Jaw Thrust Oral Motor Problems

You might have seen the last post put up here on the site where I shared a list of common oral motor problems.  These issues are the underlying areas that cause kids to have trouble with eating and look like food falling from a child’s mouth, trouble moving food within the mouth, difficulty sucking on a straw or many other common feeding issues.  Below you’ll find more information on jaw thrust and how this oral motor problem relates to difficulty in eating and drinking in kids. 



Jaw thrust is a common oral motor problem that interferes with feeding. Here are the underlying causes and how jaw thrust impacts feeding in kids.

 

Jaw Thrust Oral Motor Problem

 
Jaw thrust is an abnormal movement pattern of the jaw and occurs when the jaw and mouth opens or moves
suddenly and with force.  Typically, the jaw is able to move up and down, shift, move laterally, rotate, and hold patterns in various graded positions and strengths.  



These movements enable sucking, biting, chewing, and develops to more defined movement patterns.  As a result, we are able to bite with graded motions, hold jaw positioning, move food within the mouth, manage various food textures, and control the tongue, lips, and cheeks.  When jaw thrust is present, the jaw is held in a downward and outward position.  


Read more about development of oral motor skills
 
A strong
jaw thrust can occur for several reasons:
  • ·
    Increased patterns of muscle tone
  • ·
    Poor sitting posture
  • ·
    Neck hyperextension
  • ·
    Impaired breathing patterns leading to
    compensatory positioning resulting in jaw thrust
  • ·
    Over-stimulating sensory environment
  • ·        Hyper-reaction to input from teeth contacting
    each other during biting and chewing
 
Feeding issues related to jaw thrust:

Jaw thrust impacts components of eating,
including sucking, biting, swallowing, and chewing food.  



Jaw thrust impacts the movement and use of the tongue, cheeks, and lips as a result of jaw thrust. 


When a child eats, jaw thrust interferes with
the rhythm of eating and drinking. 



Children may present with a strong jaw thrust during meals and the
person who is feeding the child views the jaw thrust as food refusal or being
through with eating. 



Jaw thrust may result in drooling, food droppage or spilling, spilling or leaking of fluids. 

http://classes.yourkidstable.com/pages/oralmotor?ref=f6bd0d



Jaw thrust is a common oral motor problem that interferes with feeding. Here are the underlying causes and how jaw thrust impacts feeding in kids.

 

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Meltdown Mode Tricks and Tips

When kids are in a meltdown mode and the behaviors are going full force, try some of these techniques to help kids calm down and move out of a harmful or ineffective status.  Meltdowns are oftentimes a result of sensory systems that aren’t quite right, causing an overload of sensations.  

Meltdown Mode

When the body is so overwhelmed or underwhelmed by sensory input, it turns to meltdown mode.  

So, what is “meltdown mode” and what does this look like? More importantly, how can we help the child that is in a state of dysregulation so they can function? We’ll explain all of these things below.

Tricks and tips to help kids with meltdowns. These are sensory based strategies that can help kids overcome meltdowns by using a plan.
 

What does meltdown mode look like?

Meltdown mode is that episode of overwhelming feelings, emotions, and behaviors that result in a breakdown.

Meltdowns occur when sensory input is overloading a child’s sensory system. This might happen fast and result in overwhelming emotions or behaviors.  

Meltdowns look like different things to different kids:

  • You might see kicking, hitting, punching, or other sensory responses.
  • For another child, it might be fleeing or bolting. 
  • For another child, a meltdown might look like screaming or hurtful actions. 
  • Still another child might be quiet and hum to block out sensory input.
  • For some, it might be laying on the floor and not moving.  

How does a meltdown happen?

Kids can shut down when the sensory overload is a slower input. When a meltdown happens, kids need to reset themselves and their sensory systems.  

The child who is in midst of a sensory overload may have difficulty getting their attention on the strategies outlined below, but they do need to know that they are safe, loved, and that it will be ok.  

It’s important to know that there is a difference between a tantrum and a meltdown.

 

Meltdown Tricks and Tips

Just like a meltdown looks different for each individual, so do the strategies that can help move out of that mode.  

When a meltdown is occurring, it’s best to have an arsenal of tools available in mind.  Most important though, is keeping the child’s safety and best interests in mind.  

