Debra Lauharn, M.A.

, OTR
Christin R. Dowd, M.A., CCC-SLP

AGENDA
1.Anatomy and physiology of the oral/pharyngeal structures for
feeding skills
2.A sequential look at development related to feeding skills
3.Oral motor treatment and feeding

Anatomy
Lips
Teeth
Tongue
Palate/Velum
Epiglottis
Trachea
Esophagus

Normal Development and

Feeding Skills
Please refer to handout

Initial Observations
Look at motor patterns and body stability;

positioning options
Determine sensory needs: gravitational
security, tactile/auditory/olfactory/gustatory
defensiveness
Assess problems with function of individual oral
structures (jaw, kips, tongue, cheeks, palate)
Type of food child is eating
Behavioral issues: rule out medical, then
determine if its a sensory vs. behavioral issue

Medical Issues To
Consider
Reflux: The backward flow of food or liquids
that have already entered the stomach.
Crying after eating
Excessive burping
Elongating of body (head to right and up)
Projectile vomiting
Not sleeping through the night

* medications

Positioning:

What happens in your hips passes to

your lips!

Mobility develops from proximal to distal; precise

interchange between stability and mobility that

influences oral motor skills.
Oral stability is dependent upon the
development of neck and shoulder stability that
is in turn dependent on trunk and pelvic stability.
Lips, cheeks, and tongue are dependent on jaw
stability.
Position the child to support the head and trunk
so that the hands and mouth are free to work.

For Safety Sake

Children should always be fed in a highchair or the lap of

their parent
No cracked or sticky/gummy nipples (replace them)
Children under the age of 3 should not be given hard candy
No chocolate of any kind before 1 year
No honey before age 1
Hot dogs, peanuts, peanut butter, whole grapes, and candy
are choking hazards.
Begin open cup drinking at 6 months
Never lay a baby down with a propped bottle
Never give a baby a bottle or sippy cup to keep in their bed
to pacify them. If you must, only fill it with water
No bottles after 15 months
No cereal in bottle!!!!!

Sensory Needs

How comfortable is the child in his/her feeding environment

Change the noise, lighting and visual stimuli

Prepare the body and mouth for eating

(PRR/brushing, swinging, proprioception, vibration,

massage)
Changing food (temp, taste, texture) slowly
Hyposensitivity (ASD, low tone) prefer to drink and
not eat or prefer to eat soft/easy foods. *add spice
to their life
Hypersensitivity (CP, high tone) use smooth bland
food
Be social and engaging during meal times.

Techniques For Dysfunctional Oral

Structures
(Lips, jaw tongue and cheeks)

Jaw: slack/low muscle tone or jaw thrust

open/increased muscle tone and teeth grinding

Check positioning of the hips/shoulders/chin

(reduce hip extension or posterior tilt and

shoulder retraction, and position the chin down)
Give jaw control/support as needed
Calm/organize the mouth with vibration
Ice/cold increases swallow reflex (ie ice straw)
Chew tubes
Bite tip on Z-Vibe (front to back on left and right)

Chewing Techniques
The goal is to teach a graded, lateral chew with

tongue-tip dissociation and movement across midline.

Graded lateral chew with tongue tip pointing: chew tube

or Z-Vibe perpendicular to the lateral molar ridge as you

support jaw as needed, encourage 2-3 bites. Alternate
sides 4-5 times. Intro. Veggie stix or ice straw
Tongue tip Pointing and movement of bolus to lateral
incisor and molar ridge: place tube/stick food from molar
ridge to lateral incisor and alternate sides
Tongue-tip pointing and tongue lateralization across
midline: present stick-shaped food or tube on lateral
incisor and bit quickly present bolus to opposite lateral
incisor.
5 point bite: present the stick shaped bolus perpendicular
to the lateral molar ridge, to the incisor, to the front, and
move bolus around midline to opposite molar ridge.

