Presenter: Amie Teague, MA/CCC-SLP

Overview of Presentation

• Oral -Sensory

• Stages of Oral -Motor Development

• Oral -Motor & Oral- Sensory Assessment

• Feeding Development

• Oral -Sensory, Oral -Motor, and Behavioral Treatment

What is Oral-Sensory Information ?

• Oral sensory information is a term that refers to the way the nervous system receives messages from the senses (hearing, sight, smell, taste, and touch) and turns them into appropriate motor and behavioral responses.

• We see the food. We smell the food. We can hear the food crunch, pop, or sizzle. We can taste the food. We can feel the texture of the food with our hands, our lips, our tongue, and our cheeks as we chew.

What oral motor skills are needed for eating?

• Lips range of motion and strength

• Cheek range of motion and strength

• Tongue range of motion and strength

• Ability to make chewed food into a ball and sending it to back of mouth for swallowing

*Any weakness or discoordination of these skills interrupts the beautiful symphony of food preparation and swallowing

What are the behavioral components of feeding disorders?

• Behavioral components of feeding disorders include learned behaviors and behaviors that existed prior to feeding disorder.

• Examples of behavioral difficulties are reactions caused by fear of certain foods, inability to tolerate certain foods within sight, and inability to tolerate certain foods within close proximity.

Stages of Oral-Motor Development

0-4 months

• Rooting reflex present (baby able to find food source with mouth)

• Sucking reflex present

• Strong gag reflex present

4-6 months

• Opens mouth in anticipation of food

• Moves food backward with tongue

• Rooting reflex and gag reflex begin to diminish

6-9 months

• Learns to keep thick purees inside the mouth

• Swallows solid foods without gagging

• Maintains lip closure longer

9-12 months

• Able to move food around in the mouth

• Starts to use the jaw to mash food

• Uses cheek and lip corners to keep food on the biting surface

• Jaw and tongue begin to move in a circular motion for chewing

12-18 months

• Starts to chew with horizontal and circular tongue/jaw movements

• Lip closure remains intermittent during swallow

• Upper lip begins to close on cup during cup drinking for better seal

• Tongue does not protrude during drinking

18-24 months

• Able to chew firmer foods

• Uses a controlled, sustained bite on a biscuit

• Intermittently loses food or saliva while chewing

24-36 months

• Uses consistent oral movements during feeding

• Minimal spillage noted

• Circular jaw movements during chewing with scattered chewing patterns of vertical and diagonal bites

Oral- Motor and Oral- Sensory Assessment

What are we looking for?

Oral -Motor Assessment

• Facial symmetry• Lip symmetry & ROM• Cheek symmetry & ROM• Tongue symmetry & ROM• Tongue movement side to side/ tongue tip elevation• Suck/swallow/breath pattern

Are these oral structures/characteristics within normal limits?

Oral -Sensory Assessment

• Oral aversion

• Tolerates facial stimulation

• Tolerates 1-2 textures of nonfood items

Hands on Demonstration

Feeding Development

0-4 Months

• Breast milk or formula

• Eats every 2-4 hours

• Takes 4-8 ounces in 20 minutes or less

4-6 months

• Remains hungry after 8-10 breast feedings, or 32 ounces of formula a day

• Starts solid foods such as rice cereal, oatmeal cereal, etc

• (*quantity is not as important as quality at this age*)

Bottle Demonstration

6-9 months

• Continue cereals

• Add juice and Stage 1 baby foods (vegetables, fruits, then meats)

• Introduce new foods slowly

9-12 months

• Continues cereals, juices, and Stage 1 and Stage 2 baby foods

• Introduce finger foods and table foods as recommended by baby’s pediatrician

12-18 months

• Table foods and/or Stage 3 baby foods

• 3 meals/day with 3-5 snacks/day

• Learning to self feed with a spoon(often turns it over before reaching the mouth)

18-24 months

• Table foods

• Intermittently gets spoon to mouth without turning it over

• Lifts cup to mouth and may tip it too much causing spillage

24-36 months

• Table foods

• Uses fork

• Consistently get one protein, one fruit, and one starch per meal

Questions