When you hear the words “oral motor therapy” what comes to mind? Has this been a recommendation for your child? When is it appropriate? This week’s episode of the Tube to Table podcast will answer all of these questions and more. Your hosts, Jennifer and Heidi, will break down what oral motor therapy really is, when it is appropriate, and when it doesn’t make sense. For some children, strengthening and range of motion exercises may be necessary and helpful, but for many others, this type of therapy happens at the wrong time and in the wrong context. Heidi and Jennifer discuss the foundations that need to be built and focused on within a responsive way, prior to working on oral motor skills. It is so important to take a step back and look at your child’s relationship with food, their motivation for the skills they are learning, and the context where they are learning those skills. This episode will also look briefly at the Thrive by Spectrum Pediatrics Tube Weaning program’s outcome data for how oral motor skills develop throughout our program.
So what is oral motor therapy and when is it necessary?
This type of therapy focuses on building the strength of the mouth and focuses on the muscle movements necessary for the moving the mouth. This therapy can be seen with adults and children, as well as within feeding therapy and speech therapy. This episode focuses on oral motor therapy for the pediatric population that is seen in most “typical” feeding therapies. Many children do require this specific type of therapy if there is a clear strength deficit.
Most of the children we see in our program do present with some type of oral motor coordination difficulty, but this often makes sense. Children who are not able to eat or fed via tube have not had the same learning period as a child who has been eating for their entire life. It is not fair to assume that the child would have the oral motor skills necessary to be eating.
It’s a symptom, not a problem.
More often than not, therapists and medical team members view the oral motor deficit as the problem or the reason the child is having difficulty, but we view it as the symptom that is concurrent with the lack of feeding experience and tube feeding. In most settings that are not using a responsive feeding approach, the oral motor skill therapy is being done out of context and out of sequence.
- Out of context: The skills are being targeted without something that is meaningful for the child. Since they are out of context, the child is not learning the meaning behind lip closure, they are just learning to close their lips to please the therapist.
- Out of sequence: If the skills are being targeted before the child has any relationship with food or trust surrounding food, they are learning the movement for the lip closure, but not learning WHY they are doing it or what they have to do first. What makes the most sense to the children the Thrive team works with is when we start working on these skills WHEN they want to eat and AFTER they have built trust and comfort.
When you can put understanding of food and purpose first, then you are able to tweak, improve, and modify the skills that the child is working on. When a newborn baby is born, before they latch onto the bottle or the breast, they are adjusting to their environment, feeling comforted and safe. This is true for all areas of development as the child grows. We would not expect a typical child to learn how to use a spoon, without ever seeing purees. It is so crucial that the child understands how food makes them feel and that the initiation is happening BEFORE targeting the skills.
Where is the motivation?
When a child is placed at a table in a therapy room or at home and expected to practice movements without ANY internal meaning, the child is only doing that to please the therapist or parent. This is an external reason for eating, not an internal reason. As discussed in previous episodes, a child needs to learn to eat within the context of internal motivators (hunger, trust, curiosity, and enjoyment).
Outcome Data: When looking at oral motor skill development and progression throughout the Thrive Tube Weaning Program, we have found that the majority of children make the most progress in the first 10 days to 1 month of the program. This is the time frame where hunger has been introduced and the focus is building trust and comfort around food. This is not the time where oral motor skills are directly targeted. This coincides with how important initiation, trust, and comfort are when a child is working on a new skill in a meaningful context.
What do you do?
Parents will often ask “What are you going to do now?” and the answer is that we are uncovering the skills the child has. All children are driven and designed to eat. It is important to get out of the way and allow the child to do everything they possibly can without interfering.
It is also important to assist children when necessary. Some children may need to focus on strength training or working on lip closure, and that is okay. If it is done in the appropriate sequence and context, you can expect to see meaningful improvements. There is an appropriate time and place to pay attention to a child’s skill development.
Children learn to eat by eating
This is so important to remember as a parent as well as a therapist. When the skill or act of eating or chewing is taken out of the meaningful context, it loses it’s meaning and doesn’t make sense. This is making it harder for children who are already struggling. At Thrive, we encourage you to work with your therapist and advocate for your child. If you feel that the therapy is not meaningful or that the purpose of food and trust hasn’t been worked on first, let them know.
See you next week!