What are oral motor dysfunctions? When a child has difficulty controlling their lips, mouth, tongue and jaw muscles, it leads to problems eating, speaking and swallowing. There are two parts of the swallow: oral and pharyngeal
About oral-motor and oral-sensory problems
The oral-motor aspect of eating involves how the mouth muscles function: how strong the muscles are, how well they coordinate the range of motion and how far they can move as they manipulate food in the mouth. The oral-sensory aspect of eating involves how the mouth tissues perceive sensory information such as the taste, temperature and texture of food. Children have can problems with either part of the eating process or both; there is often overlap with feeding disorders.
Some children may be hypersensitive to oral stimuli, causing them to gag, grimace or have other strong reactions to certain types of food. Others may be hyposensitive (in other words, under-responsive): They may not feel food in their mouths or may let it drop out of their mouths without realizing it.
Some children with oral-sensory problems can have a feeding aversion to how foods feel or taste but will have no problem putting other things in their mouths. Children with general oral aversions will gag or vomit in response to anything in their mouths.
Oral motor dysfunction is a common issue in children with cerebral palsy (CP). Drooling, difficulties with sucking, swallowing, and chewing are some of the problems often seen. In this study, we aimed to research the effect of oral motor therapy on pediatric CP patients with feeding problems.
Dysphagia is the medical term for difficulty swallowing. Typically, if a person has the condition, it’s because the esophagus cannot move food and liquids from the back of a child’s mouth to the stomach. The muscle coordination in the face and neck is a complex and intricate set of movements that allow a person to breathe, swallow, and talk. A person with Cerebral Palsy is prone to muscle impairment, even in the face and neck region.
Dysphagia can happen to anyone, but it’s a fairly common condition among children with Cerebral Palsy or other conditions that affect the central nervous system, or those that have endured brain injury. According to medical research, as many as 90 percent of children with Cerebral Palsy may show symptoms of dysphagia.
A child that has an occasional mishap while swallowing food or liquids may not have dysphagia, but if it happens regularly, it’s highly recommended that the child be evaluated for oral-motor dysfunction.
Vibration and oral motor therapy Research
Children who have rare conditions may display difficulties with feeding and swallowing secondary due to the abnormality of the brain (one or more clefts which are filled with cerebrospinal fluid. Patients with brain deformity sometimes have varying degrees of feeding difficulties due to hemiparesis(weakness or paralysis affecting one side of the body),developmental delays, quadriparesis (weakness or paralysis affecting all four extremities), and reduced muscle tone (hypotonia).
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Difficulties can range from relatively minor difficulties in coordination of oral movements causing eating to be slow and with excessive spillage, to severe in coordination of the swallowing mechanism, causing upper respiratory infections or aspiration pneumonia. Failure to thrive is another diagnosis that can coexist with brain injury. Children with this diagnosis often take longer than 30 minutes for their mealtimes, which take away from the nourishment absorption. Other issues related to brain malformations include chewing/ movement and sensory problems.
Low muscle tone can affect the ability to chew and orally manage food. Children with low muscle tone will benefit from therapy that will work on gaining strength with tongue mobility. These children often have food fall out of their mouths or drool.
Children with a brain injury can be over-sensitive or under-sensitive to touch, texture, and temperature. This can lead to children refusing to try new food items, turning their head in refusal or in some cases, gagging and vomiting. For example, advancing textures from smooth purees to meltable solids (Cheeto) is very difficult. Other children have the opposite problem and under-react to food items near their faces. They are unable to know how large of a bite they took, where it is in their mouth, or how to move it around in their mouth. Often times they will take too large of bites spit food out or swallow items whole. A child who overreacts or under-reacts to touch around the face would benefit from a feeding program that desensitizes or sensitizes him to touch in and around the mouth. If your child is oversensitive to touch, it is best to begin touching him (with your food or spoon) outside the mouth and slowly work up to touching him inside the mouth. If your child is under-responsive to touch, you will want to bombard him with input from different types of touch and texture. For example, provide spicy or cold food items, or offer a variety of dips.
It is best to approach feeding difficulties in a multi-disciplinary approach. Often clinics include: physicians, dietians, speech pathologists and occupational therapists. Pending on the severity and degree of the feeding issue, therapy may be suggested to aid with progression.
Reference: Morris, S. & Dunn-Klein, M. (1987). Prefeeding Skills: A Comprehensive Guide to Feeding. Tucson, AZ: Therapy Skills Builders.
Holly E. Knotowicz, M.S., CCC-SLP | Speech-Language Pathologist | Children’s Hospital Colorado