Oral Motor and Feeding

Oral Motor and Feeding

Oral motor therapy also referred to as oral placement therapy is a form of therapy that uses a variety of exercises to develop strength, coordination and mobility of the oral muscles. Oral Placement Therapy for speech targets the movements necessary for standard speech production through a combination of therapy techniques.This therapy differs from traditional speech therapy in that the strategies continue to utilize auditory and visual stimuli while adding the tactile and proprioceptive sensory systems. This allows the client to feel the movements as well as hear and see them.

Oral motor therapy is a hot topic in the field of speech therapy and there is limited research to support the use of oral-motor therapy to treat speech disorders. The need for evidence-based practice has caused some to question the use of oral motor techniques in articulation therapy. All oral (jaw, lip, and tongue) motor (sensory, motor, and positioning) techniques seem to have been lumped into one small category called “non-speech oral motor exercises” and its clear that research into specific, well defined areas is very much needed. However, oral placement therapy is widely acknowledged and accepted as a way to address speech errors though the

Feeding therapy is used to address behavioral, sensory, physiological, and structural issues that may impact a child’s willingness or desire to eat. An estimated 25% of the pediatric population will experience some type of feeding issue. For premature babies and children with autism this number increasing significantly.

The following is a list of feeding milestones for children:

0-3 months

At 0-3 months babies are solely breast and/or bottle fed. They have oral reflexes for suckling and swallowing. It is best to feed infants at about a 45 degree angle.

4-6 months

At 4-6 months babies begin sucking and are no longer only suckling. The action of drinking a bottle or breast feeding is becoming less automatic and more voluntary. It is during this time period that many babies will be introduced to soft solid foods such as cereals and pureed fruits and vegetables. Cup drinking may also be introduced at this time (6 months) as they will practice their skills for future transition to the cup.

6-9 months

Between the ages of 6-9 months babies are able to open their mouths and wait for the spoon to enter. They are also able to use their upper lip to clean food off the spoon. At this time dis-solvable soft cookies may be introduced as well as ground or lumpy solids. Many babies are able to drink from straws at 9 months.

10-12 months

Mashed or chopped table foods with noticeable lumps are introduced during the age range of 10-12 months. Babies also begin to take most of their liquids from a cup although bottle or breast feeding may continue for bedtime. Their tongue may protrude under the cup in order to add additional stability. At 12 months they also have a controlled, sustained bite and are able to bite through a soft cookie and possibly a harder one depending on the presence of teeth.

13-15 months

13-15 month olds will playfully bite on the spoon. They will also begin to bite on the cup while drinking. They will improve with their biting skills and are better able to use a controlled bite to bite through a hard cookie. Chopped table food continues to be provided and more control over the lips and tongue has developed. Most 13-15 month olds will not take a bottle and instead will use a straw or regular cup.

16-18 months

At 16-18 months children are given more challenging foods that require chewing such as most meats and many vegetables. By 18 months they are capable of chewing with their lips closed; however, they often will not. When their lips are open they should not be losing any significant amount of food or liquid while eating and drinking.

19-24 months

In the 19-24 month range children will begin to gain more control of cup drinking and will bite the cup less and less. They are learning to drink in longer sequences with little to no spillage. By the age of 2 children are able to manage any type of food they like as they have learned all the skills they need to eat every type of food, although they will continue to “fine tune” these skills over the next few years. (It is still recommended that foods that may be choking hazards such as grapes and hot dogs be cut in smaller pieces to avoid choking as many 2 year olds are always moving and playing placing them at risk for choking.)

At Jennifer Katz, Inc. we develop individualized treatment feeding plans for each child and offer a continuum of service delivery models to meet their needs. In our individual and group programs, our feeding therapists work closely with many other involved professionals to assist families in coordinating services to facilitate continuity of care and optimal outcomes. Services are provided in our clinic, at home and at school to ensure success across all environments with all caregivers.

Feeding therapy goals are identified and established based on our comprehensive evaluations. Therapy frequency may range from once per month to two or more times weekly for hour sessions. All therapy is individualized to meet the needs of the patient and their family. Parents and other caregivers participate in the sessions with hands on practice and coaching to empower families and maximize progress and carryover.

Jennifer, Katie, Holly and Kate specialize in treating feeding and swallowing disorders. We work hard to stay on top off all the current medical research in this field and travel the country learning from the top experts in this field.  Our therapists are trained in the following approaches (not all are listed): SOS Approach to Feeding (Kay Toomey, Phd), Get Permission Approach (Marsha Dunn Klein, OTR/L), Food Chaining (Cheri Fraker, MS, CCC-SLP, with Laura Walbert, MS, CCC-SLP), Beckman Oral Motor Protocol, and Oral Placement Therapy (Sara Rosenfeld-Johnson, MS, CCC-SLP).   Learn more from our blog post, “Feeding Difficulties.”