When I was first put in touch with the Golden Gate Regional Center, I expected my daughter would need Physical Therapy, but I had no idea that Oral-Motor Therapy (OMT) even existed. The coordinator that met with me noticed that the Bean tended to stick her tongue out (called tongue protrusion) and suggested that we get her evaluated by an Oral-Motor therapist. She said that tongue protrusion can have a negative effect on feeding, development of mouth shape and speech. Let the education begin! I felt overwhelmed, all of a sudden, with what I didn’t know about infant development and my daughter’s condition.
We set up a meeting with the OMT office and a wonderful lady evaluated the Bean’s needs. When I think back to that time, it amazes me how far we’ve come. She was 7 months old when we started OMT. I was having trouble introducing solid foods because everything just ended up coming back out of her mouth. She wasn’t able to hold her own bottle, and still drank her milk lying back in the crook of my arm. She was barely 15lbs, was still feeding at night, and her bottles were taking an hour to finish.
The Bean had a lot of gross motor issues, which translated into problems with feeding. When she sat up, she would hold her chin up and arch her back too much (extension), which made swallowing more difficult and made it easy for her tongue to protrude. Her cheeks and lips were also very tight, which made her mouth look small and made it hard for her to babble and form new sounds.
One of the first things we worked on was her body position in her high chair. We stuffed towels behind and around her body so that she could sit more upright. We put a rolled up washcloth behind her head so that her chin would tilt downward, and more washcloths beside her head so she wouldn’t tilt her head to the side too much. All of this served to help teach her body not to arch back, and also helped her tongue to start learning not to stick out all the time. To get a sense of this, try this exercise:
- Stick out your tongue.
- Tilt your chin up so that your head tilts back. Feel the way your tongue actually pushes forward.
- Now tilt your chin down so it touches your chest. Your tongue should pull back, and if you try to keep it pushed out, you’ll probably feel a bit of a cramp in your neck.
We changed the bottles she was using to the kind with a bend in it, so that she could sit upright to drink her milk, thereby training her tongue to suckle the nipple while inside her mouth instead of between her lips. It also helped a lot with her swallowing and she started to drink her bottles much faster.
The second thing we started working on at the beginning was teaching the Bean’s tongue to lateralize – to move from side to side. In order to eat or talk, you need to be able to move your tongue in all directions in your mouth. The Bean’s tongue only moved forward and back. To train her tongue to do more moves, we used a tri-chew – a triangular teething tool with different textures on each side and at each point. She loved chewing on that thing and it really worked!
The third thing we did was facial massage. Since her cheeks and lips were so tight, I used a pen-like vibrating massager to loosen up those muscles. I also massaged her soft palette (the top of the inside of her mouth) to make sure that it stayed smooth and rounded instead of getting a high peak in the middle from all the tongue thrusting she was doing. Before she got teeth, I was also asked to encourage her to bite on my fingers by pushing down on her lower gums and then releasing.
Task number four was teaching her to eat from a spoon. As it was, every time I brought a spoon to her mouth, I would scrape the food off the spoon using her top lip, and then she would promptly stick out her tongue and all the food would run down her chin. We used a technique called parallel feeding to teach the Bean to use her lips to clear the spoon, and also to swallow with her tongue inside her mouth and with her mouth closed. Stop again for a second and try this:
- Stick out your tongue
- Part your lips a little bit
- Try to swallow – it should be impossible
- Now close your lips around your tongue and try to swallow again – easier, right, but still not comfortable?
- Now pull your tongue back into your mouth and swallow again – ahh, now that’s what swallowing is supposed to feel like.
Parallel feeding is a skill that takes some time to master. It is also tough to explain in writing. Basically, you feed from one side of the spoon, then flip the spoon around so they get the food on the other side of the spoon, and then flip it around a third time. The idea is to switch sides quickly enough that the child learns to swallow the first bite before she can stick her tongue out again, in order to get the second bite when it comes. I really wanted to include a video to illustrate my point, but my account doesn’t include video, so maybe I’ll add it at a later date. In the meantime, if you are my friend on Facebook, you can see the video here.
I have to tell you that all of these changes were a lot to incorporate into our lives. I did my best to keep up, but feeding was hard enough without adding all the awkwardness of the different techniques, body positioning, chewing homework and massage. I understood that in the long run, all the work would make everything easier, but I emotionally resisted the Oral Motor therapy right from the beginning. I didn’t WANT everything to be this hard. It seemed like I needed at least three hands to do what I was being asked to do on my own at home. Feeding took up a large portion of our day, and it was embarrassing to have so much fuss around feeding when we were out in public. At that time, I think I was still in denial that the Bean really had a serious problem. Now, looking back on the pictures and videos, I can very easily see how different she was from other babies her age. I just didn’t want it to be true.
There is more to the OMT journey that I’ll go into in upcoming posts, but first, I’ll give you a sneak peek into the future. Things got a lot better. I got really good at parallel feeding, and so did the Bean. We don’t have to do the parallel feeding anymore because she can clear a spoon with her top lip and swallows with her mouth closed and her tongue safely tucked inside. The Bean’s tongue is rarely outside her mouth anymore, unless she’s doing her Tazmanian Devil impression. It moves from side to side and up and down just fine now, and she pushes food onto her molars with that tongue, no problem. Her facial muscles have also relaxed. She has a huge, wide smile that shows up often on her face. But the Oral Motor Therapy homework is still my least favourite.