Pediatric Feeding: Is it Sensory, Oral Motor or Both?

Below, you will find a blog post on pediatric feeding therapy and answers to initial questions about feeding therapy such as “Are pediatric feeding issues related to sensory needs, oral motor problems or both?” and thoughts about where to begin with pediatric feeding therapy techniques. A question of sensory or oral motor concerns should be taken into consideration when feeding developmental milestones aren’t being achieved on target.

Occupational therapists and parents often wonder if feeding problems are related to sensory issues or oral motor skills. This article on pediatric therapy addresses that question.

Pediatric Feeding: Is it Sensory, Oral Motor or Both?

When I was in grad school, we had one, three hour lab on feeding, and were told, Speech would handle feeding, so don’t worry.  Little did I know that what I thought was going to happen, was very far from reality.

Feeding Therapy Evaluation

When a child enters a therapy clinic for an OT feeding evaluation, we are prepared for sensory deficits to be present. What we are not prepared for in school, is the potential, and probable oral motor component. This is a skill that most of us learn on the job, in trial by fire, with limited guidance. Or, so was my experience.

Due to the high level of overlap between Speech and OT when it comes to feeding, this often is a problem that OT’s face. Depending on the setting, and even the facility you are in, can determine whose job it is to handle feeding clients.

A majority of professionals maintain that if it appears sensory based and the child has a limited diet, eats only certain textures or colors, it is for OT. If it appears oral motor in nature and the child cannot chew or manage a bolus well, it is for Speech to handle.

Herein lies the problem and common misconception about problematic feeders. Feeding challenges are more than just sensory, or just oral motor.

It is both sensory and oral motor based. This can lead to a very challenging, and complex situation for an OT who is new to feeding.

Oral Motor Skills and Sensory Challenges in Feeding Therapy

When a child limits the textures and variety of foods they eat, they limit the growth and development of their oral motor skills.

Let’s take a child who eats only pureed foods, and refuses solids of any kind for an example.

Oral motor skills needed to eat a thin puree off a spoon and to eat a carrot stick are vastly different.

Puréed foods require minimal bolus management of a thin food that quickly runs down the esophagus with minimal effort. The puree is also smooth, eliminating any scary “texture” for the child to manage.

The carrot stick, on the other hand requires the child to have awareness of his mouth, tongue, and bite pressure before even creating a bolus with the bite of carrot. The child also has to manage the bolus and break down of carrot efficiently while chewing and then swallowing.

Add in the sensory component of crunchy, wet and constantly changing size of the pieces of the carrot, and the child can become easily overwhelmed.

And so, the vicious cycle of a limited diet begins. Lack of confidence with oral motor skills and sensory deficits can lead to problematic feeders.

Feeding Therapy Goals

The above example is a frequent experience that many OT’s have faced when completing a therapy feeding session. With lack of exposure and continued refusal to attempt new foods, the child’s oral motor skills are never able to develop to support the trial of new foods continuing the cycle.

As occupational therapists, it is our job to help these children become functional eaters through the use of sensory desensitization and remediation of delayed oral motor skills.

Oral Motor Development in Feeding Therapy

As oral motor development is a lengthy topic, the next post will address oral motor development and food pairings to determine gaps in skills and provide effective remediation of delayed skills.

Check out the handout below to show parents and help explain the overlap of sensory processing and oral motor skills in problematic feeders.

Would you like to print this visual guide? Click here to access the printable pdf in our free resources library. You will also receive weekly newsletters full of therapy resources, tips, strategies, and information. The OT Toolbox newsletter is perfect for therapists and those working with occupational therapists.

Disclaimer: Feeding difficulties stem from a variety of difficulties including medical, structural, sensory deficits and skill deficits. The main discussion of this post is to examine the crossover of sensory and oral motor skills. Medical and structural concerns will be addressed in future posts.