Below is a list of meltdown mode tricks and tips to try.

Try the following sensory strategies are tips and tricks to help kids when they are having a meltdown:

Proprioceptive Input to help with meltdowns

Some of these meltdown strategies can occur as part of a sensory diet, and others can be used on a whim. The goal here is to support sensory needs and regulate emotions and behaviors. 

For example, a student might use a school sensory room or it might be part of the day.

  • Bear hug
  • weighted blanket or weighted vest
  • Crash on a couch or crash pad
  • Bounce on a therapy ball
  • Hide under cushions
  • Exercise: push-ups, sit-ups, burpees
  • Jump
  • Run
  • Pull a heavy weight
  • Stretch
  • Pound pillows
  • Punch and squeeze play dough
  • Stomp
  • Bounce on a therapy ball
  • Get under a mattress
  • Joint compressions
  • Jump on a trampoline

Sensory-based movement to help with meltdowns

Distractions or a change in environment can help when meltdown mode is in full effect.  Add slow movements to these activities such as slow swinging or calmly walking.

  • Take a nap
  • Move to another space or room
  • Practice deep breathing in a quiet space
  • Go outside
  • Take a walk
  • Run at a park or play at a playground
  • Turn on music (loud or quiet)
  • Roll down hills (fast or slow)
  • Play on swings
  • Rock in a rocking chair
  • Slowly spin in an office chair (limit time in spinning as indicated)


    Refocus attention from the biggest cause of the meltdown with multiple-system sensory input:
  • Talk about impulses and jot them down in an Impulse Control Journal.
  • Deep breathing
  • Close your eyes and imagine
  • Low lighting
  • Put static on the radio
  • Set a timer to scream/run/cry/dance/jump
  • Yoga
  • Write a story
  • Act out frustrations with puppets, figures, or dolls
  • Get in water: take a shower, bath, play in water, swim

Calming Tactile Sensory Input to help with meltdowns

Incorporate calming tactile sensory input into a calm down space or room:

  • Fidget toys
  • Sand box
  • Rub on lotion
  • Brush your hair
  • Heated microwave (scented or unscented) bag
  • Write or draw with a vibrating pen
  • Use a vibrating toothbrush

Calming foods to help with meltdowns

Try some of these oral sensory motor calming foods:

  • Suck a smoothie through a straw
  • Chew on fruit chews or licorice
  • Chew gum
  • Chamomile tea

Tricks and tips to help kids with meltdowns. These are sensory based strategies that can help kids overcome meltdowns by using a plan.

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    If any or some of these tips and tricks help, it can be beneficial to talk over the successes with your child.  Address things like impulse control in a way that they are able to understand and relate to the meltdown they just experienced.  A good way to do this is with the Impulse Control Journal.  


    What are your best strategies for addressing meltdown mode?

    Colleen Beck, OTR/L has been an occupational therapist since 2000, working in school-based, hand therapy, outpatient peds, EI, and SNF. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. Read her story about going from an OT making $3/hour (after paying for kids’ childcare) to a full-time OT resource creator for millions of readers. Want to collaborate? Send an email to contact@theottoolbox.com.

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    Use these cursive writing activities to further address needs such as letter formation, progression, and practice:


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    Use these cursive writing activities to further address needs such as letter formation, progression, and practice:

    What is PANDAS?

    I’ve had a few questions and comments recently about PANDAS. I wanted to put together a collection of resources for PANDAS and PANS so that families, teachers, therapists, grandparents, and caregivers can easily find everything they need to know about this disorder.  The links below are sites that describe more about PANDAS and PANS, including diagnostic information, signs and symptoms of PANDAS, information on clinical trials, and places to find more help.  PANDAS/PANS can be a confusing diagnosis, happening overnight and with dramatic and substantial outcomes.  Use the information below as a starting point when looking for information on PANDAS.



    This information is not meant to be a diagnostic tool or means for intervention. It is essential that concerned individuals seek consult from the child’s pediatrician. This information is strictly a collection of information and a starting point when seeking out resources.


    What is PANDAS and PANS and how are kids impacted by behavioral changes



    What is PANDAS?



    PANDAS is an acronym standing for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. The disorder appears suddenly following a strep infection like strep throat or scarlet fever and results in obsessive compulsive disorder, behaviors, tics, and similar symptoms.  



