Oral Motor Development: The Baby Steps

What is oral motor development? 
Oral motor development simply involves the use of lips, the tongue, the jaw, the teeth and the hard and soft palates. Proper movement and coordination of these structures are crucial in speech production, safe swallowing, and consuming different food textures. Consistent oral motor activity begins prior to birth and continues beyond age three. By age four, most children can safely consume solid and liquid food without choking.

The milestones I'm about to list are typical, they are not strict by any means and all infants develop at their own rates. Use these milestones as a guide in monitoring your child's progress toward oral motor and swallowing development. It is suggested you consult your pediatrician before introducing new foods to your baby.

Before birth, the baby begins to develop sucking reflexes (around 36 weeks).

From birth to 3 months old, a baby will:

• Demonstrate many reflexes to protect his/her airway
• Respond to stimulation in and around the mouth
• Turn his/her head toward the nipple when a caregiver strokes his/her cheek (this is a sign for "I'm hungry")
• Consume breast milk or formula using a nipple
• Coordinate his/her breathing with two to three sucks of liquid before swallowing and breathing

From 3 to 6 months, the baby will:

• Bring both hands up to clasp the bottle, but may need assistance holding it
• Consumes rice cereal or pureed fruit and pureed vegetable baby foods
• Eats from a small infant/toddler spoon during feeding

From 6 to 9 months, the baby will:

• Hold the bottle independently
• Clean the spoon with their upper lip (get the whole airplane up in there)
• Eat pureed meats and a variety of pureed baby foods (pureed is a strangely spelled word)

From 9 to 12 months, the baby will:

• Show lip closure when swallowing liquids and soft solids
• Begin to self-feed by using his/her fingers to grab small food. The baby may attempt this with small, soft and easily dissolvable foods. Now I want Cheerios -_-
• Begin experimenting with a sippy cup
• Begin to consume mashed table foods
• Drink from the sippy cup and attempts to hold the handle by his/herself
• Drink through a straw

At 12 to 18 months, the baby will:

• Coordinate his/her sucking, swallowing, and breathing patterns for longer sequences
• Eat finely chopped table foods
• Bite through crunchy foods, like cookies or crackers
• Move the food in her/her mouth from side to side as they chew

At 18 to 24 months, the little one will feed him/herself using a spoon, but still may need assistance with this.

At 24 to 36 months, the medium one will:

• Eat and drink a variety of solids and liquids through a straw and open mouth cups
• Use a spoon to scoop soft foods while feeding him/herself 
• Independently move toward find tuning all feeding skills

At 36 to 5 years, the large one will:

• Progress toward chewing and swallowing more advanced textures such as meats, fried foods, whole fruits, etc. with close supervision by a caregiver
• Begin to use a fork to stab food (also, with supervision)
• Drink from an open mouth cup with no assistance

If this sounds like a lot to coordinate, look forward to the little things. Like catching this candid face on camera:

Resources

Richmond, Megan-Lynette. Super Duper Handy Handouts (2016): "Oral Motor Development Milestones"

What to Expect at a Feeding Evaluation

When people hear the title "Speech Language Pathologist," they usually envision a professional who only evaluates and treats speech disorders. But skilled Speech Language Pathologists are also trained in the evaluation and treatment of feeding and swallowing disorders for both children and adults.

I'm not a parent. But I do have a Chin-Pin named Tito. He's the apple in my eye. The orange thing on the left is my three-legged kitten, who leaves a new scratch somewhere on my body every day.

Tito Burrito has eating problems. It breaks my heart to fill a bowl of dog food for him just to watch him sit and stare at it. I can only imagine how difficult it must be to see your child struggling to eat. You might think he/she is just a picky eater, which in and of itself is a problem most parents should learn to confront. Young, picky eaters usually restrict themselves to a fairly unhealthy diet, displaying a taste aversion for nutritional foods that are vital in their physical development. But it might be more than just pickiness. A lot of children have trouble chewing and swallowing, which could lead to serious problems. With no intent to scare: problems with swallowing could lead to aspiration pneumonia (when food enters the lungs as opposed to the stomach).

If your child is displaying these traits, it may be time for an evaluation from a Speech Pathologist:

• extremely picky eating
• limiting food intake to a small amount
• only eating certain brands of food
• avoiding certain foods with particular textures or colors
• having poor weight gain or medical issues (malnutrition) due to picky eating habits
• having difficulty controlling food in their mouths (choking, gagging, or coughing while eating)

At Suffolk Center for Speech, our therapists create a calm, non-stressful environment where a child can be evaluated and treated for feeding problems. An evaluation will start with the parent listing a child's history regarding prematurity and developmental delays. This will give the therapist insight into possible causes of feeding problems.

Evaluation

1. A clinician may complete with your child what is called "oral-alerting activities." Some children find it difficult to eat certain foods of particular textures because the nerves in their mouths are not "prepared" for the texture. The "oral-alerting activities" prepare the child's mouth for the "foreign" texture. These activities may include, but are not limited to: tapping the lip and facial area around the mouth with a warm washcloth or introducing a child to highly sweet, salty, or sour flavors.
2. A therapist will evaluate a child's oral musculature [arrangement of muscles in the mouth, including the buccal (cheek), labial (lip), and lingual (tongue)] for ability to manipulate (chew and swallow) solid foods. Some children may have underdeveloped OR overdeveloped muscles, which can both cause feeding/swallowing difficulty. The therapist might recommend oral exercises to increase or decrease muscle tone and strength.
3. The therapist may need to assess the child's ability to bite and chew solid foods by using items such as vibrating teethers, a NUK® brush (plastic-bristled brush), toothbrush, or Chew Tube™ (plastic chewing device). The therapist will assess the way in which the child brings the objects to his/her mouth (if they will) and also how he/she tolerates manipulation of the object.
4. To observe possible aspiration risks, the therapist may give the child a variety of liquids, some thin, some thick. They'll look for overt signs of difficulty swallowing these liquids and observe potential aspiration risk. Based on this evaluation, the therapist may recommend a Modified Barium Swallow Study (MBS) or Fiberoptic Endoscopic Evaluation of Swallowing (FEES). Suffolk Center for Speech is the only private Speech Pathology practice on Long Island to offer FEES, a preferable alternative to MBS for most children and adults because it doesn't involve swallowing Barium or radiation exposure.
5. It might be helpful to bring some of the child's favorite foods as the therapist will assess their response to chewing and swallowing these different consistencies and textures. This part of the evaluation is different for every child.

Based on the results of the above listed areas (possibly more, such as posture of the mouth), the therapist may suggest intervention with a skilled Speech Pathologist to assist the child with feeding skills. The therapist might also provide demonstrations of techniques that will help with fulfilling the child's individual needs, and/or provide informative handouts to assist parents in continuing therapy at home. Here at Suffolk Center for Speech, our therapist are highly trained in feeding therapy. Motivation is crucial in feeding therapy. Our therapist are great with motivating kids to succeed in therapy and expand their eating horizons.

Written by: Tim Strampfer