A little about Kaylee: 
Hi Everyone! I am originally from Upstate N.Y., but now live in
Texas, and am the Lead OTR in a pediatric clinic. I have a bachelors in Health Science from Syracuse University at
Utica College, and a Masters in Occupational Therapy from Utica College. I have been working with children with special needs for 8 years,
and practicing occupational therapy for 4 years. I practice primarily in a
private clinic, but have experience with Medicaid and home health settings
also. Feeding is a skill that I learned by default in my current
position and have come to love and be knowledgeable in. Visual development and
motor integration is another area of practice that I frequently address and see
with my current population. Looking forward to sharing my knowledge with you all! ~Kaylee Goodrich, OTR

Click on the images below to check out these related articles: 

Jaw instability is an oral motor problem that results in impaired eating and drinking skills.  Exaggerated jaw movements are an oral motor problem that interfere with feeding including eating and drinking. Here are reasons why this oral motor issue happen and how it relates to feeding in kids. Jaw clenching is an oral motor problem that interferes with feeding and eating. Help to understand jaw clenching and reasons it might occur. 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.

Stability Bite Oral Motor Problems

You may have seen the series of oral motor posts here on The OT Toolbox. All of these oral motor issues and additional resources are described on this oral motor problem post where you can check out common oral motor issues that interfere with eating and drinking like jaw clenching, jaw instability, jaw clenching, exaggerated jaw movements, and jaw thrust. The information below is related to stability bite oral motor problems.
Oral motor problems such as stability bite is an inefficient oral motor issue that interferes with eating, feeding, and brushing teeth. Occupational therapists and those who work with kids with oral motor challenges will find this helpful.

Stability Bite Oral Motor Problems

Start by reading more about development of oral motor skills.

When presented with a spoon, fork, cup, or straw, the child exhibiting a stability bit tightly bites down in order to gain stability in a voluntary manner. They are able to voluntarily open their mouth unlike jaw closure.

A stability bite occurs because of several reasons:

  • Low muscle tone
  • Poor posture
  • Fluctuations in muscle tone
  • Poor control of the jaw
  • Poor or inconsistent proprioceptive feedback from the jaw
  • Poor graded control of jaw movements
  • Lack of experience with biting and chewing exploration

Feeding issues related to a stability bite

  • When kids present with stability bite, eating and drinking are not efficient.
  • Rhythmical eating and drinking can result.
  • It is possible for a pattern of internal jaw instability to develop with continued use of external stability that a stability bite provides.
Oral motor problems such as stability bite is an inefficient oral motor issue that interferes with eating, feeding, and brushing teeth. Occupational therapists and those who work with kids with oral motor challenges will find this helpful.

Jaw Clenching Oral Motor Problems

You may have seen some of the oral motor problems posts in a recent series we’ve had here on The OT Toolbox.  We’ve been talking all about oral motor skills and today brings another in that series.  If you missed any of those posts, you can find all of the past posts on oral motor skills and how they relate to feeding here.   

 
Below you’ll find information related to jay clenching oral motor issues and the reasons that this particular oral motor problem occurs.  You’ll also find feeding issues that may ensue from jaw clenching.


 
Jaw clenching is an oral motor problem that interferes with feeding and eating. Help to understand jaw clenching and reasons it might occur.
Start by reading more about development of oral motor skills.
 

Jaw Clenching Oral Motor Problems

Jaw clenching occurs when the jaw moves into a tight position as a result of body movements and the ability to open the mouth occurs. Jaw clenching can result in shortening of jaw musculature and contractures.  This leads to anatomical inability to open the mouth.


It’s possible that the observation of a clenched jaw in feeding may be confused with stability biting and tonic bite response. 


Teeth grinding can occur as a result of a clenched jaw.


Jaw clenching occurs because of several reasons:


Poor posture with overall flexion

Over-Stimulating sensory environment

Increased stress

Impaired control of jaw movements

 

Feeding issues related to jaw clenching:

When a child presents with a clenched jaw, their ability to
develop the skills needed for feeding are greatly impacted.  
 
