Making meal times count - mini series - Part 3 - Oromotor Skills
Joanne Jones 
What are oromotor skills?
Part 3
Children's ability to use their mouth, muscles in their face, jaw and lips are called oromotor skills. The tongue is fundamental to being able to talk. When it comes to communication, there is expressive language, and that's children's ability to lay down the concepts and get them out of their heads. But if you can't talk, you can still express yourself through signing and using symbols, through using gestures, facial expressions and movements. Some children begin to develop those language skills and yet they're not still talking. These children have got difficulty with speaking and organizing their lips, tongues, mouths and their jaws in order for them to start talking. Often children will get diagnosed with expressive language difficulties, dyspraxia, and phonological delay. All children, whether they've got these difficulties, need to build up their awareness, muscle tone and motor memory between the brain and the muscles in the mouth. For some children, it doesn't happen and they need support. The reasons for that are:
1. The child might have a tethering i.e. a tongue tie - a tongue tie can happen anywhere along the tongue. The tongue in utero is initially completely blended with the floor of the mouth. As the fetus develops the tongue and the front of the mouth begin to separate. So the tongue becomes a free moving structure, but at any point along that, there can be a stopping of that separation or a bit that's missed hence the tongue remains tied. That can be right at the front of the tongue, or towards the back of the tongue. Children who have a tongue tie at the front of the tongue, are often identified immediately at birth because their tongue looks like a snake's tongue or a heart-shaped tongue. These babies don't feed well because the front of their tongues is tied really tightly. Often the practitioners that do tongue division are only qualified to do the front. For some children, their front bit is the only bit of their tongue that is tethered, but for other children, the tethering goes all the way back. If your child's now struggling with talking, but did have a tongue tie operation, there's a potential that tethering happens towards the back of the tongue. For children whose front of the tongue is free, they can be quite good breastfeeders. Other children aren't. Some babies manage. It looks as though they are okay and it's not affecting their feeding. Actually, that is a fallacy that is not based on fact. For some children tethering at the back of the tongue comes into play when children start to talk.
2. For some children it's about the muscles being weaker or having higher tone. So if your child has got muscle difficulties in other parts of the body, because of muscular disorders such as cerebral palsy, or anything neurological that affects muscles, it can also affect the muscles of the mouth. And so for some children, their muscles have just not got enough control of their tone in order for them to start to make speech sounds.
3. Some children have missed important developmental windows of the muscle development. These are children who have been very fussy eaters, who didn't wean particularly well, who choked a lot and maybe had to be very cautious, had a lot of medical interventions in certain parts of their eating development. That kind of puts them off eating. Some children have a choking episode early on, and then are very cautious about eating. Some children miss those developmental windows for eating. If they missed the weaning process it could mean that their motor milestones may be delayed. So for some children, the muscles are not quite working, not because there's anything neurologically the problem, but because they've developmentally not been through that process.
4. The other thing that can happen is that the messages being sent from the brain to the tongue are miscommunicated or misfired. This is a dyspraxic type problem where the children can't send the messages fully to their tongue, lips and mouths. So it can be very difficult for them to form strings of sounds.
5. I always talk about a filing cabinet for language development. We put all our words in files and folders like animals are all together, toys, everyday things etc. Children who have phonological difficulties store all their speech sounds in the filing cabinet without ordering them. So when they come to find them, they have difficulty accessing these sounds because those are not yet stored in a particular order. Some children go through what is called a phonological delay, which is the normal pattern that happens in everyday development, but just happens a little bit slower for them. However, some children have a phonological disorder. That means that they mis-stored everything in their filing cabinet, and now they're having a hard job accessing the right sound.
Even if the child has an underlying problem such as dyspraxia or phonological difficulty, practising mouth movements, and building up strength and awareness around the mouth is never going to be counter-intuitive. ALL children should work on their oromotor skills.
I'd like you to have a look at your child's tongue and see whether there's any connection anywhere along the under part of the tongue and the floor of the mouth. Sometimes children's floor of the mouth rises up and that compensates for the tethering. But actually, if you were to hold the floor of the tongue down, the tongue wouldn't be able to lift.
Here are Part 1 and Part 2 of this mini series of blog posts.
If you are wondering how to start helping your late talking child, my FREE workshop called The Can Do 3 Keys is a good starting point.
If your child needs support with oromotor skills then my at-your-own-pace course Our Mighty Mouths is open for enrolment.
I am also running a free 3 day support spell for those parents and professionals who want to learn how to support communication during bath times. It is called Babble Bath and will be run on Facebook. I hope to see you there.