Oral Motor Function In Pediatrics
The ability to swallow and speak requires oral motor skills. This includes control of the lips, checks and jaw as well as the tongue, and hard and soft palate inside the mouth. Disruption of function in any one or all these oral functions can lead to aspiration of fluid or food, the inability to swallow safely, and the ability to speak. Dysphagia is difficult swallowing. Dysarthria is difficult speaking. These issues may appear together or separately after paralysis.
Dysphagia (difficulty with swallowing) can lead to dehydration, malnutrition, aspiration of food and fluid into the lungs leading to pneumonia and pushing of food up through the nose and sinus cavities. Symptoms of dysphagia include coughing, choking, drooling, feeling like something is constantly in the throat, inability to swallow. Your child may not be able to tell you they feel these symptoms but as a caregiver, you may observe them. Even slight changes should be brought to the attention of your healthcare provider.
Paralysis can affect swallowing throughout oral and swallowing function or just on one side.
Testing is performed using swallow studies where fluid is introduced to the child in a healthcare setting while using fluoroscopy (a very mild x-ray). Sometimes, a tube is passed to observe the inner workings of the mouth and throat.
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Treatments include oral motor therapy usually provided by a Speech-Language Pathologist. This includes desensitization, oral motor strengthening, and swallowing techniques. Methods for clearing the airway are also provided. Further assistance may be provided by an Occupational Therapist and Physical Therapist for fine motor control and adaptive equipment.
Techniques to improve swallowing that may be prescribed include:
- Sitting bolt upright when drinking or eating
- Drinking only tepid fluids
- Adding thickener to liquids
- Taking small bites
- Tucking the chin when swallowing
- Learning how to clear the throat
Since most of the techniques can only be performed by an older child, a feeding tube may be needed for younger children or if mouth feeding is not possible at the current time.
Detailed information about dysphagia can be found here.
Dysarthria (difficulty in speaking) can be from a variety of specific speech issues. Overall, it is an inability to produce clear speech. This might include mumbling, slurring, talking too loud or soft, too slow or fast, robotic sounds, hoarseness, or stuffy nose sounds. Caregivers may notice poor tongue, lip, and jaw movement.
With paralysis, all the oral motor functions may be affected or just one side.
Testing is performed by a Speech-Language Pathologist who will assess your voice quality and speaking ability, in words, sentences, and conversation depending on the development and age of the child.
Treatments for dysarthria may include:
- Adjusting speech patterns, slower, louder, clearer
- Development and strengthening of lips and tongue
- Changing vocalizations to express emotions
- Exercises for breathing and breath support
- Adding gestures, writing, or adaptive or alternative communication devices
- Family members will be given tips for conversing and listening to their child
Dysphagia and dysarthria may be treated at the same time. Success in treatment requires participation by the child, parent or caregivers, and therapists. It is a process that results in improvements and plateaus. As your child develops, more options become available.
More information about dysarthria can be found here.