Feeding and Oral Motor Approach

Pediatric Feeding Disorder (PFD) is defined by the World Health Organization as impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill-based systems, and/or behavioral complications. Speech-language pathologists (SLPs) are the primary providers of oral motor, feeding, and swallowing services. Our approach to pediatric feeding and oral motor therapies begins with a comprehensive evaluation by a licensed speech-language pathologist. This includes in-depth review of child’s developmental milestones (including parent interview and review of pertinent medical records), evaluation of child’s intra-oral mechanism, direct observation of feeding, and trial treatment techniques to determine the child’s prognosis for treatment. Feeding and oral motor therapies help children learn how to eat or how to eat better. 

Signs that place a child at risk for a feeding and/or oral motor disorder may include:

  • delayed oral motor skills
  • delayed acquisition of feeding milestones
  • bottle feeding difficulty
  • difficulty transitioning to oral feeding
  • reduced/immature chewing patterns
  • pocketing food
  • excessive drooling
  • food refusal and feeding aversion
  • failure to progress with food textures
  • mealtime struggles

Our treatment approach to Pediatric Feeding and Oral Motor Therapy begins with assessing the child’s oral motor and/or feeding skills to identify strengths and weaknesses in order to determine a therapy plan.

Children may have difficulty with oral motor skills acquisition (weak suck, difficulty transitioning to chewing), oral defensiveness (gagging), as well as difficulty with mealtime behavior. Inadequate oral intake, food refusal, picky eating, or pocketing in the oral cavity can be corrected by the feeding specialist. 

Oral Motor / Feeding treatment with an SLP may include:

  • strengthening oral musculature
  • increasing lips and tongue range of movement and precision
  • improving bottle or cup drinking
  • facilitating mature chewing patterns
  • improve containment of oral secretions (drooling)
  • normalizing oral sensory defensive behaviors
  • eliminating food refusal and feeding aversions
  • introducing expanded food textures
  • facilitate positive mealtime behaviors
  • implementing home feeding schedules and routines

Pediatric Oral Motor / Feeding Therapy

Development of Oral Feeding Skills use of evidence-based techniques to support feeding development and transition through age appropriate food textures. Treatment focuses on providing strategies to develop skilled movement of the oral mechanism to promote safe and efficient eating, drinking, and swallowing.

Bottle Selection evaluation to determine appropriate nipple/bottle system to improve infant feeding. Individual bottle selection considers appropriate flow rate to facilitate coordination of suck-swallow-breathe in infants with feeding difficulty. Appropriate nipple selection in infancy helps support oral skills which support development of feeding skills.

Tethered Oral Tissues (TOTs) protocol begins with the speech-language pathologist evaluating the child for the presence of tongue and lip ties and the impact on feeding, swallowing and speech development. There are three forms of TOTs: buccal, labial, and lingual. Lingual TOTs is most commonly known as “tongue tie or ankyloglossia.”  The Mayo Clinic, in 2016, indicated that tongue tie can affect the way a child eats, speaks, and swallows and can interfere with breast feeding. The treatment plan includes specific objectives and strategies for treating both pre-release and post-release to support optimal feeding.

Oral-Motor Therapy is based on the rationale that deficient oral-motor control or strength may be inhibiting feeding development. Goals of an oral-motor approach include increasing the child’s awareness of the oral mechanism and its structures, reducing oral-tactile sensitivity, and increasing differentiation of oral movements to achieve successful feeding skills.

Sequential Oral Sensory Approach to Feeding (SOS) utilizes a systematic approach to address both the sensory processing and the oral motor skills necessary for a variety of food groups and textures. This approach focuses on increasing a child’s comfort level by exploring and learning about food properties. SOS teaches the child to interact with food in a playful, nonstressful way. Therapy begins by determining the child’s ability to tolerate food consistencies; then gradually build on having the child accept upgraded food tastes and consistencies. The Sequential Oral Sensory Approach to Feeding (SOS) has proven to be a successful approach to helping the child eat and enjoy new foods.

Myofunctional Therapy (Tongue Thrust Therapy) is a therapeutic regimen which has been developed to correct improper muscle and swallowing habit patterns. Children with myofunctional deficits frequently have coexisting feeding problems. Our therapy protocol consists of a diagnostic evaluation and specific myofunctional exercises for home carryover. The goals of myofunctional therapy are to facilitate improved oral function in order to eliminate tongue thrust, to prevent functional increase in open bite or overjet, to assure stability of correct occlusion, to correct the negative impact on feeding and to eliminate any noxious habits.

Talk Tools® developed by Sara Rosenfeld-Johnson, is tactile therapy approach incorporating a hierarchy of child-friendly tools for executing muscle-based exercises for feeding. These tools are deigned to improve specific muscle groups through the use of horns, straws, bite blocks, and other oral motor instruments with the goal of improving feeding.

Oral Defensiveness and Aversion Treatment includes gradual and repeated presentation of nonpreferred oral-facial stimulation as judged appropriate for the child’s needs. New foods are gradually introduced to increase child’s tolerance and minimize aversive responses.

Positive Mealtime Behavior is an approach to promote positive mealtime experiences for the child and to help parents create satisfying mealtimes for their children. The speech-language pathologist will guide the family to implement feeding schedules, mealtime routines, and positive mealtime behaviors. 

Therapeutic Intensives Feeding is the process of performing multiple therapeutic sessions throughout the week. The Suburban Speech Center Therapeutic Intensives Feeding treatment plan provides individualized, strategic therapy to the child identified with a moderate-severe feeding disorder. Research on service delivery models, best practice models and evidence-based practice (EBP) supports an intensive therapy schedule for many children with moderate or severe feeding disorders.

At Suburban Speech Center, our pediatric feeding and/or oral motor therapy approach is individualized to each child’s needs. Home carryover is an integral part of the program. Each family is provided with techniques and strategies to incorporate in the home environment.

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