Warning this is a very long post, very interesting, very educational, very necessary, but very long.
Okay so on to my topic, oral motor therapy. In my very own biased opinion oral motor therapy is the most important therapy along with speech and feeding therapy for children with Down Syndrome. Why? Well the first time you meet someone you assess them. You assess how they look by what they are wearing, their hairstyle, their weight, their gender, their race . . . yes I hate that we do it but we all do. We see with our eyes first. The thing is I have control (for the most part) over what I look like. I can dress nicely, fix my hair up, wear some makeup . . you get the point.
Then comes speech. You judge a persons intelligence on what comes out of their mouth. You just do. Imagine meeting a very nicely dressed adult and not understanding a word that comes out of their mouth. Or they curse a lot. (Sort of like me) Or they use slang or speak Ebonics . . . you get the point. Your impression of that nicely dressed person changes.
Well I want Seth to be able to give people a great first impression. I always dress him in clean, nice clothing and his hair is always presentable, he is never dirty. I think that stereo typically people think children with special needs are not attractive or are unkempt and I want to dismantle that idea. Seth is a very handsome child and I always try to have him looking his best.
Speech is a crucial part of our lives, Seth can't use sign language forever. So it all starts with oral motor therapy. What is oral motor therapy? What does it consist of? How does speech work? These are all very important questions to ask when thinking about speech development.
Oral motor therapy: The use of specialized exercises designed to improve and maintain the strength and coordination of the tongue, lip and jaw muscles. (Yes I shamelessly copied that from another website because it succinctly defined oral motor therapy.)
What kinds of oral motor therapy are there? What does it consist of?
Chewy tubes work on the jaw muscles. The TalkTools chewy tubes come in a set of four, in differing hardness levels ranging from soft to hard. The basic premise is that you have your child start with the easiest chewy tube (TalkTools yellow I believe) and try to have your child chew down on it ten times on each side of the mouth. Only use the softest one until your child masters it, meaning your child can do three reps of ten times on each side of the mouth. Yes this will take a while but it's all about building that jaw strength. You then move on to the next color/hardness level but you do not stop using the first one, you do ten chews on each side of the first one, then continue on with the next, once your child masters the next you add the other in the cycle. When your child masters them all they may be given them just to chew on randomly. Seth loves to chew on them randomly still to this day. (Yes he mastered them!!)
Ways to get your child to use chewy tubes: Yeah it's hard to make our children chew, well any child, if they don't want to. My solution? PEANUT BUTTER!!! Seth loves food and peanut butter on those damn chewy tubes works!! Pick something your child likes, something sticky or gooey. Shit we used Nutella as well. Fuck it. . anything that works. Food is a bribe in my house for therapy reasons. How do you think we got him to sign "more"? (Cookies!!) LOL.
This is a Nuk Brush:
It looks like a baby toothbrush. It's a brush for the inside of the mouth. I started young with Seth, about 6 months old, I can't really remember. I still have them, they are available on Ebay and other places and are relatively cheap. So what do you do with this thing?? You brush. All along the inside of their mouths. In Seth's younger days he loved this!! Why? TEETHING!! It felt good, he even used it on himself. Brushing does two things, two really important things. First it stimulates the muscles on the inside of the mouth like the inside cheek and it the inside parts by the lips. Secondly it is a prevention against oral aversion. A child that is exposed to massage and having someone/something inside of their mouth is less likely to have an aversion. A lot of kids with DS have oral aversion and can't stand having their mouths touched or eat different textures. We never had this problem with Seth and we were religious about brushing. We brushed the inside of his mouth 3x/day before the chewy tubes and then he would eat his meal.
So it went Nuk brush, chewy tubes, meal. There's a method to this madness. The Nuk brush was a more gentle way to get into his mouth, kind of preparing his mouth for the chewing, waking his mouth up. Then the chewy tubes to work on his chewing. Then he would eat and work more on chewing and he would have the best tone of the day because we just did the exercises so he was eating/chewing better and was more able to try new/different textures of food.
Seth started drinking from a straw at 10 months old. Why is a straw so important?? Well quite a few reasons. Can you stick out your tongue when drinking from a straw?? Try it. Do it now. No you can't. So it helps with our kiddos tongue thrust because the tongue is forced back when straw drinking. Look at yourself in a mirror when drinking from a straw. How are your lips shaped?? Your lips do a lot of work drinking out of straw. They have to form a seal around the straw so that no liquid can escape. How about sucking? You have to suck on a straw to get the liquid right? This helps our kiddos sucking reflex. Look at your cheek muscles when you suck on a straw? What are they doing?? They are doing a lot of work.
Straw drinking is like an instant oral motor exercise for our kids. It works so many muscles. Plus do your really want to have the 3 year old with the big bottle of juice?? No. No one does. Seth didn't master the straw until 13 months old but I've seen younger kids master it much earlier. Throw out those bottles. . . do it. It's a great change. And you know what? Straws are so convenient. I just buy a bottle of juice at the store and stick a straw in it. No special cups (I do have straw cups for Seth at home) but out and about all I do is throw some straws in my bag or a juice-box. It makes life easier.
