1. Presenter: Amie Teague, MA/CCC-SLP

2. Overview of Presentation Oral -Sensory Stages of Oral -Motor Development Oral -Motor & Oral- Sensory Assessment Feeding Development Oral -Sensory, Oral -Motor, and Behavioral Treatment

3. What is Oral-Sensory Information ? Oral sensory information is a term that refers to the way the nervous system receives messages from the senses (hearing, sight, smell, taste, and touch) and turns them into appropriate motor and behavioral responses. We see the food. We smell the food. We can hear the food crunch, pop, or sizzle. We can taste the food. We can feel the texture of the food with our hands, our lips, our tongue, and our cheeks as we chew.

4. What oral motor skills are needed for eating? Lips range of motion and strength Cheek range of motion and strength Tongue range of motion and strength Ability to make chewed food into a ball and sending it to back of mouth for swallowing *Any weakness or discoordination of these skills interrupts the beautiful symphony of food preparation and swallowing

5. What are the behavioral components of feeding disorders? Behavioral components of feeding disorders include learned behaviors and behaviors that existed prior to feeding disorder. Examples of behavioral difficulties are reactions caused by fear of certain foods, inability to tolerate certain foods within sight, and inability to tolerate certain foods within close proximity.

6. Stages of Oral-Motor Development

7. 0-4 months Rooting reflex present (baby able to find food source with mouth) Sucking reflex present Strong gag reflex present

8. 4-6 months Opens mouth in anticipation of food Moves food backward with tongue Rooting reflex and gag reflex begin to diminish

9. 6-9 months Learns to keep thick purees inside the mouth Swallows solid foods without gagging Maintains lip closure longer

10. 9-12 months Able to move food around in the mouth Starts to use the jaw to mash food Uses cheek and lip corners to keep food on the biting surface Jaw and tongue begin to move in a circular motion for chewing

11. 12-18 months Starts to chew with horizontal and circular tongue/jaw movements Lip closure remains intermittent during swallow Upper lip begins to close on cup during cup drinking for better seal Tongue does not protrude during drinking

12. 18-24 months Able to chew firmer foods Uses a controlled, sustained bite on a biscuit Intermittently loses food or saliva while chewing

13. 24-36 months Uses consistent oral movements during feeding Minimal spillage noted Circular jaw movements during chewing with scattered chewing patterns of vertical and diagonal bites

14. Oral- Motor and Oral- Sensory Assessment What are we looking for?

15. Oral -Motor Assessment Facial symmetry Lip symmetry & ROM Cheek symmetry & ROM Tongue symmetry & ROM Tongue movement side to side/ tongue tip elevation Suck/swallow/breath pattern Are these oral structures/characteristics within normal limits?

16. Oral -Sensory Assessment Oral aversion Tolerates facial stimulation Tolerates 1-2 textures of nonfood items

17. Hands on Demonstration

18. Feeding Development

19. 0-4 Months Breast milk or formula Eats every 2-4 hours Takes 4-8 ounces in 20 minutes or less

20. 4-6 months Remains hungry after 8-10 breast feedings, or 32 ounces of formula a day Starts solid foods such as rice cereal, oatmeal cereal, etc (*quantity is not as important as quality at this age*)

21. Bottle Demonstration

22. 6-9 months Continue cereals Add juice and Stage 1 baby foods (vegetables, fruits, then meats) Introduce new foods slowly

23. 9-12 months Continues cereals, juices, and Stage 1 and Stage 2 baby foods Introduce finger foods and table foods as recommended by baby’s pediatrician

24. 12-18 months Table foods and/or Stage 3 baby foods 3 meals/day with 3-5 snacks/day Learning to self feed with a spoon(often turns it over before reaching the mouth)

25. 18-24 months Table foods Intermittently gets spoon to mouth without turning it over Lifts cup to mouth and may tip it too much causing spillage

26. 24-36 months Table foods Uses fork Consistently get one protein, one fruit, and one starch per meal

27. Questions