handout for the therapro webinar oral motor treatment

Handout for the Therapro webinar Oral Motor Treatment Strategiespresented by Kate Barlow, OTD - June 16, 2020

Copyright © 2021 Kate Barlow. All rights reserved. No part of this material shall be reproduced or transmitted in any form or by any means without permission from the author.

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Oral Motor Treatment Strategies

June 16, 2020

Kate Barlow, OT, OTD, OTR

A little about me… Education: Boston University BS in OT, Class of 1997 Virginia Commonwealth University Post Professional Masters and Doctorate in OT, Class of 2015 Career Path: 12 years Public Schools 3 years Management 3 years Children’s Hospital Outpatient 4 years Early Intervention: Feeding Consultant 5 years Teaching Trainings: Beckman Talk Tools Vital Stim SOS Infant Massage Feeding Matters

https://libguides.aic.edu/OT_OER/webinars

International Mentorship Meeting Hosted by: Dr. Kate Barlow

Time: June 1st, 2020 3:00 PM Eastern Time (USA)

Topic: Feeding Children with Cerebral Palsy Presented by Maggie Lamb, SLP

Zoom Meeting ID# 913 9837 1848

Join URL: https://aicedu.zoom.us/j/91398371848



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Feeding, Eating & Swallowing Presented at State Conferences of VA, MA, NH, & CT Presented ARFID research at WFOT in South Africa Presented for Therapro® Saturday Seminar Series Awarded grant from Feeding Matters research with Dr. Rabaey on Pediatric Assessment Tools Presenting at 20th International Integrated Care Conference Pediatric OTs & SLPs: Please Participate in a 20-question anonymous survey on Pediatric Feeding Assessments. Link to Survey: https://bit.ly/2VTcLR6

Course Objectives

After this presentation, participants will be able to: •  Understand the importance of

screening all children for feeding difficulties

•  Apply treatment interventions for specific oral motor deficit areas

Appropriate foods for a child’s age & chewing skills



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Jaw Strength

Development of Chewing Skills: 1.  Phasic Bite (food first introduced) 2.  Munching (with practice, up and down

movements, 6-8 m) 3.  Tongue Lateralization (emerges 6-8 m) 4.  Chewing Vertical (9-12 m)

Diagonal/Lateral (12-18 m) Circular Rotary (18-36 m)

Question?

Why is tongue retraction with lateralization so important for feeding?

Tongue Retraction

•  Needed to place food from center of mouth onto teeth (retraction with lateralization)

•  Need to properly drink from a cup or straw

•  Every sound (phoneme) in the English language requires tongue retraction except “th”



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Buccinator Muscle

Orbicularis Oris

Superior Pharyngeal Constrictor

Muscular Sling for Propulsion

•  Orbicularis Oris, Buccinator and Superior pharyngeal constrictor muscles work together to create posiDve pressure

•  Lip seal •  Narrowing of cheeks

The Happy Eaters



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Prevalence of Feeding Problems

“Feeding and swallowing problems are reported in 10% to 25% of all children, 40%-70% in premature infants, and 70%-80% in children with developmental disabilities or cerebral palsy” (Korth & Rendell, 2015)

Prevalence of Feeding Problems

“Feeding disorders occur in approximately 25% to 40% of toddlers and school aged children and range from mild to severe” (Tarbell & Allaire, 2002)

“Approximately 20-50% of normally developing children and 70-89% of children with developmental disabilities are reported to experience some type of feeding problems.” (Benjasuwantep, Chaithiaynon, & Eiamudomkan, 2013)

Pediatric Feeding Disorder

Consensus Definition & Conceptual Framework

“Impaired oral intake that is not age-appropriate,

and is associated with medical, nutritional,

feeding skill, and/or psychosocial dysfunction.”