Yeah it doesn't get more straightforward than this. It's simple. Facial massage. Massage your child's face a couple of times a day. They love it. Children love to be touched and massaged and held and it's just a great way to bond with your child. Yeah it's a bit weird in the beginning but you will get used to and so will your child. It's the cheapest too because your hands don't cost a damn thing. But there is a method to the madness. Start at the tops of the cheeks and massage down towards the mouth. Massage at the top of the sides of the nose down towards the mouth. Massage the upper lip down towards the mouth. You see a pattern here right?? Massage towards the mouth. When massaging by the chin massage up . . . towards the mouth. All the massage goes towards the mouth. Ok I think you all got that now. I did the massage before the Nuk brush. If it seems like way too much for your child, and it is in the beginning, do it at other random times during the day.
Fun oral motor tools:
We had this one:
Kids love to chew on it and it vibrates so it works for jaw strength and to stimulate the inside of the mouth. Good job whomever invented this thing!! And they are cheap. Cheap is always good for me. It's one of my mottos!
Now a lot of children aren't going to be able to blow bubbles to a bit older, Seth still struggles with this at 3 1/2, he is like 50/50 with bubble blowing. But who cares because he tries and he loves bubbles. It helps with the "O" lips as I call them. It also helps with lung capacity and inhaling and exhaling. It's great, it's cheap, it's fun and I don't know one child that doesn't just love bubbles.
There are some specialized horns made just for this, for oral motor therapy, screw them. Pick up a cheap recorder or horn from the dollar store, believe me they are going to chew them to heck and they will eventually be destroyed. Your child can practice sealing their lips around the end and blowing air into them. Same kind of concept as blowing bubbles except this is a bit easier. So it's a beginner oral motor tool.
Oh yea I went there. I brought out the candy. Lolipops . . why you may ask? Licking!! Tongue control!!! Chewing on the hard candy and trying their best to get some of it. It works!! Mostly it's good for licking though!!! Is a lollipop going to kill your kid . . no . . . so get over it and give the damn kid a lollipop. It took me a while to process this one as well. I like these lollipops because I'm anal and always feel like my child might fall and choke on his lollipop:
And the little loop is also good because Seth now has a super human hold on his candy. It's almost impossible to pry out of his sticky, grubby hands!!
There is a great article on the Talk Tools website. It's called The Oral Motor Myths of Down Syndrome. Google it. First result.
Basically here is the run through. It's a long run through but it's totally worth reading.
Kids with Down Syndrome have a high palate. The thing the you hit with your tongue at the top of your mouth - that's your palate.
Kids with DS have larger tongues than typical kids.
Kids with DS are mouth breathers.
Kids with DS have tongue protrusion.
Kids with DS are prone to ear infections/hearing loss.
All of this issues, well people with DS aren't born with these issues. People with DS are born with one thing in common, besides the 47 chromosome thing. . . low muscle tone. And low muscle tone is the reason for each one of these problems and I'm going to tell you why, starting from the top of the list.
Kids with Down Syndrome have a high palate - well I learned that the palate actually forms around our tongue. If you have Down Syndrome and your tongue tends to stick out because of low tone and low ability to keep your mouth closed . . well your palate doesn't form correctly around the tongue. So now your mouth doesn't properly fit your tongue and your tongue sticks out. Good thing that the palate forms for a while, with oral motor therapy and keeping that tongue inside the palate can properly form and make room for that tongue. Boom we just knocked out the first two. So palate and tongue myths are done.
Kids with DS are mouth breathers. Well wouldn't you be too if your mouth was constantly open. Keep your mouth open and try to breath through your nose. Can you do it? I can't. Neither can your child with DS. So no they are not naturally mouth breathers, they become mouth breathers because of the low tone.
Kids with DS have tongue protrusion - we already solved that one with the whole palate issue.
Kids with DS are prone to ear infections and hearing loss. Ok the truth is going to hurt here because you can stop this from happening to your child. In fact you are probably the cause (unintentionally) of your child's ear infections. How does one feed a newborn? We lay them down in our arms and feed them, we don't think of doing it any other way. Well it's the wrong way for children with DS. WRONG I TELL YOU. Why? Well when we drink there is a little muscle in our ear that closes so fluid doesn't get in there. Swallow and see how your ears feel. If you have low muscle tone is that little muscle closing properly? Is fluid getting in?
The solution: Feed your child in an upright position where the ears are above the mouth at all times. Chronic ear infections lead to hearing loss. Some kids don't even have symptoms of fluid in the ear or ear infections or hearing loss. And how do we learn how to speak?? Through hearing. We learn how to speak through proper hearing of articulation of words and sounds, none of which is possible with fluid buildup in ears. Seth recently had ear tubes done, I didn't know that he had fluid in his ears until after the surgery. What happened a month after that surgery? A speech explosion. So much speech (I'm crying here). There is nothing like knowing that you possibly fucked up your child's speech by not knowing about an important medical issue. So get your child's ears checked out frequently!
There is more but you have to read the article.
Ok I'm done here. With all my heart I hope this post helps a couple of moms who are lost in the world of oral motor therapy. I know I was once, about 3 years back. I'm so glad I had knowledgeable people who were there for me, I hope I can be that for all of you.