional information about strategies to address eating, visit the Activities of Daily Living.

Sensory Deficiencies

Oral sensitivity is a physiological issue due to neurological differences.  It is a physical problem related to sensory processing.  Children diagnosed with autism, septo-optic dysplasia, and other neurological disorders frequently exhibit sensory processing problems.  Oral sensitivity should not be confused with oral defensiveness which is a psychological issue based on past experiences.  There are behavioral causes to oral defensiveness which we will discuss later. 

The development of trust is of utmost importance when working with children who have oral sensitivity.  New sensory experiences are stressful situations.  Recognizing and respecting the responses of a child, while slowly introducing changes to routines is the best method of intervention.  It may take a child months or years to improve his or her sensory processing skills.

Sensory- based oral motor problems are focused on the characteristics of food and liquids including texture, smell, temperature, or taste.  A child can be hyper- or over sensitive, or hypo or under sensitive to these characteristics.  Evaluate the current preferences of a child related to texture, smell, temperature and taste. Then offer new learning environments which introduce slight developmental changes. 

Texture

For example, the texture of food and liquid can alert the senses or calm the senses, as texture provides tactile sensory input.  Liquids are typically the least alerting texture.  After liquids, smooth puree and then lumpy puree slowly alert the senses, offering more input.  Next mushy and soft foods increase alertness, then ground or chopped foods increase alertness a bit more.  Firm and crunchy items that can be easily dissolved challenge the senses even more, followed by crunchy items that are hard.  Finally, foods that contain mixed textures are the most alerting to the body, such as fruits with skins still attached, or yogurt with fruit mixed in inside.

An autistic child who enjoys crunchy items such as potato chips and crackers for example, may have difficulty with mushy foods like soft cooked vegetables.  Active Learning intervention for this child would introduce crunchy but easily dissolved foods or firm foods during play activities. 

        • For example, a child could use hard vegetables such as carrots or celery as drumsticks in music therapy. 
        • Crushed cereal could be used in art projects. 
        • Chocolate chips can be used in sensory activities to increase a child’s tolerance to soft food items, such as chocolate chips that may melt with touch. 

It is not unusual to have a child who exhibits a specific sensitivity in the mouth, but another type of sensitivity of the hands.  For example, a child might eat smooth puree foods, or drink only liquids, but will only touch dry, hard items with his hands.  

Temperature

A young child puts his mouth on a large icicle while his mom holds him.
A young child puts his mouth on a large icicle while his mom holds him.

Some children have difficulty with the temperatures of foods.  Room temperature foods are the least alerting to the body, followed by warm items.  Cool foods, such as those found in the refrigerator are next, followed by cold foods – such as those items found in the freezer.  Hot items and finally foods with alternating temperatures are most alerting.  A piece of warm apple pie with a scoop of cold ice cream creates alternating temperatures and can be a difficult sensory experience to process. 

Give the child opportunities to use the mouth to explore various materials that have differing temperatures. If you think about it, all materials have a temperature that varies between hot and cold.

        • Playing with ice cubes might be too much, but could they mouth a cold teething ring in a Little Room or on a Position Board?
        • A cloth bag of rice that has been warmed in a microwave, might be interesting to explore with lips and tongue. 
        • Comparing cold metal to warm metal can be interesting. Place metal spoons and other metal objects in pans of ice water or very warm water. Let the child compare or notice the changes in temperature as the objects go from one pan to the other.

Taste

Taste is another characteristic of food that influences a child’s awareness of the environment.  Bland foods are least alerting to the senses, followed by savory flavors which includes onions and spices like sage or rosemary.  Sweet items follow, then salty and spicy.  Spicy items may include pepper, curry, or cumin.  Sour flavors are more alerting to the body and include citrus foods such as oranges or lemons. Lastly bitter flavors such as cabbage, Brussel sprouts, and radishes are the most alerting. 

Oral motor activities should be fun learning experiences offered outside of mealtimes. Mealtimes focus on food intake instead of necessarily the developmental process of acquiring oral motor skills.

        • Offer you child or student various fruits or vegetables to play with during an adult-child interaction.
        • Use spice bottles such as cumin, curry powder, onion powder, sage or rosemary.  Add dry rice or peas to the bottles with just a pinch of the spice. Tape or glue the shaker top onto the bottle and let the child shake and mouth the bottle. 
        • Give your child Quak sticks or honey dipping sticks with just a bit of something sweet like pudding or sweet potatoes on it to explore with the mouth. 

Pressure

Lastly, the pressure applied to the lips and tongue is another tactile characteristic that occurs during mealtimes.  Deep pressure is least alerting to the body where light pressure is most alerting.  Be aware of vibrating tools as they can provide low or high amplitudes of stimulation, and these variations can cause children to respond differently.  The skin around the mouth is an extremely sensitive area.  Simply attempting to bring an object to this part of the body can be viewed by the child as aversive.  The introduction of oral motor activities performed improperly can have a negative effect on oral motor development.

