Oral-motor skills refer to the movement of the muscles of the face (e.g., jaw, tongue, and lips) to facilitate adequate muscle tone, muscle strength, range of motion, speed, coordination, and dissociation. Oral motor skills develop within a system that changes rapidly both in structural growth and neurological control during the first three years of life. During this period, children engage in a great variety of oral motor experiences as they satisfy their basic needs for food and comfort and begin to explore their world.
Development of Oral-Motor Skills
Oral-motor development follows a stepwise progression building on the suckle reflex to acquire the more complex oral-motor milestones such as the suck, munch, and chew. Just as with gross motor skill development, milestone acquisition is not driven by maturation alone. When the infant uses the suckle reflex successfully with breast or bottle feedings, they master suckling and its coordination with breathing.
Younger children would typically revert back to sucking behaviours with puree or softer consistencies, which does not require such differentiated movement of the lips, jaw and tongue for preparation. Children should be offered foods of a texture that require chewing during this optimal period of 6 months to 2 years in order to develop the required oral-motor skills.This reciprocal, dynamic influence between the child’s practice during feeding and oral-motor skill development continues until the child has accomplished the most advanced skill, rotary chewing.
Oral-motor skill development is integrally linked with increasingly complex tongue movements. In the typical pattern of development
- anterior/posterior (in/out) pattern (i.e., suckling)
- superior/inferior (up/down) pattern (i.e., sucking)
- lateral (side to side) pattern.
As the child’s oral motor function advances, she/he learns to stabilize the jaw, working the tongue off this stable base first centrally with sucking and then laterally with munching. Range of movement increases to allow sweeping anteriorly (to the front), posteriorly (to the back), laterally (to the sides), and with tongue tip elevation. Tongue protrusion under the cup may occur and biting down on the cup may be used to help compensate for the lack of jaw stability not seen until 2 years of age.
Lip closure is important for efﬁcient oral feeding at all stages of feeding development. In the transitional phase of feeding, lip closure or pressure is needed for maintaining a lip seal and for removing food from the spoon. The jaw opens just wide enough to accept the spoon. The upper lip comes down and inward to remove the food as the lower lip provides stability.
To manage solid foods, the 2-year-old child needs a different set of motor skills. In a typically developing child, these skills develop as the child learns to handle liquids and purees and mouths toys. A 2-year-old child has the ability to bite through a texture, such as a hard cookie. Rotary jaw movement begins at around 10 to 12 months and will continue to develop into the child’s second year. Jaw strength must be graded and adequate to break down the bolus of food. Depending on the size and texture of the food bolus, the child may transfer it between right and left molar areas in combination with a rotary chew pattern.
What happens if there is a delay in the oral skills development?
If an infant does not experience successful practice with the suckle reflex before the reflex fades at 4 months of age, the suckle pattern may not be mastered. As a result, the infants may not be able to successfully initiate nutritive sucking (i.e., nipple feeding) without the propelling effect of the suckle reflex even if the child practiced non-nutritive sucking (for example, on a pacifier).
Delayed introduction of spoon feeding, and cup drinking may lead to delayed oral-motor development, resistance to developing the necessary skills following introduction after the optimal period of 6 to 7 months of age, and potential behavioural feeding issues, such as avoiding certain textures of food. For some children, these more common feeding problems may reflect a specific oral-motor problem, such as uncoordinated tongue movement during lateralization or dysfunctional oral transport of the food bolus to the back of the mouth to initiate the swallowing reflex.
Children with muscle-based issues that affect feeding often use compensatory movements such as wide jaw excursions, tongue protrusion, jaw/lower lip protrusion, biting the spoon, and using head retraction to remove the food from the spoon. Oral transit time may be delayed, and the sensory feedback that facilitates a swallow may be inhibited.
If the child does not have the motor skills to adequately masticate (chew) a solid bolus of food, he/she may develop compensatory strategies. Compensatory motor skills may include a non-dissociated munch chew, suckling the food on the surface of the tongue, or pooling of the bolus on the anterior (front) surface of the tongue or behind the front central incisors. In addition, food may be held inside the mouth for an extended period of time, or the bolus may be swallowed prior to being adequately chewed. Inadequate motor skills can also lead to avoidance of certain types of food, which can lead to sensory preferences for taste, texture or temperature.
Connection between lip, tongue and jaw movements in speech and feeding
- The jaw is the key structure for adequate oral movement. If jaw instability has been identified, then the lips and tongue cannot function appropriately. Therefore, you should begin with jaw activities. Jaw activities address: jaw symmetry, jaw alignment, jaw stability, jaw grading and cheek muscle control as movement patterns directly associated with feeding and speech production.
- If the jaw is stable but there is instability in placement and movement of the lips and tongue, you would begin with lip activities.
- If the jaw and lips are stable and can move independently (dissociated) , then you would begin with tongue activities. When we observe normal development, we note that functional tongue dissociation also develops in a hierarchy. We should not expect our clients to perform a higher level of function than their developmental skills allow.
When we observe normal development, we note functional Jaw- lip – tongue dissociation develops in a hierarchy:
|Age||Muscle Movements||Feeding Skills||Speech Sounds|
|Jaw||High||m,r, s, n, z, sh, b, f, ch, j, p,oo, ee|
|Medium||r, t, l, d, th, dh,oh|
|Low||k, g, ng, a,ae|
|Lips||Lip closure around the spoon develops relatively early, but patterns of lip closure during swallowing typically do not present until 12 months of age.|
Lip pursing or closed lips during swallowing has also been reported to begin in 2- and 3-year-old children.
|Open to Closed|
Closed to Open
Single sip cup drinking
|m, p, b
|Protrusion/ Retraction||oo, oh
|Lower Lip Retraction/Tension||f,v|
|Lower Lip Protrusion/Tension||sh, ch, j, r, er|
|Tongue||Birth – 4 months||Retraction- Protrusion: Equal range of motion (balance)||Suckle for breast or bottle feeding|
|4 months||Retraction (increases and becomes more prominent movement)|
|-This placement is needed for all sounds in English with the exception of the voiced and voiceless “th”.|
|At around 5 to 6 months, tongue movements increase in range to include lateral excursion and the tongue begins to move independently of the jaw. |
Controlled rotary jaw movements and tongue lateralization should be noted by approximately 2 years of age
|Retraction (stability) |
- Lateralization of tip
|-Move bolus from midline to the back molar(s) for safe/effective chewing |
- This movement pattern is the criteria for teaching independent self feeding of cubed solids.
|This placement is not used for speech sound production but is a prerequisite skill for tongue-tip elevation and depression which is needed for speech.|
|A mature pattern of swallowing with tongue tip elevation is also noted at 12 months of age||Retraction (stability) - Tongue-Tip Elevation/Depression ||Manipulate the bolus and stabilize the tongue for Swallowing.||t, d, n, l, s, z, sh, ch, j, k|
|Retraction (stability) - Back of Tongue side spread||Produce back of tongue side spread phonemes and all speech sounds in a co-articulated manner as a result of stability at the back of the tongue which allows for mobility of the blade and tip. Without this skill,
speech clarity at the conversational level will be compromised.
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