Oro-Motor Skills - Get Hackney Talking

What does Oro-motor skills mean?

Children can have difficulties with controlling their mouth, lips, tongue and closing their mouth. This can make it hard for the children to make shapes with their mouths e.g. blowing, licking, sticking their tongue out. These children can also have limited awareness of how their mouths feel and therefore sometimes dribble without noticing. Some know they are dribbling but find it hard to control it.

Exercises to Help Control of the Lips and Mouth

Blowing games can help breath control

Trying blowing on a mirror to watch the ‘steam’.

Blow bubbles across soapy water in the bath.
Blow pieces of shiny paper feathers, even Ping-Pong balls off the table or into the bath.
Blow mobiles – easily made with paper and string.
Blow bubbles. Catch them on the wand and get the child to blow them away.
Slightly harder – blow candles out. Be careful!!

Bumper Cars

Blow ping pong round a bowl of water with a straw. Try and bump the other balls.

Noise makers

Collect toys that make a sound when you blow e.g. Party blowers, toy trumpets, toy whistles, mouth organ (harmonica)
Have two of each type, one for you and one for your child. Experiment in making long sounds, short sounds, loud sounds, soft sounds, and encourage your child to copy you:
- Take a deep breath from your tummy, so that you feel your tummy go out
- How many short sounds can you make with one breath
- How long can you keep a sound going for?
- How loud can you make the sound?
- Can you alternate: loud, soft, loud, soft…?

Practising lip shapes can help with speech sounds.

Have a go at making a long ‘oooooh!’ sound or ‘aaaah!’. Do these at the same time as lifting up your arms high in the air, then dropping them down to ‘aaaah!’
Exaggerate loud kissing noises and lip shapes. Kiss teddy. Put lipstick on and kiss a mirror or a piece of paper – see if your child wants to have a go.
Try sucking and blowing through a straw. This could be from a cup, bowl or in the bath.

Mirror work

If your child likes looking in a mirror, trying sitting next to him/her in front of the mirror and making funny faces – changing your lip shapes. See if he can copy!

Exercises to Help Control of the Tongue

Licking off a plate

This encourages protrusion of the tongue and tongue pointing and tongue movement.
Put jam / marmite/ nuttella / honey / hundreds and thousands on a plate. Encourage your child to lick the food up: you may need to demonstrate on a plate of your own. Discourage your child from picking up the food using only their lips. At first you may have to raise the plate to the level of the child’s mouth, but make sure it remains horizontal. Once your child is successful at this you can gradually lower the plate to table level.

Licking off a lolly stick/spatula

Put some sticky food (e.g. honey etc.) onto the stick. Hold the stick straight upwards in front of your child’s mouth and encourage him/her to lick it clean by moving his tongue upwards. As your child improves, gradually move the stick further from the mouth. Make sure your child does not move his head but makes his tongue do the work. You may need to gently hold his head still.

Licking from round the lips

Dab food onto a position on the lips. Encourage your child to lick it off. The aim is to get upward, downward and sideways movement.
Licking out a small container

Put some food into a short container such as an e.g. cup and encourage your child to lick it clean.

Mirror Work

Copy tongue movement with your child in front of the mirror

Sticky Shapes

Make a picture using gummed stars and shapes which have to be licked in order to stick to the paper.

Tongue Exercises Inside the Mouth:

Your tongue cleans the outside of the upper teeth
Your tongue cleans the outside of the lower teeth
The tongue cleans the inside of the upper teeth
The tongue cleans the inside of the lower teeth
The tongue makes a handstand
The tongue forms a roll
The tongue pretends to be a big sweet hiding in the right cheek
The tongue pretends to be a big sweet hiding in the left cheek
The tongue sucks the roof of a mouth to make a tutting sound

Tongue Exercises Outside the Mouth:

Your tongue tries to touch your chin
Your tongue tries to touch your nose
Your tongue “jumps like a rabbit” (repeatedly touch your chin then your nose)
Your tongue tries to reach your right ear
Your tongue tries to reach your left ear
Your tongue “wags like a dog’s tail” (repeatedly move from the left, to the right)
Your tongue licks your top lip, then your bottom lip. Then lick all around your lips.

Exercises to Help Control Dribbling

Encourage the child to close their mouths

(If your child needs to breathe through their mouths this isn’t really possible.)
You can tell your child to close their mouths and/or gently lift their jaw upwards.
You can also remind your child to close their mouth by getting them to copy you.
Get your child to practise closing their lips by getting them to hold a piece of paper between their lips and walking for a few steps.
Get them to puff out their cheeks and let them go. This can be done in front of a mirror.
Use straws, Kazoos, trumpets, bubbles.
Playing with noises e.g. raspberries, kisses, car noises, mmm, puh puh puh

Experimenting with taste, temperature, texture

This helps your child to become more aware of their mouths, which in turn helps them to be more aware of when they dribble.
Try sucking up a variety of drinks e.g. hot drinks (tea/coffee/hot chocolate), fruit juice, thick and thin milkshakes, drinks straight from the fridge. You could try sucking other things such as chocolate spread yoghurt, jam.
Try tasting a variety of food e.g. hot, cold, sour, sweet, spicy. Try putting the food on your child lips as well as the tongue.

