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Caring for children with oral motor and oral sensory problems
About oral-motor and oral-sensory problems
The oral-motor aspect of eating involves how the mouth muscles function: how strong the muscles are, how well they coordinate the range of motion and how far they can move as they manipulate food in the mouth. The oral-sensory aspect of eating involves how the mouth tissues perceive sensory information such as the taste, temperature and texture of food. Children can have problems with either oral-motor or oral-sensory or both; there is often overlap with feeding disorders.
Some children may be hypersensitive to oral stimuli, causing them to gag, grimace or have other strong reactions to certain types of food. Others may be hyposensitive (under-responsive): They may not feel food in their mouths or may let it drop out of their mouths without realizing it.
Some children with oral-sensory problems can have a feeding aversion to how foods feel or taste but will have no problem putting other things in their mouths. Children with general oral aversions will gag or vomit in response to anything in their mouths.
What causes of oral-motor and oral-sensory problems?
Both oral-motor and oral-sensory problems are caused by problems with nerves. Adults may develop these kinds of feeding problems after a stroke or head trauma. But when children develop oral-motor and oral-sensory problems, the cause is less clear. Some children may be born with nerves that function abnormally and may never have experienced a normal eating experience. Others may develop altered nerve patterns if they’ve experienced a lot of medical issues, such as surgeries or extended hospital stays that require tube feeding. Anything that interrupts normal eating at a critical developmental stage can have an impact on oral-motor and oral-sensory function.
There are certain sensitive periods when a child’s brain is ready to learn new eating skills such as spoon feeding and solid table foods. Introducing those skills too early or waiting too long can also result in oral-motor and/or oral-sensory problems.
There can also be a behavioral component in addition to the physical problem. A child who frequently vomits may develop an aversion to food, for example. Feeding disorders are often multifaceted and thus require an interdisciplinary approach from pediatric feeding specialists who can treat the physical and behavioral aspects of the problem.
How often do oral-motor and oral-sensory problems occur?
Five to 10 percent of typically developing children have a serious feeding disorder at some point, and that could include oral-motor or oral-sensory problems. Up to 80 percent of children with developmental disabilities have some sort of feeding disorder.
How do oral-motor and oral-sensory problems develop?
It depends on the child. Some children might have problems from birth while others may develop an oral-motor and/or oral-sensory problem after a significant medical event or once they transition to a new type of food (for example, from liquids to purees or from purees to table food). Children who have other medical issues may be diagnosed within the first six months of life, but others are often referred for a feeding evaluation around 15-18 months of age, if the child isn’t growing well or hasn’t advanced to table food.
Children who were born extremely premature; who have GI, respiratory or neurological disorders; or who have genetic syndromes may be more likely to develop oral-motor and/or oral-sensory problems. Kids on the autism spectrum often have sensory issues that can affect their eating.
What are the symptoms of oral-motor and oral-sensory problems?
Symptoms of a motor problem could include:
- Delayed advance of textures because the child can’t physically manage chewing solid foods
- Slow or inefficient chewing
- Food left in the mouth
- Food falling from the mouth
- Coughing or choking
- Low intake of food (the child may not consume enough calories because it takes so long to eat)
- Delayed advance of other feeding milestones (such as transitioning to a regular open cup from a sippy cup)
Symptoms of a sensory problem could include:
- Refusal to eat
- Crying during meal times
- Delayed eating milestones (the child may be able to tolerate liquids and purees but have trouble with chewable foods, or vice versa)
- Unusual taste preferences (such as salsa on eggs)
- Food falling from the mouth
Why are oral-motor and oral-sensory problems a concern?
Any type of feeding disorder can significantly affect a child’s nutrition at a critical age for growth and development, possibly leading 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. Children with oral-motor problems may have trouble swallowing safely and could be at risk for aspiration and choking.
Eating is not only critical for survival, it’s also an integral part of our social experience. A child who can’t eat or won’t eat can have a serious impact on the entire family’s quality of life.
How are oral-sensory and oral-motor problems diagnosed/evaluated?
A thorough medical history is essential: It’s important for our medical team to understand how feeding has gone since birth to know where the problem started. Our Feeding team 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 and what modifications caregivers make to get your child to eat.
Your Feeding team’s speech pathologist will do an oral-sensory motor exam, examining your child’s facial structure, muscle strength, range of motion and sensory reactions.
The next step is a feeding observation to see how your child eats. Our feeding experts will look for signs of weakness in the cheeks, poor range of motion or uncoordinated movements to indicate oral-motor problems. Gagging, vomiting or other strong reactions to certain foods or textures can point to an oral-sensory problems.
Children who have oral-motor or oral-sensory problems will be evaluated for swallowing problems (also known as dysphagia). Poor oral control can lead to aspiration, so the speech pathologist will make sure your child can swallow safely. A barium swallow study and videoflouroscopic swallow study, also known as a modified barium swallow study, can reveal any potential problems with the swallowing process.
What is the treatment for oral-sensory and oral-motor problems?
Our experts will tailor a customized treatment plan based on your child’s needs. If your child lacks the proper oral-motor skills, your feeding team’s speech pathologist can lead him or her through exercises that build the mouth muscles and proper eating techniques. If your child has a sensory problem, your child’s team may recommend desensitization therapy (repeated exposure to problematic foods or textures) or may suggest modifying what or how your child is fed (for example, changing the type of utensil or cup) until your child’s feeding abilities improve. Hyposensitive children may need extra sensory information, such as extra flavoring, to recognize the presence of food. If there’s a behavioral component to your child’s feeding issue, the treatment plan could include cognitive behavior therapy with one of our pediatric psychologists. Whatever approach we take, our goal is to make sure your child can eat safely and efficiently.
What happens after treatment?
Treatment length depends on the problem and your child’s age and skill level. Feeding therapy can take months or years. Therapy ends when your child has met expectations and is able to manage age-appropriate foods, but some patients may have chronic oral-sensory and/or oral-motor problems.
When should you contact a physician?
Talk to your pediatrician if your child shows any signs of difficulty eating or unusual eating patterns. If a toddler hasn’t transitioned to table foods by 15-18 months of age, it usually warrants a feeding evaluation.
What is the long-term outlook for oral-motor and oral-sensory problems?
The outlook is highly variable. Most children with these sorts of issues eventually do well and are able to eat normally, but the more complex the condition, the longer it will take. Some children who have other medical complications may require a lifelong modified diet.
How do I live with oral-motor and oral-sensory problems?
Feeding disorders can take a toll emotionally on children and their parents, so don’t hesitate to ask for help if you need it. The Feeding team will coach you on what you can do at home to optimize your child’s eating success.