They cannot utilize rhythm in eating and
drinking. 
 
Initiation or sustained movement patterns during eating and drinking
are impacted.
 
Oral Motor Exercises
 
 
 
Jaw clenching is an oral motor problem that interferes with feeding and eating. Help to understand jaw clenching and reasons it might occur.
 

Jaw Instability Oral Motor Problems

jaw instability

Have you been following along on our oral motor series this past week? You can find all of the posts related to oral motor skills and how they relate to feeding on the site. Each area will be addressed along with reasons why abnormal oral motor problems occur and their influence on eating and drinking. Be sure to check out the past oral motor problem posts and come back as the remaining areas are addressed in upcoming posts.

Jaw instability is an oral motor problem that results in impaired eating and drinking skills.

Jaw Instability and Oral Motor Problems

Jaw instability is observed when the jaw slips and shifts due to inefficient tone and control, resulting in a child who opens and closes the mouth to reset positioning.  Jaw instability is also observed in the child who holds their mouth closed in a tense open position or closed by biting.

Jaw instability occurs because of several reasons:

  • Laxity of the temporomandibular joint
  • Delayed development of jaw stability due to hypotonia
  • Structural problems at the temporomandibular joint
  • Poor control of the jaw
  • Poor grading of movement patterns
  • Poor isolation of jaw movements from the body

Read more about development of oral motor skills.

Feeding issues related to jaw instability:

When a child presents with jaw instability, every aspect of eating and drinking are affected.

  • Difficulties present in the use of cheeks, lips, and tongue in coordinated eating and drinking when jaw instability is present.
  • Controlled biting and chewing occur.
  • Positioning the jaw when not chewing can be uncomfortable, painful, or difficult.
  • Graded biting and chewing can be difficult.
  • The child might experience more stability with biting and chewing motions when approaching food from the side of the mouth.

Looking for ways to address jaw instability?

Oral Motor Exercises for the Jaw

Be sure to check out this resource on oral motor exercises to begin.

Specifically with the jaw, certain oral motor exercises can support mobility and motor coordination to support eating, drinking, and overall jaw instability:

  1. Vibrating toothbrush
  2. Vibrating toys
  3. Sensory chew tools
  4. Baby teethers
  5. Mesh feeding bags with sour, sweet, and cold foods
  6. Foods that offer heavy feedback through the jaws: fruit leather, licorice, dry fruit, cranberries, raisins, etc.
 
 
Jaw instability is an oral motor problem that results in impaired eating and drinking skills.
 

Exaggerated Jaw Movements Oral Motor Problems

You might be following along with our series related to oral motor problems that relate to feeding. In it, we are covering all of the specifics about oral motor problems that translate to difficulty with eating and drinking. So far, we’ve covered jaw thrust but have more oral motor problems that will be covered in the coming days. Today, exaggerated jaw movements are addressed, along with the cause of these movements and how they relate to feeding issues.


Exaggerated jaw movements are an oral motor problem that interfere with feeding including eating and drinking. Here are reasons why this oral motor issue happen and how it relates to feeding in kids.


Start by reading more about development of oral motor skills


Exaggerated Jaw Movements Oral Motor Problems





Exaggerated jaw movements are different from jaw thrust in that the movements are not forceful.  When exaggerated jaw closure occurs, it can be a compensation strategy for jaw instability or 

There are several reasons for these exaggerated jaw movements:

Fluctuations in muscle tone
Impaired oral control
Decreased muscle tone
Exaggerated excursions can be an overflow or organizing movement
Increased oral tone
Oral hypersensitivity to the teeth touching teeth, utensils, tongue, food, straw, or a drinking cup
Poor sustained jaw closing
Jaw instability
Poor graded movement patterns


Feeding issues related to exaggerated jaw movements:

Exaggerated jaw movements interfere with stability needed for drinking from a straw, cup, or bottle, removing food from a spoon, biting, or chewing. 