(Goday et al., 2019)



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Pediatric Feeding Disorder Consensus Definition & Conceptual

Framework (2019)

•  Proposes a universally accepted definition of pediatric feeding disorders (PDFs), using the World Health Organization’s International Classification of Functioning, Disability and Health

•  Definition facilitates a team approach for treatment and health policy

•  Defines 4 domains of PDFs; Evaluation in each domain is recommended



Pediatric Feeding Disorder Consensus Definition & Conceptual Framework (2019)

4 Domains of PDF

Medical Nutritional

Feeding-

Skill

Psychosocial Factors

OT Evaluation of PFD’s

Kate’s Domains of a Feeding Evaluation

Oral Motor (Feeding Skill &

Nutritional Factors)

Sensory/ Picky Eaters

(Feeding Skill & Psychosocial

factors & Nutritional Factors)

Avoidance (Medical &

Psychosocial factors &

Nutritional Factors)

Posture/

Mechanics (Medical&

Feeding Skills & Nutritional Factors)



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PFD Considerations

Oral Motor

Trunk

Neck

Jaw

Lips

Cheeks

Tongue

TOTs

Thickened Liquids

Avoidance

Reflux

ConsDpaDon

Allergies

Stress

AspiraDon

PANDAS

Liver/Renal FuncDons

Eosinophilic esophagiDs (EOE)

Sensory/Picky

Current Diet: Always Eats

Current Diet: SomeDmes Eats

Current Diet: Will not Eat

Current Diet: Used to Eat

5 Target Foods

Meal Time RouDne

Daily Schedule of AcDviDes, including meals

ToileDng RouDne & Brushing Teeth

Posture/Mechanics

Feeding chair

Side lying

AdapDve Equipment

Respiratory rate

Oxygen SaturaDon

Temperature

Food Consistency

MBS

Is the child below the 5th PercenDle for Weight?

Assessment •  Start with fun activity while

interviewing caregiver (Remember the 3 P’s)

•  Assess oral motor skills –  ROM and Strength for

lips, jaw, cheeks and tongue

•  Self Feeding Skills/Posture/Mechanics

–  Utensils/open cup/straw •  Sensory Assessment

–  What will the child touch?

–  Sensory Profile?

Oral Motor Assessment:

Beckman Oral Motor Protocol

•  Requires specialized training •  Administered by trained OT or SLP •  Provides information on which

specific muscles require intervention •  Age range: Infant to adult



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Free Feeding Screening Tools

https://www.feedingflock.com/tools – Neonatal Feeding Assessment Tool (NeoEAT)

(Parental Questionnaire, Both Bottle & Breast, birth to 7 months) – Pediatric Eating Assessment Tool (PediEAT)

(Parental Questionnaire, 6 months to 7 years) – Child Oral and Motor Proficiency Scale (ChOMPS)

(Parental Questionnaire, 6 months to 7 years) – Early Feeding Skills Assessment (EFS)

(Clinician completed, birth to 6 months) – Family Management Measure of Feeding (FaMM Feed)

(Completed by all family members) – Feeding Impact Scales

(Parental Questionnaire, birth to 18 years)

Oral Motor Assessment

•  Lip closure & strength •  Gum Massage •  Posterior Cheek Strength •  Tongue ROM & Strength •  Jaw Strength •  Motor Planning

Treatment Interventions

•  Base your treatment interventions from your observed areas of weakness during the assessment.

•  Remember that most of the swallowing muscles are Type II muscle fibers. Treatment must work on strengthening muscles with resistance to trigger Type II. You have to challenge the patient.

•  Remember to always “warm up” patient first. Get them comfortable & relaxed. (Don’t just try to glove up and stick your hands in their mouth.)