        • Observe which types of objects the child prefers and notice how the child makes contact with his mouth while in independent play in such environments as the Little Room and Resonance Board.
        • Hold various preferred objects near the child’s mouth for the child to explore as she chooses during adult-child interactions. Make note of how the child uses his lips, touch and teeth to explore the object. 

Motor Issues

Motor problems affecting oral motor development will be the next area we explore.  A child might have difficulty or exhibit premature movement of the lips, tongue, jaw, teeth, head or other part of the body.  These motor challenges can result in immature oral motor skills. 

There is a relationship between sensory perception and motor movement.  The more sensory input received, the harder the muscles will work and the greater the impact on the motor pathways.  We move to experience sensory input, and sensory input influences movement.  Participation in daily oral motor activities allow a child the opportunity to progress through the Dynamic Learning Circle to experience new movements of the head, lips, mouth, cheeks, and tongue.   

A young child explores a wooden flute with her lips and tongue.
A young child explores a wooden flute with her lips and tongue.

Children with limited mobility or with oral motor deficiencies must be allowed to engage the mouth to explore.  Use of the Little Room, Support Bench, Position Boards, HOPSA Dress, Activity Boards or Velcro Vests may provide enriched environments for this learning to occur. 

When time allows, adults may also assist in providing oral motor activities from which motor skills can be practiced.  Such skills may include opening and closing the mouth, moving the lips, biting down, and moving the tongue in and out, up and down, laterally and rotary.

When presenting an object for a child to explore using the mouth, offer it in a position that allows the child to move.  Present the object near the mouth, close enough so that when the child moves independently, contact is made.  The child, not the adult, makes the decision whether or not to repeat movements. 

Behavioral Issues

Behavioral-based oral motor problems include such challenges as picky eaters, aversion to eating, food refusal, and limited eating.  Past medical, sensory, motor, psychological or social experiences influence our reactions to familiar circumstances.  Behavioral responses are a form of communication and should be acknowledged.  If we can identify the real reason for the behavior and address the underlying issue, behavioral responses will decrease.  

Why might a special needs child primarily mouth objects?  The child could be trying to explore the environment, gain attention from adults, receive sensory input, or is simply relating to the world at his or her emotional level of development.  Responding in the wrong manner can results in continued behavioral actions.   

Take time to review the basic principles of Active Learning including the Dynamic Learning Circle and the Five Phases of Educational Treatment to understand behavioral based reasons for a child’s activity.   

Video Examples of Oral Motor Issues and Tips to Facilitate Development

Oral Motor- Exploration of Chime

Description: In this video of a young boy, notice the protrusion of his tongue. He is unable to eat liquid or food by mouth and receives his nutrition from a gastro-tube. The chime activity allows him to gain head control and allows for exploration with the mouth.

 

Oral Motor- Using a Spoon and Cup

Description: The 2-year-old girl in this video is introduced to the use of a spoon and cup. Although in this video her foods are pureed, she is currently eating table mashed foods.

 

Oral Motor- Interacting with Hard, Crunchy Candy

Description: The 6-year-old boy in this video receives all of his nutrition from sippy cups and takes no food from a spoon. In this video he interacts with hard, crunchy candy broken into fine pieces, as he is reluctant to touch mushy textures.

 

Oral Motor- From Smooth to Lumpy Puree

Description: This boy has oral sensitivity to lumpy textures of food and is resistive to feeding himself at meals. In this video the staff increases food texture from pudding, which is sweet and has a smooth puree texture, to cottage cheese, which is a more salty or sour flavor and has a lumpy puree texture.

 

Oral Motor- From Sippy Cup to Open Neck Bottle and Spoon

Description: Prior to starting any meal, this boy is offered the opportunity to interact with the tools to be utilized during that meal. This video shows meals two months apart and by the second recorded dinner, the sippy cup has been replaced with an open neck bottle and a spoon is introduced during dinner.

 

Oral Motor- Vibrating Toothbrush

Description: In this video, a boy is presented with a vibrating toothbrush. He is allowed to become aware of the toothbrush, to experiment, explore and repeat his actions.

 

Oral Motor- Hard Candy and Licorice

Description: In this video a boy moves a hard candy in his mouth (to ensure safety, the candy was attached to a string). He is also introduced to licorice with the use of a Buncher, which allows him to hold it independently.

 

Oral Motor- Learning to eat with a Spoon

Description: In this video, we observe a boy who is learning to eat with a spoon which requires him to grasp the spoon and bring it into his mouth before he can rack the food off with lips and teeth. He is not yet able to scoop food independently.

 

Oral motor development collage