Oral-motor and oral-sensory problems are issues with eating. These affect how well a child can eat. Some kids have trouble chewing or moving food around in their mouths. Others may avoid certain textures, temperatures or flavors.

Kids may struggle with either part of the eating process or both. There is often an overlap with feeding disorders.

Any type of feeding disorder can significantly affect a child’s nutrition. This can lead to failure to gain weight, poor weight gain or failure to thrive. Not getting enough calories and fat can also affect brain growth and development.

Kids with oral-motor problems may have trouble swallowing safely and could be at risk for aspiration and choking.

Oral-Motor Issues

Oral-motor issues involve how the mouth muscles function.
This includes:

• How strong they are
• How well they work together
• Their range of motion
• How they manipulate food in the mouth

Symptoms of a motor problem could include:

• Late to eating solid foods because they struggle to chew them
• Slow or inefficient chewing
• Food left in the mouth
• Food falling from the mouth
• Gagging
• Coughing or choking
• Not eating enough because it takes so long to eat
• Late to feeding milestones (like using an open cup)

Oral-Sensory Issues

Oral-sensory issues involve how the food feels in the mouth. This includes how the mouth tissues perceive sensory information. This can be the taste, temperature or texture of food.

• Kids who are hypersensitive to oral stimuli may gag, grimace or have other strong reactions to certain types of food.
• Kids can also be hyposensitive or under-responsive to food stimuli. They may not feel food in their mouths or it may drop out of their mouths.

Some kids with oral-sensory problems can have a feeding aversion. They may hate how foods feel or taste, but they will have no problem putting other things in their mouths. Kids with general oral aversions will gag or vomit in response to anything in their mouths (not just food).

Symptoms of an oral-sensory problem could include:

• Gagging
• Refusal to eat
• Crying during mealtimes
• Vomiting
• Late to eating milestones, including trouble with chewable foods
• Unusual taste preferences (such as salsa on eggs)
• Food falling from the mouth

Risk factors for oral-motor and oral-sensory issues include kids:

• Who were born extremely premature
• Who have GI, respiratory or neurological disorders
• Who have genetic syndromes
• On the autism spectrum

Both oral-motor and oral-sensory problems can be due to nerve issues. Some kids may be born with nerves that don’t work right — they may have never eaten normally. For other kids, medical issues, like surgeries, extended hospital stays and tube feeding, have altered their nerve patterns.

Anything that interrupts normal eating at certain sensitive periods can have an impact. For example, when a child’s brain is ready to learn new eating skills, such as spoon feeding and solid table foods. Starting those skills too early or waiting too long can also result in feeding issues.

There can also be a behavioral component to these food issues. A child who vomits a lot may get an aversion to food, for example.

Treatment plans vary depending on each child’s unique situation.

A kid who needs to work on their oral-motor skills may see a speech pathologist. They’ll work on exercises to build the mouth muscles and improve eating techniques.

If your child has a sensory problem, they may need desensitization therapy. This is careful, repeated exposure to troubling foods or textures. The care team may suggest changes to what or how you feed your child until their eating abilities improve. This could involve changing the type of utensil or cup.

Hyposensitive kids may need extra sensory information. We can add extra flavoring to help them notice the food.

Cognitive behavior therapy can help if there’s a behavioral component to your child’s feeding issue.

Whatever approach we take, our goal is to make sure your child can eat safely and efficiently.

Feeding disorders are often multifaceted. They need a team of experts in pediatric feeding. They work together to treat the physical and behavioral aspects of the problem.

We bring together experts in:

• Speech therapy
• Occupational therapy
• Nutrition
• Behavioral health
• Other medical experts

Your First Visit

A thorough medical history is essential. It’s key to share as much as possible about how feeding has gone since birth. This will help the care team know where the problem started.

The feeding specialists will want to know about:

• Your child’s reaction to certain food textures
• How long it takes your child to eat
• What foods your child avoids
• What changes you make to get your child to eat

The speech pathologist will do an oral-sensory motor exam.

They’ll examine your child’s:

• Facial structure
• Muscle strength
• Range of motion
• Sensory reactions

The next step is a feeding observation to see how your child eats.

They’ll look for:

• Signs of weakness in the cheeks, poor range of motion or uncoordinated movements. These can indicate oral-motor problems.
• Gagging, vomiting or other strong reactions to certain foods or textures. These point to an oral-sensory issue.

They will also check if your child has swallowing problems (also known as dysphagia). Poor oral control can lead to aspiration. We will make sure your child can swallow safely.

Your child may need additional testing to reveal any potential problems with the swallowing process. These could include:

• Barium swallow study: Shows how food and liquid move through the mouth, throat and esophagus.
• Videofluoroscopic swallow study: Shows how your child chews and swallows different textures to check for safety and coordination. Also known as a modified barium swallow study.

During Treatment

Treatment length depends on the problem and your child’s age and skill level. Feeding therapy can take months or years.

Feeding disorders can take a toll emotionally on you and your family. Don’t hesitate to ask for help if you need it. Our team will coach you on what you can do at home to help your child’s eating success.

After Care

Therapy ends when your child has met expectations. They should be able to manage age-appropriate foods. Some kids may have chronic oral-sensory or oral-motor problems and need long-term care.

The outlook is highly variable. Most kids with these sorts of issues eventually do well and are able to eat normally. For more complex conditions, treatment will take longer. Some kids who have other health issues may require lifelong diet changes.