Helping them to sit

Children tend to dribble less when they are upright, as it is easier to swallow. Encourage your child to sit up rather than slouch. If this is difficult for your child you may need additional advice from a Physiotherapist or an Occupational Therapist.

Positioning

Position is fundamental to saliva control, and the quality of eating and drinking skills. Our handling of infants and children should provide the support to enable them to experience what it is like to have an upright head with good lip closure. Seek advice from the physiotherapist when appropriate. It may be unrealistic to expect saliva control when the child cannot achieve good head control.
Generally, the child should be in an upright position with the head in alignment with the body. The head should be in the mid-line so that the head is upright and the chin very slightly tucked in.

Oral control

Children may need help in experiencing jaw stability as a pre-requisite to saliva control. The mouth may be constantly open, or any request to open the mouth may result in it being opened too small or wide.
Achieve good trunk and head control before using any oral control.
Practise this position whilst the child has the opportunity to relax – watching TV, reading a book etc.
Check whether the child can breathe through his nose. A blocked nose from a cold will make breathing difficult. Some children are persistent mouth breathers – check whether they can achieve nose breathing before doing this exercise
Place your arm behind the child’s neck, using your arm to support the head and elongate the neck.
Place your index finger on the child’s chin, with your thumb on their cheek.
Provide firm control but remember not to place the rest of your hand on their neck, as this will inhibit swallowing.
Do not allow the child to become distressed – limit the time.
You will probably want to support your arm with a pillow or rolled up towel.
Improved head control and jaw stability should trigger spontaneous, more automatic control of saliva. Remember that this may be lost for a time whilst the child is absorbed in other activities.

Oral Stimulation

Sensory input can help to produce a movement pattern – in this case more effective swallowing.
Positioning as above is essential
Wiping, (see below) is good sensory stimulation
Try pressure around the mouth, using small circular movements of the first finger, above the lips on either side, or below the lips centrally
Pressure in a slightly downward direction on the upper lip may produce a spontaneous swallow.

Brushing teeth

This is excellent oral stimulation and should be encouraged after every meal, even snack if possible, as it helps with saliva control and chewing.
Adopt the same position as you would for feeding. Start with the side most tolerated by the child.
Roll the head of the toothbrush under the top lip, then down. Treat the mouth in four sections, brush from centre to back, starting with the outside of the teeth.
Give the child time to swallow. Do not induce a gag reflex by moving too far back.
Encourage mouth closure as much as possible. You may need to use oral control as described above to assist.
Move along the teeth and back to the centre using a downward movement for the top teeth and an upward movement for the bottom teeth.
Encourage spitting out by bringing the child’s cheeks in to purse the lips, giving a sip of water if appropriate.
Try to repeat the sequence for the inside of the teeth, then the surface of the molars.

Wiping the mouth

Do nots:

Do not wipe across the mouth as this makes you dribble more.
Do not push your child’s head back when wiping the mouth
Do not wipe the mouth unless necessary
Do not wipe the mouth suddenly or quickly
Do not wipe the mouth without letting your child know
Do not use a large cloth or flannel that touches the sides of the face as well – this often increases saliva production as it provides too much stimulation.
Do not tell the child to swallow. It is impossible to swallow with an open mouth – this increases sensitivity and awareness.
Do not use light movements – they are overstimulating.

Do:

Pat firmly around the mouth with three dabs using a pad of tissue.
Try and help your child to do this for him/herself.
Maintain your child in a good head and trunk position
Work on jaw stability if appropriate
Use a small tight wodge of absorbent material that will only touch the child’s mouth
Do let your child see or feel the approaching cloth
Approach at a reasonable rate not too fast, not too slow
Wipe slowly ad firmly; use up to three ‘pressure dabs’

Top Tips!

All movements should be done slowly
For exercises with an open mouth, open your mouth as wide as you can
Sitting in front of a mirror, so that your child can see both him or herself as well as you may be helpful
It may also help to lightly touch the cheek on the side you want your child to move their tongue (or nose, or chin)
You could also try dabbing jam or chocolate spread in the area you want them to move their tongue, so they can lick it off!
Position is fundamental to saliva control, and the quality of eating and drinking skills. Achieve good trunk and head control before using any oral control.
Do these exercises for approximately 5 minutes a day!