Pediatric Services
Myofunctional Therapy
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Orofacial myofunctional disorders (OMDs) are patterns involving oral and orofacial musculature that interfere with normal growth, development, or function of orofacial (mouth and face) structures, or call attention to themselves.
Myofunctional therapy treats the UNDERLYING orofacial myofunctional disorders of chewing, breathing and swallowing.
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There is not a known, single cause of OMDs but may be caused by several factors:
-Blocked nasal passages due to tonsil size or allergies. When the nasal passages are blocked, people may need to breathe through their mouths instead.
-Anything that causes the tongue to be misplaced at rest or makes it difficult to keep the lips together at rest.
-Sucking and chewing habits past the age of 3 years.
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According to the ASHA, signs and symptoms of orofacial myofunctional disorders include:
-A child who breathes through the mouth or has difficulty breathing through the nose.
-Limited tongue movement or range of motion.
-Eating may be messy or difficult beyond age appropriate timelines.
-An overbite, underbite, and/or other dental problems.
-The tongue pushing past the teeth, even when a person is not talking or using the tongue.
-Difficulty saying some sounds, like "s" in "sun," "sh" in "ship," or "j" in "jump."
-Drooling, especially beyond age 2.
-Difficulty closing the lips to swallow.
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The primary purpose of orofacial myofunctional therapy is to create an oral environment in which normal processes of orofacial and dental growth and development can take place, and be maintained. Orofacial myofunctional therapy focuses on:
-Promote nasal breathing for optimal breathing and facial development
-Prevent tongue thrust at rest which can lead to dental, speech and swallowing difficulties
-Promote lip seal for optimal facial development
-Identify and address restricted tongue, lip, cheek ties to prevent breathing, swallowing and speech difficulties
-Identify and target significant speech problems (developmental vs. hidden cause) in order to improve functional communication
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American Speech-Language-Hearing Association. (n.d.). Orofacial Myofunctional Disorders. (Practice Portal). Retrieved Nov, 11th, 2023, from www.asha.org/Practice-Portal/Clinical-Topics/Orofacial-Myofunctional-Disorders/.
Speech Therapy
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Speech sound disorders (SSDs) are characterized by errors in producing sounds of a language whether that be difficulties with perception, motor production, and/or phonological representation of speech sounds and segments that impact speech intelligibility. Speech sound disorders (SSDs) are widely spread in preschool and school age children.
Speech therapy works to prevent, assess, diagnose, and treat speech sound disorders that may impact effective communication.
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In most cases, the cause is unknown. Factors Influencing Typical Acquisition
-Family history
-Pre and Perinatal problems
-Gender - girls typically acquire speech earlier than boys and research has shown that boys make significantly more speech sound errors
-Hearing Difficulties and Frequent Otitis Media (ear infections)
-Language development and intelligence is correlated to speech developing in the early stages of development
-Individual variability
-Structural Variabilities (lips, teeth, tongue, palate) which may impact speech production
-Oral sensory function plays a role in development and monitoring of speech sound production
-General Motor Abilities
-Genetic Disorders - Down syndrome, fragile x syndrome, macroglossia, hearing loss
-Neuromotor Disorders - Apraxia (refer to Apraxia page) an/or Dysarthria
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Signs and symptoms of speech sound disorders include;
-Decreased intelligibility
-Omissions/deletions— when certain sounds are omitted or deleted (e.g., "do" for "dog" and "pane" for "plane")
-Substitutions—one or more sounds are substituted (e.g., "ping" for "sing" and "wibbon" for "ribbon")
-Additions—one or more extra sounds are added or inserted into a word (e.g., "buhlack" for "black")
-Distortions—sounds are altered or changed (e.g., a lateral lisp of "s" and/or “z”)
-Syllable-level errors—weak syllables are deleted (e.g., "nana" for "banana")
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When intelligibility is impacted it creates an issue with being able to connect with others through communication and to make ourselves understood. It is also noted that a normal sound system is important to learning to read and spell. Treatment is necessary to remediate sound errors and provide a functional means of communication to set our children up for success.