    PANS, or pediatric acute-onset neuropsychiatric syndrome, refers to children with sudden onset of obsessive–compulsive and other neurobehavioral symptoms, including children with PITAND (pediatric infection-triggered autoimmune neuropsychiatric disorder), children with PANDAS, and children with exacerbations that are due to environmental or metabolic triggers.



    Symptoms of PANDAS and PANS

    There is not a predictable sequence of symptoms, but a child with a diagnosis of PANDAS/PANS may present with the following symptoms:

    • ADHD symptoms (hyperactivity, inattention, fidgety)
    • Sensory defensiveness
    • Attention difficulties
    • Hyperactivity
    • Impulsivity
    • Age-inappropriate behaviors
    • Obsessions
    • Choreiform movements
    • Separation anxiety (child is “clingy” and has difficulty separating from his/her caregivers; for example, the child may not want to be in a different room in the house from his or her parents)
    • Restricted eating or changes to eating patterns
    • Mood changes, such as irritability, sadness, emotional lability 
    • Trouble sleeping, night-time bed-wetting, day-time frequent urination or both
    • Changes in motor skills (e.g. changes in handwriting)
    • Personality changes
    • Joint pains
    • Changes in occupational performance and performance skill deficits
    • Separation anxiety
    • Oppositional behaviors
    • Marked deterioration in handwriting
      or math skills
    • Urinary frequency/enuresis
    • Joint pain or stiffness
    • Sleep problems
    • Slow processing speed

    How to Help a child with PANDAS/PANS:

    Occupational Therapy can help with these symptoms and the difficulties as a result of PANDAS/PANS, as outlined here.

    More information about PANDAS and PANS
    This fact sheet breaks down diagnosis and treatment strategies.

    This research library has a comprehensive collection of references and published works related to PANDAS.  This is a great source for recent research and work related to PANDAS/PANS.


    An overnight transition from a typical child to high emotional temperament changes can be overwhelming and scary! The NIHM website has information that answers the question ‘What is PANDAS?”.  



    This site has local support groups available and can direct you to local practitioners.

    Find hands-on and creative ways to address attention and executive functioning skills.



    Try these sensory-based tricks and tips to help with meltdowns.


    Books on PANDAS and PANS for kids, parents, teachers, and therapists


    Books about PANDAS and PANS:

    These books may help kids with PANDAS or PANS to better understand the disorder and symptoms.  Children with siblings or friends who are experiencing symptoms of PANDAS or PANS would benefit from information relayed in easy-to-understand children’s books with pictures.  Also included in this list of books about PANDAS are books that can be referred to parents and teachers of children who are experiencing PANDAS or PANS. 

    Affiliate links are included in this post. 

    In a Pickle Over PANDAS is a book for kids with PANDAS or PANS

    In a Pickle Over PANDAS is a children’s book about a young boy who wakes up one morning with new and strange things happening in his body.  They symptoms of PANDAS are described in a way that kids will understand and relate to.  This book is a great resource for kids who are struggling to understand what PANDAS is and that they are not alone. 


    Saving Sammy is a book written by a mother of a boy with a sudden onset of PANDAS and describes her fight against the medical establishment to prove the link between infection-triggered PANDAS and her son’s sudden-onset OCD and Tourette syndrome.

    PANDAS and PANS in School Settings is a handbook for teachers, administrators, school professionals, school based Occupational Therapists, and anyone who works with a child who is struggling with PANDAS or PANS.  This handbook can help identify challenges and offers strategies to incorporate into the learning environment. 

    Childhood Interrupted: The Complete Guide to PANDAS and PANS is a guide for parents of children who are experiencing PANDAS/PANS and are seeking information related to behaviors, treatment interventions, therapy, support, and interventions. 


    A Child’s Introduction to Understanding PANDAS  is a book that parents can work through with their kids as they struggle to explain what exactly PANDAS is and how it’s affecting the child. This workbook is a resource for identifying a individualized strategy plan using the book’s journal sheets and strategy plans. 


    How to take the Grrr out of Anger is a book that can address one of the common symptoms of PANDAS and PANS.  For kids that are experiencing behavior and emotional challenges as a result of PANDAS/PANS, the new feeling changes can be confusing and overwhelming.  This book is a guide to helping kids understand anger-management tips strategies that can be used in healthy ways.  This book can help kids understand and deal with the anger and emotions they feel.