•  Give Choices- Give control to the patient



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LIPS

Lip Closure Activities:

•  Kisses on the Z-Vibe Animal Tops or hand •  Blowing through a straw or off hand to move a

cotton ball or sparkle ball •  Teaching straw drinking through the squeeze

bear or juice box

Lip Awareness

•  Vibrate with the Z-Vibe •  Place Z-vibe tip or plastic baby

spoon in cup of ice water •  Fish Faces in front of a mirror with

frosting on the lips •  Place a Cheerio on lip and have

patient bite off or move from side to side (children able to retrieve food off lips at 18 months)

Lip Strength

•  Blow bubbles •  Talk Tools Bubble Hierarchy •  Blow whistles •  Blow plastic windmills •  Blow Party Blowers •  Resistance exercises



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Lip Strength

Talk Tools Lip Press & Button Pull

Jaw Strength

•  Beckman Resistive Chewing Chew tube 20x R and L

•  Lip Prints: “Play Doggie” •  Gum Chewing (Talk Tools has a program)

Jaw Strength

Put anything in Polyester organza: •  Slim Jim, Steak, Chicken

Nuggets, etc. Babies R Us Munchkin Fresh Food Feeder



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Tongue Awareness

•  Spice up foods (add tabasco, garlic, etc.) Also helps control weight.

•  Lick Sour flavors (also facilitates a pucker) •  Lick Fun Dip •  Lick Hot Balls •  Use Z-vibe •  Use Iced Z-Vibe tip or Cold Plastic Spoons

Tongue Lateralization

•  Use Hard munchables (celery or carrot stick) •  Use mirror and model silly faces •  Use Z-Vibe to facilitate lateralization •  Play tongue “tag” with Z-vibe, lollipop, Slim

Jim, Nuk Brush or frozen spoon •  You can work on tongue strength by using

resistance with a tongue depressor or Z-vibe while working on lateralization

Tongue Retraction

Talk Tools Straw & Talk Tools Horn Program

Make Sure straws are not placed on the tongue!



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Tongue Tip Elevation

•  Emerges 12-15 months •  Use Z-Vibe to facilitate elevation

•  Use Nuk brush, Slim Jim or small lollipop to “Tag”

•  Talk Tools: Cheerio Hold Up

Cheek Awareness & Strength

•  Z-Vibe end tip to inside & outside of cheeks •  Beckman Cheek stretches •  Vital Stim®

Infant Massage

•  Improves weight gain •  Improves circulation •  Help with bonding •  Improves digestion & metabolism •  Promotes physical self-awareness •  Helps to sooth and relax child & parent •  Boosts immune system by moving

lymph fluid (Heath & Bainbridge, 2000)



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Oral Motor Assessment: Beckman Oral Motor

Protocol

Talk Tools for Oral Motor Treatment Strategies

Great for children who are cognitively able to follow directions.

G-Tube to Oral Transition

Marsha Dunn Klein, MEd, OTR/L & Suzanne Evans Morris, PhD, CCC-

SLP

www.notube.com



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Feeding Matters Conference 2020

Rachel Rosen, MD

•  Only 20% of aspirating kids get pneumonia •  Even if kids are aspirating, the recommendation is now to keep

them eating something to continue to improve swallow function. Avoid NPO if possible

•  Reducing G-tubes is an attainable goal- only 5% of aspirating children are now getting G-tubes (and no increase with hospital admissions)

•  Use homemade blends when possible and thicken G-tube feeds

Feeding Matters Conference 2020 Rachel Rosen, MD

•  Thickening liquids improves swallow for both reflux and aspiration

•  Thicken breast milk when necessary with commercial thickener (get MD approval for children under 12 months)

•  Breast milk in lungs compared to formula was actually worse than formula

•  Consult nutritionist for thickening for osmolality guidelines

Questions about Feeding?

