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Although oral motor is a hot topic among SLPs, there is no denying its benefits in terms of chewing and swallowing.  So many children seen at our clinic exhibit minimal strength and coordination of the oral musculature for chewing and swallowing purposes.  When going into an evaluation, I always look at the whole child: the background history, the anatomical structures, the home environment, his or her articulation skills, his or her language skills, and his or her oral motor skills.  When I speak with parents and they tell me their child is a picky eater, I immediately ask which foods he or she avoids.  Most of the time the avoided foods are fruits, vegetables, and meat.  If we really think about it, a child who has low tone or strength in his or her oral musculature will not be able to eat most of those foods safely.  Many fruits and vegetables have a fine skin coating which may seem easy enough to eat, but in all reality, the skins on foods are one of the most difficult.  This is because the teeth and jaw have to not only break the food down, but have to work even harder to really grind those skins up in order to prepare for a safe swallow.  The same can be said for meats.  Sure, chicken nuggets seem to be every picky eaters’ dream and most will eat chicken nuggets; however, most chicken nuggets are overly processed and therefore, do not have a true meat consistency.

In our scope of practice, we are responsible for all stages of dysphagia.  Working in pediatrics and working so closely with Occupational Therapists on feeding, it is especially important to be knowledgeable about how to strengthen the musculature for chewing and swallowing.  We need to be able to assess which muscle(s) (e.g., cheeks, lips, tongue, jaw) are affecting the child’s chew and come up with a proper plan of care to help the child become proficient in eating.  This may be in the form of using chewy tubes, z-vibes, hard straws, mesh, jaw exercisers, etc.  Below is a table listing the various types of “chewing” patterns we observe and which foods are adequate for a child to eat in each stage along with the oral motor tools we use to treat feeding disorders:

Foods to Eat at Various Stages of Chewing Development

Stage

Food Type

Examples

No Chewing; Only Sucking or Mashing Solids

Purees, crunchy dissolvables

Applesauce, yogurt, pudding, pouches, Gerber/generic puffs, cheese puffs, veggie straws, Cheerios (anything that dissolves quickly in the mouth to reduce the risk of choking)

Munching (Jaw only moves up and down)

Crunchy dissolvables-may use mesh

Gerber/generic puffs, cheese puffs, veggie straws, Cheerios (anything that dissolves quickly in the mouth to reduce the risk of choking)

Mixed Munching and Rotary Chew (Jaw moves up and down and occasionally diagonally)

Crunchy dissolvables, crunchy solids, soft solids

Gerber/generic puffs, cheese puffs, veggie straws, Cheerios, crackers, graham crackers, pancakes, waffles, small pieces of easy meats (no steaks, nothing that takes a lot of strength to chew), fruits, vegetables

Rotary chew and proper strength in oral musculature

All foods

All foods

 

Tools to Help Build Strength in the Mouth:

 

Chewy Tube: Builds jaw strength and helps build rotary chew

Infadent: Desensitizes the mouth.  Perfect for orally defensive children

Z-vibe/Vibrating Toothbrush: Desensitizes the mouth and increases alertness of the mouth.  Perfect for orally defensive children and children who constantly drool

Pediatric Feeder: Teaches kids how to drink from a straw

Hard Straw Cup with Lip Blocker: Lip blocker keeps the teeth and tongue off the hard straw and builds lip strength and closure

Mesh: Allows children to chew foods completely while getting only small pieces from the mesh at a time and teach them the purpose of chewing