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American Speech-Language-Hearing Association (n.d.) Speech Sound Disorders: Articulation and Phonology. (Practice Portal). Retrieved March, 24, 2022, from www.asha.org/Practice-Portal/Clinical-Topics/Articulation-and-Phonology/.
Bernthal, J.E., Bankson, N.W., & Flipsen Jr, P. (2017). Articulation and Phonological Disorders Speech Sound Disorders in Children. New Jersey: Pearson EducationIn
Williams, A.L., Mcleod, S., & McCauley, R.J. (2010) Interventions for Speech Sound Disorders in Children. Maryland : Paul H. Brookes Publishing Co.
Feeding Therapy
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According to ASHA,
Feeding is the process involving any part of eating or drinking (gathering and preparing food/liquid to consume, sucking/chewing and swallowing). A feeding disorder is characterized by problems with a range of eating activities (impaired oral intake, that is not age appropriate and is associated with medical, nutritional, feeding skills and/or psychosocial dysfunction).
Characterized by:
-Refusal of age appropriate foods/liquids
-Having a restricted variety or quantity of foods/liquids
-Producing disruptive/inappropriate behaviors for developmental norms during mealtime
-Difficulties mastering developmentally normal self-feeding skills
-Difficulties using developmentally normal feeding devices/utensils
-Experiencing less than optimal growth
VS.
Swallowing is transportation of saliva/liquids/food from mouth to stomach while keeping the airway protected. A swallowing disorder/Dysphagia can occur in one or more of the four phases of swallowing and can result in aspiration (entry of food/liquid/saliva into the airway). Long term consequences may include food aversion, oral aversion, aspiration pneumonia, undernutrition, dehydration, gastrointestinal complications, poor weight gain, rumination disorder, ongoing need for enteral nutrition, psychosocial effects, feeding/swallowing problems that persist into adulthood.
Feeding therapy focuses on helping a child learn how to eat and/or expand the variety of developmentally appropriate foods in their repertoire
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Causes may include:
-underlying etiologies associated with feeding/swallowing disorder may include
-complex medical conditions (allergies, GERD< heart disease), developmental disability, neuromuscular coordination (prematurity, low birth weight, hypo/hypertonia, genetic syndromes, medication side effects, neurological disorders, sensory issues, structural abnormalities (cleft lip/palate, tethered oral tissues), behavioral factors or social-emotional factors
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Signs/Symptoms of feeding & swallowing difficulties may include:
-Vary based on the phase of swallow being impacted
-back arching
-breathing difficulties
-coughing/choking
-crying during mealtimes
-decreased responsiveness during feeding
-difficulty chewing foods that are developmentally appropriate
-difficulty starting the swallow
-difficulty managing secretions
-refusal
-frequent nasal congestion
-frequent respiratory illnesses
-gagging
-loss of food/liquid
-noisy/wet vocal quality
-taking longer to finish meals
-refusing certain textures, brands, colors,
-taking only small amounts of food, overpacking mouth, or pocketing food in mouth
-delayed development of mature swallow
-vomiting
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Functional feeding and swallowing skills allows for our children to receive adequate nutrition/consumption of foods and liquids in order to maintain a diet to support child development. It also provides children and caregivers opportunities for social experiences and communication that create the foundation for future interactions.
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American Speech-Language-Hearing Association (n.d). Pediatric Feeding and Swallowing. (Practice Portal). Retrieved September, 29, 2022, from www.asha.org/practice-portal/clinical-topics/pediatric-dysphagia/.
Oral Habit Elimination
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Noxious Oral Habits are non-nutritive habits that exert pressures against oral structures, leading to disruption of normal muscle patterns. Swallowing, speaking and dental developmental processes may be impacted.
Oral habit elimination programs help replace noxious oral habits with positive oral habits to improve overall oral functioning and create an optimal oral environment.
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Babies begin sucking in utero during the third trimester. In the first few months of life pacifiers are used for analgesic effects, shorter hospital stays for preterm infants, and a reduction in the risk of sudden infant death syndrome. Pacifiers have also been studied and recommended for pain relief in newborns and infants undergoing common, minor procedures in the emergency department (e.g., heel sticks, immunizations, venipuncture).