Please feel free to email me: [email protected]



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References: Continuing Education

1.  Beckman Oral Motor www.beckmanoralmotor.com 2.  Talk Tools www.talktools.com 3.  SOS (Sequential Oral Sensory)

www.sosapproach-conferences.com 4.  Vital Stim® www.ciaoseminars.com

References- Books

•  Infant and Child Feeding and Swallowing; OT Assessment & Intervention by Sherna Marcus, BScOT & Suzanne Breton, MA, BScOT

•  Pediatric Feeding Disorders; Evaluation & Treatment by Kelly VanDahm, MS, CCC-SLP

References- Books

•  Pre-Feeding Skills, Second Edition, by Suzanne Evans Morris and Marsha Dunn Klein

•  Feeding and Nutrition for the Child with Special Needs: Handouts for Parents by Marsha Dunn Klein



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References- Books

•  Lip Prints by Joanne Hanson

•  Tips & Techniques for the Z-Vibe by Debra Lowsky, MS, CCC-SLP

References

Accreditation Council for Occupational Therapy Education (2018).Standards and interpretive guide. American Journal of Occupational Therapy, 72. Retrieved from: h_ps://ajot.aota.org/arDcle.aspx?arDcleid=2716477.

American Occupational Therapy Association. (2017) The practice of occupational therapy practice in feeding, eating and swallowing. American Journal of Occupational Therapy, 71. Retrieved from: h_ps://ajot.aota.org/arDcle.aspx?arDcleid=2652875

Benjaswantep, B., Chaithirayanon, S., & Eiamudomkan, M. (2013). Feeding problems in healthy children: prevalence, related factors and feeding practices. Pediatric Reports, 5(10), 38-42

Didehbani, N., Kelly, K., Austin, L, & Wiechmann, A. (2011). Role of parental stress on pediatric feeding disorders. Children’s Health Care, 40, 85-100

Korth, K. & Rendell, L. (2015). Feeding intervention. In J. Case-Smith, J & J. Clifford O’Brien (Eds.). Occupational therapy for children and adolescents (7th ed). 389-414. Elsevier Mosby.

Field, D., Garland, M. & Williams, K. (2003). Correlates of specific childhood feeding problems. Journal of Paediatrics and Child Health, 39(4), p. 299-304. DOI: 10.1046/j.1440-1754.2003.00151.x

Goday, P., Huh, S., Silverman, A.,Lukens, C., Dodrill, P., Cohen, S., Delaney, A., Feuling, M., Noel, R., Gisel, E., Kenzer, A., Kessler, D., Kraus de Camargo, O., Browne, J., & Phalen, J. (2019). Pediatric feeding disorder- Consensus definition and conceptual framework, Journal of Pediatric Gastroenterology and Nutrition, 68(1), 124-129.

Heath, A. & Bainbridge, N. (2000). Baby massage: the calming power of touch. Dorling Kindersley. Heller, S. (1997). The Vital Touch: How intimate contact with your baby leads to happier, healthier

development. Henry Holt and Company.

References Continued

Morris, S. & Klein, M. (2000). Pre-Feeding skills: A comprehensive resource for mealtime development (2nd ed.). Therapy Skill Builders.

Rommel, N., Demeyer, A., Feenstra, L., & Veereman-Wauters, G. (2003). The complexity of feeding problems in 700 infants and young children presenting to a tertiary care institution. Journal of Pediatric Gastroenterology and Nutrition, 37(1), p. 75-84

Rommel, N, Bellon, E., Hermans, R., Smet, M, De Meyer, A., Feenstra, L., Dejaeger, E., Veereman-Wauters, G. (2003). Development of the orohypopharyngeal cavity in normal infants and young children. The Cleft Palate-Craniofacial Journal, 40(6), 606-611.

Standley, J., Cassidy, J., Grant, R., Cevasco, A., Szuch, C., Nguyen, J., Walworth, D., Procelli, D., Jarred, J. & Adams, K. (2010). The effect of music reinforcement for non-nutritive sucking on nipple feeding of premature infants, Pediatric Nursing, 36(3), 138-145

Tarbell, M. & Allaire, J. (2002). Children with feeding tube dependency: Treating the whole child. Infants & Young Children: An Interdisciplinary Journal of Special Care Practices, 15, 29-41

Toomey, K. (2011). Sequential Oral Sensory Approach to feeding. SPD Foundation. http://spdfoundation.net/education/sosfeedingeducation/

handout for the therapro webinar oral motor treatment

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