Tongue Retraction
In tongue retraction the tongue pulls back into

the posterior of the mouth or in the pharyngeal

airway. Can be related to low or high muscle tone
with neck hyper extension or cleft palate
Work on building tone by bouncing on a ball or lap

before positioning for eating

Child is prone over lap then stroke tongue from
middle to tip toward lips
When seated, keep childs chin tucked down, gently
tap/hold under chin to increase tongue
tone/stability, vibrate from middle to tip and lateral
to tip (Z-vibe)

Tongue Protrusion
Low tone tongue moves forward beyond the border of

the gums and may stick out between the lips and may
cause food to be pushed out of the mouth
Build tone in the trunk and provide proximal stability by

compression of spine through shoulders, bounce on lap

or ball
Position in feeding chair with increased support of the
trunk and feet
Feed to the sides of the mouth to improve tongue
lateralization
Thicken liquids
Present flat bowl spoon in horizontal position midway
and vibrate to tip (Z-Vibe)
Offer vibration with battery operated toothbrush or ZVibe

Lip retraction
Lip retraction occurs with increase muscle tone pulling/drawing

the lips and cheeks backward to form a tight horizontal mouth,

making it difficult to suck from a bottle or remove food from a
spoon. Lip pursing occurs when the child attempts to counteract
the effects of retraction. Before each meal:
Check sitting position for too much hip extension/shoulder

retraction/head extension
check for overstimulating environment and sensory properties of
the food given (spicy/bland)
Midline orientation/3 point massage (cheeks, facial folds, upper lip)
Reduce hypertonicity in cheeks with vibrating hands on each cheek
forward or vibrating bug/Z-vibe
Lip massage: rub infadent finger or roll cut down toothette from the
R corner to midline, the L corner to midline *DO NOT CROSS
MIDLINE
Facial molding with towel or flat palms move the cheeks forward
and chin/lower lip upward
Straw drinking or cup drinking (with cut out cup)

Low tone cheeks/lips

Hypotonia in the cheeks reduces the strength/skill of

the lips causing inefficient sucking and bolus

collection, excessive drooling and open mouth,
decreased awareness and overstuffing/food
pocketing. Before each meal:

Increase tone in body with bouncing and compressions

Engage midline orientation with 3 point massage
Play patty-cake and other games to the cheeks that provide

firm input to sides of the face

Lip massage: rub lips from midline out ward to sides
(stretch)
Explore mouth with ice, spicy, tart/sour foods to increase
pucker
Hide soft food/banana or cheese in cheek pockets and
have child squeeze side of cheek to push food to center
Vibrate to increase awareness
Straw drinking
Three Point massage

Straw drinking/Cup use

Use a squeeze box with short, thick straw *place

straw at corner of mouth and quickly move to midline

(repeat on each side).
Use aquarium tubing in squeeze bottle
Use cork or medium bead to adjust the length of
straw in the mouth. The portion that enters the
mouth should be very short at first.
Use thick liquids (honey consistency) with straw or
cup (ie. milkshake, applesauce, baby food)
Use cut out cup and push corner to corner to improve
lip closure and decrease tone *use jaw control as
needed.
*Try club soda and juice to increase awareness of liquid

Incorporate solid foods in

therapy
Cheetos and other junk food are good starter

foods (they melt)

Shave a carrot or potato for teething, texture,
and proprioception/biting
Use veggie stix for chewing

Prevent Food Jags

Food jags are when a child will only eat

certain foods and may demand that they are

presented the same way (ie.certain label food,
on a stick, wrapped in paper towel)
The brain does not produce pathways to
accept other foods
Steps to prevent food jags

Works Cited

(2010). Retrieved September 20, 2010, from Mealtime notions llc: http://www.mealtimenotions.com

C Drobek, C. M. (2005). Building Blocks of Pediatric Therapy. Detroit: Children's Hospital of Michigan Detroit Medical Center/W

Harrison, T. (1996). Feeding your 1 to 5 year old building good eating habits. Okemos, Michigan: United Dairy Council of Mich
K. Toomey, E. R. (2007). When Children Won't Eat The SOS Approach to Feeding. Farmington Hills, MI: Abilities Center.
Klein, S. M. (1987). Pre-Feeding Skills. Tucson: Therapy Skill Builders.
Logemann, J., (1993). Manual for the videofluorographic study of swallowing (2 nd ed.) Austin, TX: Pro-Ed
Overland, L. (1996). Feeding Therapy: A Sensory Motor Approach. Talk Tools Inoovative Therapists International.
Winstock, A. (2005). Eating & Drinking Difficulties in Children. Oxen: Speechmark Publishing Ltd.