Tongue Thrust Therapy

Question:  I am an SLP seeing a 8 year old student with a tongue thrust.  What products would be the best for addressing the tongue thrust?  How long does it usually take for them to affect a change in a child’s lingual placement?

 


 

Great question.  For tongue thrust therapy, I use the protocol outlined in the book Swallow Right, 2nd edition by Roberta Pierce.  It’s a must and a wonderful reference for therapists working on swallowing / tongue thrust therapy.  It typically takes me about 12-16 weeks to correct a tongue thrust, depending on the child and other factors of course.

 

For some of the exercises in the book I use ARK’s Probe.  Roberta uses a twizzler or stirrer to do them (the Probe wasn’t developed at the time it was written).  But I find it much easier and more effective with the Probe because it provides more input.  It’s also a versatile tool for a variety of related skills such as jaw stability, tongue tip elevation, mid tongue elevation, back of tongue elevation, tongue pops, oral awareness, and more.  I use one Probe in therapy, and my client has one as well for home practice.

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Tongue Tip Elevation Exercises

Tongue tip elevation is the ability to lift the tip of one’s tongue up to the alveolar ridge (the spot just behind the upper front teeth).  As a shorthand, we often call this location “on spot,” as in, “get your tongue tip on spot!”

 

Tongue tip elevation is an oral motor skill necessary to say certain speech sounds (t, d, n, l, s, and z).  It’s also where the tongue should rest during normal oral resting posture (when you’re not eating or speaking).

 

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75+ Feeding Therapy Tips & Strategies

For any therapist seeking to specialize in feeding, the best piece of advice I could give you is to become a sponge.  Take courses and workshops, read as many articles as you can, talk to and learn from your colleagues, join special interest groups on Facebook and ASHA etc., follow blogs, observe other therapy sessions, and don’t forget – learn from the children you treat as well.  They will be your best teachers.

 

Feeding issues are complex.  So take in as much information as you can from as many outlets as you can.  But, take it all in with a grain of salt, because not every strategy will work for every child.  Over the past 35 plus years, a number of people have told me that their way was the only way.  Although that certainly would have made my job easier if it were true, I’ve never been able to use any one method “by the book.”  Each child is different, so it will be up to you to evaluate their needs and cater treatment accordingly.

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Straw Drinking Prerequisite – Tongue & Jaw Dissociation

Question:  I’m working with a client who has Down syndrome.  She can’t differentiate her tongue from her bottom lip when drinking from a straw.  I’ve tried having her drink from a straw using a Lip block to see if that helps, but the tongue still just takes over everything.  Any ideas?
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I always recommend getting children on straws (ideally with Lip Bloks) for their oral motor benefit.  The straw + Lip Blok combination can help naturally exercise and fine tune oral motor skills / oral positioning.

 

However, some skills / prerequisites have to be in place first before the child can effectively drink from a straw, such as trunk control, suck-swallow-breathe coordination, tongue and jaw dissociation, etc.  You have to walk before you run so to speak (and you have to have a certain amount of strength, coordination, etc. before you can do either).  Most children start straw drinking around 8-10 months old.  So if she’s not at that age level developmentally yet, she may need time and/or your help to get there.

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Lip Closure & Rounding Exercises

Lip closure (also known as lip seal) is the ability to close one’s lips around a spoon, straw, cup, etc.  It’s also important in order to say certain speech sounds, such as /p/b/m/, and it’s a factor in preventing drooling.

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Lip Closure & Rounding Oral Motor Practice

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Recently I was working with a 9-year-old child who has Angelman syndrome.  The mother was asking if there was anything she could do to decrease drooling. One of the first things I look for with drooling is whether or not the child has lip closure.  The child was not closing her lips and could not do so on command, so I touched the Z-Vibe to her lips for about 2-3 seconds, and voila – immediately her lips closed.  I waited a few minutes and repeated the stimulation, and she closed her lips again.  She just needed that extra sensory input to be aware of her lips to close them.