    What to Do When Your Brain Gets Stuck is a book that addresses the obsessive compulsive tendencies that are common with PANDAS and PANS.  This book helps kids understand the obsessions or compulsions they may feel and act on and guides kids and parents through strategies that can help.  The book has a lot of activities, tools, and guided instructions that can help kids take control of their OCD actions or thoughts. 

    Books on PANDAS for parents, teachers, kids, and therapists impacted by Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus

    Information on PANDAS for parents, teachers, kids, and therapists impacted by Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus






    References:
    Janice Trigilio Tona, Sutanuka Bhattacharjya, Denise Calaprice; Impact of PANS and PANDAS Exacerbations on Occupational Performance: A Mixed-Methods Study. Am J Occup Ther 2017;71(3):7103220020P1-7103220020P9. doi: 10.5014/ajot.2017.022285.

    Tona, J., & Posner, T. (2011, November). Pediatric Autoimmune Neuropsychiatric Disorders: A New Frontier for
    Occupational Therapy
    InterventionOT Practice, 14-19. 

    PANDAS—Questions and Answers. (2016, Sept) Retrieved from: https://www.nimh.nih.gov/health/publications/pandas/index.shtml

    Calm Down Strategies for School

    calm down strategies for school

    A child is over responding to sensory input from the classroom environment.  The fluorescent lights are too bright, the janitor is rolling his cart down the hallway, a new pair of socks are too tight, and a fly is buzzing near a window.  The combined sensations are too much. 

    Calm down strategies for school might look different for each student. Also, there are many different reasons why a calm down tool is needed by children in the classroom. 

    Calm Down Strategies for School


     

    The classroom is an environment that is a place where over-responsiveness can easily interfere with learning, self-confidence, or social emotional development. 


    Having a toolbox of sensory strategies to address over-responsiveness can be invaluable in the classroom.  

    Use these sensory calm down strategies for school to help kids with self-regulation and over responsiveness in the classroom.
     
     
     

     

    Calm Down Strategies for School

    Below are sensory strategies for school that can be used with children who over-respond to sensory input, have difficulties with anxiety, or struggle with attention or executive functioning difficulties. Check out our resource on executive functioning in schools


    A child who needs self-regulation strategies to better learn or function in the classroom can benefit from one or more of these strategies.  Every child is different and each will respond in different ways. Not all of these sensory strategies will help every child.  Consider underlying issues and consult a school-based occupational therapist for assessment and interventions.


    Related Read: Try these free classroom fidget tools and sensory strategies for the classroom.

    You’ll also want to check out our resource on back to school sensory activities because the back-to-school transition period is a time when calm down strategies might be needed.

    Use these sensory calm down strategies for school to help kids with self-regulation and over responsiveness in the classroom.

     

    How to help children calm down at school:

    Incorporating specific activities into daily school transitions can be a big help. Unpredictable transitions for children are one of the main reasons a tantrum or sensory meltdown may occur. Some of these ideas include:

    • Use a predictive schedule
    • Limit close seating
    • Minimize auditory stimulation (Utilize earbuds, sound-minimizing headphones, white noise, whisper phones)
    • Increase space between children
    • Movement breaks
    • Sensory seating
    • Provide a calm down area or sensory safe zone
    • Weighted lap blanket or compression garments
    • Try tactile tools at the desk
    • Decrease visual distractions (trifold, work standing at an easel, single color bulletin boards)
    • Use a visual schedule for transitions
    • Provide a warning before fire drills or bus evacuation drills
    • Plan an accommodation for school-wide assemblies
    • Provide a calm down portion of the day build into the schedule with deep breathing and soft music
    • Yoga breaks
    • Stretches before desk work or tests
    • Add wall push-ups or chair push-ups into the daily schedule
    • Water bottles with a straw at each desk (ask parents to send in sports bottles)
    • Allow gum during tests or quiet work time
    • Quiet fidget toys
    • Movement learning with the whole classroom

     
     



    Here are more classroom sensory strategies that may help.

    Use these sensory calm down strategies for school to help kids with self-regulation and over responsiveness in the classroom.