 Stability in the jaw is necessary for efficient swallowing and controlled eating. 


 When the jaw’s movement patterns are exaggerated, an individual spills food and is at risk for aspiration due to difficulty with swallowing.


Graded movements on a cup or utensil are difficult, resulting in food spillage or drooling. 


Oral Motor Exercises for the Jaw

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


If you are looking for exercises related to common oral motor problems, this FREE printable pack of oral motor exercises goes along perfectly with the series I have planned for you.  Get your free printable packet of 20 different feeding therapy ideas AND 20 oral motor exercises.  These are treatment ideas for oral motor problems that professionals can utilize over and over again.  

 
 
Exaggerated jaw movements are an oral motor problem that interfere with feeding including eating and drinking. Here are reasons why this oral motor issue happen and how it relates to feeding in kids.

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.

 

St. Patrick’s Day Shamrock Chocolate Pops Treats

This St. Patrick’s Day, surprise someone special (or a whole crowd) with these easy miniature Shamrock chocolate lollipop treats.  These little treats are quick to put together and a big hit.  Sometimes, my kids receive treats that are huge and then the sugar rush is a little out of control.  These small sized lollipops are the perfect little snack for St. Patrick’s Day preschool, play dates, or parade crews!

Miniature Shamrock Chocolate Lollipop treats for St. Patrick's Day


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St. Patrick’s Day chocolate lollipop treats:


We started with a handful of lollipop sticks.  I used a steak knife to cut the sticks into thirds.  You will have a ton of lollipop sticks left over, but don’t worry.  You can dye the lollipop sticks and use them for learning activities like shape building activities.

Pull out a cookie sheet covered with aluminum foil.  Arrange green chocolate chips into groups of four.   Pop them into a preheated oven set at 250 degrees F.
Miniature Shamrock Chocolate Lollipop treats for St. Patrick's Day
Keep a close eye on the chocolate chips.  It will only take a minute or two for the chips to soften.  You want them to just start to melt, but not too much.  I used a toothpick to pull the tips into the center of the four chocolate chips.  Place the lollipop sticks on the chocolate and slightly twist it so the stick is covered in chocolate.

Miniature Shamrock Chocolate Lollipop treats for St. Patrick's Day
Miniature=cute.

Miniature Shamrock Chocolate Lollipop treats for St. Patrick's Day

Miniature Shamrock Chocolate Lollipop treats for St. Patrick's Day
These two were Big fans of our Little shamrock treats!

Need a quick shamrock activity to go along with your shamrock chocolate pops?  Try making this shamrock thumbprint art.

Rainbow Smoothie Recipes for Kids

We LOVE healthy fruit and veggie smoothies in our house.  When the kids hear the blender blending, they come running!  So when I saw this smoothie recipe below, I knew I had to feature it.  I love the rainbow of colors in the smoothie recipe.. Then I started thinking that we need more colors of smoothies here! I can’t wait to try all of these smoothie recipes with my kids.  We’ll sip our way through the rainbow!


Kids will love these healthy smoothie recipes!  Sip your way through the rainbow with red, orange, yellow, green, blue, purple smoothies. From Sugar Aunts.

A Rainbow of Smoothie Recipes:

RED SMOOTHIE: Watermelon and Lime Smoothie from Housing a Forest
ORANGE SMOOTHIE: Tropical Orange Delight smoothie from mom Endeavors
YELLOW SMOOTHIE: 
GREEN SMOOTHIE:
BLUE SMOOTHIE: Blueberry Kale smoothie from Coffee Cups and Crayons
PURPLE SMOOTHIE: Very Berry smoothie from Crazy Adventures in Parenting



And make a rainbow of colors with a Rainbow smoothie recipe from Jodie Fitz

What is your favorite smoothie recipe?