A few facts to heighten awareness of sensori-motor speech and feeding delays in the pediatric population. Here are a few red flags that should warrant concern:

  1. Difficulty latching on to the breast or bottle
  2. Trouble transitioning from breast to bottle and bottle to cup
  3. Difficulty coordinating suck-swallow reflex for either breast or bottle feedings
  4. Overall low tone in the trunk musculature and articulators (abdomen, velum, jaw-lips, tongue, cheeks)
  5. Excessive or habitual drooling not associated with the eruption of teeth
  6. Difficulty dissociating articulators
  7. Hyperactive or hypoactive gag reflex
  8. Difficulty forming a food bolus
  9. Increased number of chews/swallows
  10. Increased duration of mealtimes
  11. Pocketing food in the mouth
  12. History of choking/aspirating
  13. Gastro esophageal reflux issues
  14. Food overstuffing
  15. Immature feeding skills: Child continues to suckle or use a munch (up and down) pattern verses a more mature rotary chew pattern.
  16. Weakness in oral musculature (i.e. as observed by an open mouth posture and forward tongue placement (not secondary to allergies or upper respiratory issues)
  17. Trauma due to intubation and /or Tube feedings

If it is determined that a child has feeding issues, it may be due to sensory, motor or a combination of sensory and motor skill deficit. A comprehensive assessment targeting normalizing sensory skills and achieving adequate (not excessive) strength in one or all of the child’s articulators: the abdomen, velum, jaw, lips, cheeks and tongue musculature, may be recommended. This can be accomplished via use of Oral Placement Therapy (OPT) techniques that are directly related to oral movements required during the oral prepatory phases of feeding and for standard speech production. Often we see children who have feeding and concomitant speech production and speech intelligibility issues. Thus, implementing a three part treatment plan consisting of feeding, speech and OPT techniques is warranted. Some activities might include normalizing the oral sensory system to allow for a variety of tastes,textures and temperatures to be consumed. Learning how to drink from a straw or cup can be accomplished early by teaching children a hierarchy of skills. In addition, lateralizing the tongue in order to place the bolus on the back molars is a critical step as it is a prerequisite for lingual elevation (for standard swallows and alveolar and lingual dental sounds). Food placement techniques and non food therapeutic tools can also be used to teach tongue-tip lateralization. Regardless of the goals selected, a speech and language pathologist must work closely with the child’s parents and gain the child’s trust. Feeding is a social experience with lots of dynamics. The therapist,child, parent and his/her pediatrician along with other professionals, must take a team approach and move slowly, ensuring comfort and success along the way.

Reference:

Red Flags of Children with Sensory-Motor Feeding /Speech Deficits

By: Emilia del Pino, M.S., CCC/SLP

Published in ADVANCE for Speech-Language Pathologists Magazine

September 2009