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Sometimes a simple prompt like that will elicit lip closure.  Other times you may need to do extra practice until the concept “sticks,” or until they have the oral motor skill to do it.  It really just depends on the child. Continue reading Lip Closure & Rounding Exercises

The Oral Motor Benefits of Straws

Whenever a parent asks me what they can do to improve their child’s oral motor skills, one of my first questions is usually:  Are they drinking from straws?
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Drinking from a straw is a very simple yet effective way of improving one’s oral motor skills.  It works on lip seal, tongue retraction, cheek strength, correct jaw position, suck-swallow-breathe coordination, consecutive swallows, and more.  Sucking can also help some individuals organize, increase their attention, and soothe/calm themselves.
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Straw drinking usually starts around 8-10 months of age.  An easy way to teach beginners is with the Bear Bottle Kit, which has a special valve that keeps liquids at the top of the straw (so only a small amount of effort is required to drink).  Or, older kids may prefer the Cip-Kup, which functions the same way but has a more ‘grown-up’ design.  For more information on how to teach straw drinking, click here.
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My Child Chews on Everything – What Can I Do?

Have you ever craved crunchy foods?  Or chewed gum?  Ever chewed on your pen caps while concentrating or bit your fingernails when nervous?  We all have oral sensory habits to some extent.
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For children with sensory needs and/or Autism, however, oral sensory input can play a particularly important role.  Chewing throughout the day (especially during times of stress and/or anxiety) can help them calm, focus, and self-regulate.
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There are several things you can do to help meet that need safely.  For the purposes of this post I’ll refer to children, but the recommendations here can apply for any age.  Some kids grow out of it, others may always have oral sensory needs to some extent through adulthood.
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Please note that the information here is based on my experience with the children I have personally seen as a speech therapist, and may not be relevant for everyone.  There is NO substitution to an in-person evaluation with a trained professional, with treatment catered to your child’s needs.

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Food Pocketing in the Lips, Cheeks, and/or Gums

Question:  My four year old daughter pockets food in her lower gums.  Foods like pizza, chicken, egg whites, etc. (that do not melt like crackers or cookies).  She will simply let it stay in her gum pockets until she looks like a chipmunk and eventually we will have to remove it with our fingers.  She is not able to automatically understand the natural process of not allowing the food simply stay in her gum pockets.  How can we help her get the natural biting and chewing action which will prevent her from pocketing food in her gums?  We have a Grabber already and have her practice chewing on both the left and right sides.


Food Pocketing - possible causes & what you can do

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Great question.  There may be a few different reasons involved and a few different strategies to try: Continue reading Food Pocketing in the Lips, Cheeks, and/or Gums

Why Does My Older Child Chew on Everything?

Question:  My 9 year old chews on everything… erasers, foam rubber, shirt collars.    He has always had an oral fixation since he was a toddler, putting toys in his mouth and chewing on everything in sight.  Is this something more than typical childhood behavior?  I’ve read on some discussion boards that your “Grabbers” are often used by other kids with the same issue.  Looking for advice…


Great question.  For babies and toddlers, putting things in their mouths is a normal stage of oral development.
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Some children, however, continue to chew non-food items well past the mouthing/teething stage.  For some, it is a passing phase.  Other individuals will always have a need to chew that may continue into adulthood.
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Why do some older kids need to chew?.

Why?  There could be many different reasons, and it’s not always a straight answer.  But in my personal experience with the children I see in therapy, it’s typically one (or a combination of) the following:

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The Right and Wrong Way to Spoon Feed

The Right and Wrong Way to Spoon Feed

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Did you know that there is a right and wrong way to spoon feed?
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The wrong way involves lifting your hand upward as you remove the spoon from the child’s mouth.  This method scrapes the spoon against the teeth, gums, and/or upper lip to get food off of the spoon.
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Scraping is not the normal, natural way to feed.  And specifically for children with oral motor delays, it’s a missed opportunity, as it doesn’t allow the lips to do their job and close around the spoon.  It can also force the child’s head back as they try to “chase” the spoon upward.  You can see this happening in the image above and also in the beginning of the video below.
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