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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.
6/16/20
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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
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.
6/16/20
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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
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.
6/16/20
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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”
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.
6/16/20
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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
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.
6/16/20
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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)
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.
6/16/20
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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
(Goday et al., 2019)
(Goday et al., 2019)
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)
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.
6/16/20
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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
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.
6/16/20
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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
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.
6/16/20
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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
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.
6/16/20
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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
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.
6/16/20
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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!
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.
6/16/20
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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)
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.
6/16/20
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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
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.
6/16/20
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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: Kate.barlow@aic.edu
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.
6/16/20
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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
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.
6/16/20
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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/
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