    Need more information on sensory processing, grab the Sensory Processing Disorder Handbook below. 

    Use these sensory calm down strategies for school to help kids with self-regulation and over responsiveness in the classroom.

     

    Free Classroom Sensory Strategies Toolkit

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      Free Sensory Processing Disorder Booklet

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        Colleen Beck, OTR/L has been an occupational therapist since 2000, working in school-based, hand therapy, outpatient peds, EI, and SNF. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. Read her story about going from an OT making $3/hour (after paying for kids’ childcare) to a full-time OT resource creator for millions of readers. Want to collaborate? Send an email to contact@theottoolbox.com.

        6 Ways Core Strength Impacts Handwriting

        When a child sits down to write at a desk, it can be easy for everything to go awry and messy, illegible handwriting to result.  It might be poor carryover of handwriting skills, difficulty with letter formation, visual motor skills that are not up to par, or weak fine motor skills and pencil grasp struggles.  The issue with sloppy handwriting is that there is a LOT going on!  One tip to check as soon as a child sits down to write, is their posture.  Everything from head positioning and visual view of the writing space to positioning of the arm and hand on the paper stems from the midline and base of support.  Because of this, I wanted to share ways that core strength impacts handwriting.

        Core strength impacts handwriting legibility and neatness when it comes to attention, posture, and every aspect of handwriting, a great resource for teachers or school based OT in the classroom who work on handwriting with kids.


        Core Strength and Handwriting

        The child with weak core strength may have sloppy handwriting that just can’t be fixed.  Band-aides of pencil grips, specialty lined paper, and handwriting modifications can help improve written work, but when a weak core is holding up the child, the handwriting struggles will never be fully fixed. 


        It is so important to start with the midline and base of support when it comes to handwriting.  That proximal beginning of assessing the child can make a world of difference with just a few adjustments in posture and strengthening. 


        When there are handwriting problems, there are underlying issues that cause them.  Core strength is a big cause of handwriting struggles.


        Here are 6 ways that core strength impacts handwriting legibility and neatness:



        1) When a child has a weak core, they may tend to sit with a modified base of support.  They might slump over at their desk and lean on their elbows.  You might see a slouched back, knees and legs sticking out between the rows of desks.  You might see kids who are slumped over their papers or are leaning on one hand as they write.  You might see the child lying forward on an extended arm that reaches over the front of their desk.  An inefficient posture can lead to poor handwriting.  Read more about a 90/90/90 posture and how to promote that posture using cue cards.



        2) Classroom teachers will say they often times see students who are not active and alert during school tasks.  A weak core can transition to inattention and inability to focus on learning or handwriting tasks.  A core strengthening plan can help this problem.


        3) When the core is not engaged, the child’s non-dominant hand can not support the paper.  When this happens, the paper isn’t stabilized and legibility can suffer.  Coordinating both hands together with an engaged midsection requires a strong core. Read here about tricks for holding the paper when writing.


        4) A weak core can lead to a child who can’t engage their muscles over a period of time.  This looks like a child who wiggles, moves in their seats, jumps up, and slouches.  With all of that wiggling and moving, handwriting can suffer!


        5) Copying a list of words from a smartboard, book, or homework assignment center across the classroom or desk requires visual shift and the ability to quickly scan using visual perceptual skills.  When a child who has weak core tries to copy a list or sentences, they might present with a slouched upper back and neck over their desk.  Looking up and back down again can be really difficult for these students with the repeated flexion and extension of the neck.  This can result in skipped words, letters, and phrases as well as poor margin use, line awareness, and spatial awareness when writing and copying written work.


        6) A weak core leads to weak fine motor skills distally.  The engaged and strong muscles of the abdomen and upper body allow for strength and engagement of the upper arm, and in turn leads to dexterity and motor control of the hands.  When the core is weak the hands can not effectively do their job to hold the pencil and manage tasks such as in-hand manipulation.

        What should you do when weak core muscles impact handwriting?

        Strengthening the core can have a HUGE impact in handwriting!  


        Use the strategies and tips to give kids the strong core foundation they need to improve handwriting.

        Core strength impacts handwriting legibility and neatness when it comes to attention, posture, and every aspect of handwriting, a great resource for teachers or school based OT in the classroom who work on handwriting with kids.