Academic journal article The Journal of Early and Intensive Behavioral Intervention

Early Oral-Motor Interventions for Pediatric Feeding Problems: What, When and How

Academic journal article The Journal of Early and Intensive Behavioral Intervention

Early Oral-Motor Interventions for Pediatric Feeding Problems: What, When and How

Article excerpt

Abstract

Children with developmental delays often have feeding difficulties resulting from oral-motor problems. Based on both clinical experience and a review of published studies, oral-motor interventions have been shown to be effective in improving the oral function of preterm infants and children with neuromotor disorders, such as cerebral palsy. However, oral-motor problems may be under identified in other populations of children with developmental difficulties. The purpose of this paper is to provide a conceptual framework for understanding oral-motor skill development and problems that can occur in any infant and young child and to review oral-motor treatment techniques and their empirical support.

Keywords: dysphagia, feeding behavior, oral stimulation, oral-motor, behavioral intervention.

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Oral-motor problems in children are easy to recognize when the child coughs and chokes while eating. However, the majority of feeding problems present initially in more subtle ways, such as difficulty introducing spoon feedings or advancing texture, or limited variety of foods accepted (Kerwin, 1999). For some children, these more common feeding problems may reflect a specific oral-motor problem, such as uncoordinated tongue movement during lateralization or dysfunctional oral transport of the food bolus to the back of the mouth to initiate the swallowing reflex. Children with neurological disorders, or those born prematurely often exhibit oral-motor problems (Gisel, Alphonce, & Ramsay, 2000; Lau & Hurst, 1999; Sullivan, Lambert, Ford-Adams, Griffiths, & Johnson, 2000). Increasing evidence suggests that oral-motor problems are under-recognized in children with problems other than cerebral palsy (Ramsay, Gisel, McCusker, Bellavance, & Platt, 2002; Reilly, Skuse, Wolke, & Stevenson, 1999), including children with autism disorders (Amato & Slavin, 1998).

Oral motor skills develop within a system that changes rapidly both in structural growth and neurological control during the first three years of life (Arvedson & Lefton-Greif, 1996; Bosma, 1986). During this period, children engage in a great variety of oral motor experiences as they satisfy their basic needs for food and comfort and begin to explore their world. Developmentally, a feeding problem exists when a child is "stuck" in their feeding pattern and cannot progress (Eicher, 2002; Kerwin, 2003; Palmer & Horn, 1977). Because oral motor skills represent a sequential progression of increasingly complex movement patterns, any disruption in practice can interfere with or limit positive oral motor practice, resulting in the loss of advancement in skill development and the learned behaviors that ensue (Illingworth & Lister, 1964). The challenge of treating children with feeding problems comes in identifying the specific areas that interfere with skill advancement for the individual child (Rudolph & Link, 2002; Stevenson & Allaire, 1991). Understanding each of the active factors interfering with skill advancement and the interaction of those factors enables the treating team to: 1) identify the specific factors contributing to the feeding problem; and then 2) ameliorate them to allow the child successful practice leading to positive learning, skill advancement and mastery (Kerwin & Eicher, 2004).

The following case history will serve as an example of some of the common, but more subtle, oral motor problems in children that require early, intensive intervention: bottle dependence, difficulty advancing texture, food refusal and food selectivity. Joey is a 4-year-old boy with hypotonia (i.e., low muscle tone), mild cognitive and motor delays, severe speech delay, poor social relatedness, and a tendency to perseverate. He will eat only yogurt, Dutch apple dessert and pureed banana baby foods, and will drink only apple juice from a sippy cup. Joey's mother reports that Joey always loved bottle-feeding, but preferred to drink lying down rather than while being held. …

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