What is Oral motor skills ?
Oral motor skills refer to the movements of the muscles in the mouth, jaw, tongue, lips and cheeks. The strength, coordination and control of these oral structures are the foundation for feeding related tasks, such as sucking, biting, crunching, licking and chewing
Let’s learn how it starts developing….
DEVELOPMENT OF ORAL MOTOR SKILLS
Oral motor skills are the finest of the fine motor skills we develop as human beings. It begins in the womb, and is fully developed and established by 3 years of age. Like many other skills we learn, oral motor development is supported by primitive reflexes, postural control and other physiological milestones developing in synchrony. When the synchrony is broken, problems arise
WHERE IT ALL BEGINS: Oral motor skills start in the womb with the development of primitive reflexes that support feeding at full term. It is important to note that these reflexes develop in the 3rd trimester between the 28th week and the 37th week gestation. When working with a pre-term baby, these reflexes have not developed and successful feeding will require higher levels of support from an outside source.
ORAL MOTOR SKILLS BIRTH TO 3 MONTHS OF AGE: As reflexes begin to integrate, feeding becomes more and more voluntary, and less of a non-voluntary response to stimuli from the breast or bottle. This occurs in a full term infant around 6 weeks of age. This is important to note, as unsuccessful feeding in the first 6 weeks of life, can set the tone for developing eating patterns throughout life.
ORAL MOTOR SKILLS AND FEEDING AT 3 – 7 MONTHS OF AGE: By 4 months of age, most infants have gained fair head control and are able to remain in an upright position with support, and parents are beginning to introduce puréed foods. As they have grown, the anatomical structure of their jaws and tongues has dropped forward to support munching patterns. They also may open their mouth when a spoon is presented and are able to manage thin purees with minimal difficulties.
ORAL MOTOR PATTERN 3-7 MONTHS:
- Munching patterns
- Lateral jaw movement
- Diagonal jaw movement
- Lateral tongue movement
The development of these patterns allows infants to be successful with thin and thick purees, meltables and soft foods such as banana and avocado.
ORAL MOTOR SKILLS AND FEEDING AT 7-9 MONTHS OF AGE: Between 7 and 9 months of age, infants are now moving into unsupported sitting, quadroped and crawling. This development supports jaw stability,breath support and fine motor development for self feeding skills. Infants at this age now begin to be able to successfully manage “lumpy” purees, bite and munch meltables and softer foods with assistance and the development of rotary chewing begins.
ORAL MOTOR PATTERNS 7-9 MONTHS OF AGE:
- Lip closure
- Scraping food off spoon with upper lip
- Emerging tongue lateralization
- Movement of food from side to side
The above skills are clearly noted during the 7-9 month age range. If these skills are missing, eating a larger variety of textures will become difficult.
Rotary Chewing: Rotary chewing is broken into stages. The first stage being diagonal rotary chewing, and the second being circular rotary chewing.
Diagonal Rotary Chew: Diagonal rotary chewing is when the jaw moves across the midline in a diagonal pattern and comes back. This type of chewing often looks like an X from a frontal view.
Circular Rotary Chew: As the child develops, a circular rotary pattern emerges. In this pattern, the child’s jaws line up, slide across, jaws line up, and slide across again, looking like a circle from a frontal view.
Rotary Chewing Supports: Rotary patterns begin emerging around 10 months of age. The child at this time is also developing dissociation of his head from his body. This supports increased independence with biting pieces of food, lateralization of a bolus across the midline, and decreased spillage from the lateral sides of the mouth.
ORAL MOTOR SKILLS AT 12-15 MONTHS OF AGE: By 12 months of age, the child has developed the oral motor basics to support feeding. As time goes on, the child will practice these skills resulting in less messy eating and the ability to handle more challenging foods. At this age, a child is able to manage foods with juice, and chew and swallow firmer foods such as cheese, soft fruits, vegetables, pasta and some meats.
ORAL MOTOR SKILLS AT 16-36 MONTHS OF AGE: Between 16 and 36 months of age, the child continues to develop their jaw strength, management of a bolus, chewing with a closed mouth, sweeping of small pieces of food into a bolus, and chewing ‘harder’ textured foods such as raw vegetables and meat. A full circular rotary chew should also be developed at this time to support eating all varieties of foods.
IMPACT OF DELAYED ORAL MOTOR SKILLS
Oral motor skills play a large role in a child being a successful eater and having a positive experience with food. When a skill is missing, feeding becomes difficult and stressful for everyone involved. By assessing where the delay in skill is, new skills can be developed successfully, leading to an efficient eater.
Even though your child is using their mouth, their body may also be craving sensory experiences. The proprioceptive and vestibular senses can help meet the body’s sensory needs. If used regularly, they may even reduce the child’s need for oral stimulation. Speak to your Occupational Therapist for additional strategies if needed.
Generally, oral motor skills involve the strength and flexibility of the muscles in your face and mouth. Developing oral motor skills is of vital importance for children, for without them many basic day-to-day functions become impaired
Several parts of your body are responsible for your oral motor skills, including your jaw, cheeks, soft palette and tongue. Oral motor skills are needed to suck, swallow and chew as well as to keep your mouth closed at night to prevent drooling. Your oral motor abilities also affect the clarity of your sp
In the early childhood setting children with poor oral motor skills are easily identified. These children are often difficult to understand, can have a limited diet through disliking the taste or texture of food, may mouth or chew non-food objects, and can teeth grind. They can have poor sensory awareness of the mouth eech. and low muscle tone in this area. This can result in an open mouth posture, dribbling and difficulty chewing\
The purpose of this leaflet is to look at some sensory based causes of oral motor difficulties and ways in which Occupational Therapy can help
Advice for oral sensory seeking behaviors
Each child is different and each child will require different types or amounts of stimulants to satisfy their sensory need. If your child is developmentally quite young, some of this mouthing may be explorative. Generally you may have more success if you can find something to substitute that will give the child similar pay-off
Oral stimulation and co-ordination activities include:
- Crunchy textured foods i.e. cereals, pretzels, crackers, vegetable sticks and fruits
- Chewy toys e.g. chewy tubes, chewellery and chew buddies
- Rather than chewing, some kids like the feel of something vibrating in their mouth, i.e. battery toothbrushes.
- To help actively increase sensory awareness encourage blowing windmills, bubbles, or whistles
- Utilize deep pressure techniques (please seek further advice from your Occupational Therapist for a demonstration if you are unsure).
These help to provide proprioceptive stimulus. If your child is sensitive around their face, prepare them beforeØ you approach their face. Use slow, firm strokes over the hands, arms, shoulders, body and neck. Gradually working towards the centre of the face. Massage the cheeks and around the mouth using circular andØ up/down motions to stimulate the jaw muscles
-By Dr. Bhavya Singh