The American Academy of Pediatrics recommends that parents consider offering pacifiers to infants one month and older at the onset of sleep to reduce the risk of sudden infant death syndrome.
Potential complications of pacifier use, particularly with prolonged use, include a negative effect on breastfeeding, dental malocclusion, and otitis media and potentially speech problems. Adverse dental effects can be evident after two years of age, but mainly after four years.
The American Academy of Pediatrics and the American Academy of Family Physicians recommend weaning children from pacifiers in the second six months of life to prevent otitis media.
Pacifier use is not actively discouraged and may be especially beneficial in the first six months of life. However, the risks begin to outweigh the benefits around six to 10 months of age and appear to increase after two years of age.
Typically after six months of age, pacifiers transform from a means of nonnutritive sucking to objects of affection that give the child a sense of security.
Removing the pacifier can be a great source of anxiety for children and parents. Key alternatives to pacifier use in younger infants include swaddling, rocking, soft music, singing, and infant massage. Older infants or toddlers may be distracted from pacifiers with activities, toys, or other objects of affection. Some weaning methods that have been studied include physician or parent encouragement, putting unpalatable substances on the pacifier, and stopping the habit abruptly.
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Some common noxious oral habits include:
-Thumb/Finger sucking
-Blanket Sucking
-Fingernail Biting
-Pacifier Sucking
-Tongue Sucking
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We treat noxious oral habits FIRST because we need to remove any obstacles that can come between the tongue and the palate and which utilize pressures that are counteracting the growth of the upper jaw.
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Academy of Orofacial Myofunctional Therapy, 2022, Introduction to Orofacial Myofuntional Therapy
Sexton S, Natale R. Risks and benefits of pacifiers. Am Fam Physician. 2009 Apr 15;79(8):681-5. PMID: 19405412.
Apraxia of Speech
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According to Bernthal, Bankson, & Flipsen (2017), Childhood Apraxia of Speech (CAS) is a neurological pediatric speech sound disorder where precision and consistency of movements underlying speech is impaired. The main problem/area of deficit is with planning/programming of speech.
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Bernthal et al. (2017) and ASHA stated the most common origin of CAS is UNKNOWN or idiopathic, however, it can be a reflection of a known neurological condition such as cerebral palsy, trauma, childhood stroke or known neurobehavioral disorder such as Fragile X Syndrome, rett syndrome, Autism, epilepsy etc.
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Reduced sound inventory
Inconsistencies in productions
For example, after multiples attempts of the same word they come out different every time
Difficulty with timing of sounds, syllables and prosody
Sounds out of order in the word
Vowel errors and a limited vowel repertoire
Timing errors
Sound distortions
Groping
Impaired volitional oral movements
Poorer expressive language compared to receptive language
Voicing errors
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According to ASHA reduced intelligibility and comprehensibility can be difficult and frustrating for children with CAS. When intelligibility is impacted it creates an issue with being able to connect with others through communication and to make ourselves understood. It is also noted that a normal sound system is important to learning to read and spell (Bernthal et al., 2017). Early intervention is necessary in order to remediate sound errors and provide a functional means of communication to set our children up for success and reach their highest potential.
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American Speech-Language-Hearing Association (n.d.). Childhood Apraxia of Speech (Practice Portal). Retrieved March, 26, 2022, from www.asha.org/Practice-Portal/Clinical-Topics/Childhood-Apraxia-of-Speech/.
Bernthal, J.E., Bankson, N.W., & Flipsen Jr, P. (2017). Articulation and Phonological Disorders Speech Sound Disorders in Children. New Jersey: Pearson Education, Inc.
Roth, F.P., & Worthington, C.K. (2016).Treatment Resource Manual for Speech Language Pathology 5th Edition. New York: Cengage Learning.
Developmental Consults
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Build your knowledge about speech, feeding and myofunctional development and learn strategies to help your child achieve optimal orafacial development.
Curious if your child would benefit from our services?
Complete our oral motor dysfunction screener.
