A speech therapist recently wrote to me about a child she is working with. Some of the information has been edited for privacy purposes.
Question: Stephanie, I am working with a 6 year old boy who is drooling. He had his adenoids recently removed. His parents have noticed a decrease in his drooling, but the problem still persists.
He does not have open lip posture, his top teeth slightly protrude and he swallows nicely on command. His awareness of his excessive saliva is poor. This saliva impacts his articulation. When he swallows, his speech (articulation and vocal quality) are more intelligible.
What can I do to help this student? Any specific oral motor exercises you recommend?
Answer: Take a look at his tonsils. I’m wondering if he has a tongue thrust since you noticed his top teeth are protruding. The tongue thrust may be occurring for a variety of reasons, including large tonsils (the tongue will be misplaced anteriorly if the tonsils take up too much room posteriorly). If you feel his tonsils are enlarged, it may be appropriate to revisit the pediatric otolayngologist (ENT).
If you are in NYC, you can find a list of pediatric ENT’s here.
As with any oral motor work, you have to start from the bottom-up. Make sure his body posture and jaw are strong and stable, then the tongue, and finally the lips. Weakness at any of these levels needs to be addressed. Have you taken any good oral motor courses? Try renting Talktools / Sara Rosenfeld Johnson’s level one class to get started, if you feel this is an area you need experience. Once you know his jaw, lips and tongue are strong and stable, here are some Ideas To Eliminating Drooling:
1. Help him become aware of his mouth
2. Improve his swallowing frequency and efficiency (he needs to fully retract the saliva)
3. At rest, his lips should always be closed
Talk to him about wet vs. dry mouth, lips and chin to build his awareness. Have him wear terrycloth wristbands. Ask him to wipe his lips and chin when they are wet. Each time he wipes his lips and chin, he should be reminded (until he does this independently) to swallow. You may need to teach him the concept of swallow. Wristbands will also act as a visual reminder to dry his face and to swallow. Purchase a few pairs as they need to be washed daily.
If you or his parents do catch him with lips apart, remind him to keep his lips together, especially at rest and when he is actively involved in a task. Can he keep his lips closed during a fine motor task?
To help him build awareness of his lips, have him put on flavored Chapstick, make “raspberries” and smack his lips. If it is safe to, and he can tolerate vibration, use a gentle, child-sized battery operated toothbrush to brush his teeth, inside of his cheeks and tongue. With firm (not too hard / not too light) pressure, run the toothbrush over his lips, to stimulate them / make him more aware.
Good luck – please let me know if you have more questions.
P.S. Should you actively work with this child for 4 weeks (and speech homework is consistently practiced) and improvement is not observed, a follow-up pediatric ENT visit is critical.
Stephanie Sigal, M.A. CCC-SLP is a New York State and ASHA certified Speech and Language Therapist. She works with children with articulation and language delay, as well as with children that drool and suck their thumbs on Manhattan’s Upper East Side. You can contact Stephanie at firstname.lastname@example.org.
Many children make predictable developmental sound substitutions as they are learning to talk. Articulation errors may involve substituting one sound for another (“tar” for car), omitting a sound in a word (“boo” for blue), or distorting a sound.
Stephanie is a speech therapist and can be contacted at email@example.com. She provides speech therapy in their New York City Upper East Side homes.
We finally managed to get rid of our daughter’s pacifier! However, We’ve noticed that she is sucking on her thumb and fingers now. How can we help her?
This is a common predicament. The most important thing is to anticipate when your daughter will suck her fingers and why she will do so. Is she hungry? Bored? Tired? All three?
If she is hungry, try giving her hard, crunchy or chewy foods (e.g., vegetables cut into strips, raisins, pretzels). Encourage her to chew the food “on the side” (on the molars) to give input to her temporomandibular joint (TMJ). The TMJ was soothed by the pacifier, now we need to provide a substitution. Gum chewing, when the jaw stays in alignment, can effectively provide this input as well.
If your daughter is tired, but it’s not an appropriate time to nap, turn on the music and encourage jumping jacks, toe touches, rolling on the floor, playing catch / rollie pollie, stretching, yoga, dancing, etc. The worst thing to do is to plop her in front of the television, which would probably encourage the thumbsucking.
If she’s bored, try to have art activities like these on hand – they will keep little fingers busy (please note that these suggestions contain small parts and should be used with caution / supervision only):
There are also specific oral-sensory-motor exercises that a speech therapist like myself can recommend based on your child’s needs. These activities may include massage, vibration and resistance exercises.
I work with children in their NYC (Upper East Side) homes and can be contacted at 646-295-4473 or firstname.lastname@example.org.
It is difficult for people who don’t know my child to understand what she says. What is your approach for improving articulation problems in children?
Along with traditional speech therapy techniques (targeting individual speech sounds), I use a muscle-based (oral motor) approach to improve the strength and coordination of the jaw, lips and tongue.
When completing a muscle-based assessment, I begin at the level of the jaw, administering child friendly exercises that a parent or caregiver may carryover for homework. Exercises for the lips or tongue may be incorporated as well, depending on your daughter’s skill level. These exercises may include blowing horns and bubbles using specific, hierarchical, adult directed methods that target the necessary movements for speech clarity.
Exercises to be completed at mealtime may also be incorporated. For example, when a child drinks from an open cup, we only want her to use her lips to take a sip. We do not want her using her teeth (jaw) on the cup. It is best to see dissociation – the jaw, lips and tongue working independently. The same is true for removing pureed food from a spoon. Children should remove the puree with only their lips.
We also want to eliminate the use of pacifiers, bottles, sippy cups, and thumbsucking, as the suckling action that occurs will work against all our efforts. Nutrition should never be compromised; the bottle or sippy cup should be removed when your child can drink effectively from an open cup or straw.
I discuss the recommended exercises with parents during or at the end of each therapeutic session, and a written program plan along with detailed instructions is consistently provided. Parents are encouraged to call or email me with questions about the homework in-between sessions.
The specific sounds your child is having difficulty producing are analyzed using a standardized test. It is then determined which, if any sounds are appropriate to address. This depends on her ability to say the specific sound (maybe she can say the sound in isolation, but not in a word) and the muscle-based results.
I have found that using a muscle based approach, along with traditional articulation therapy increases speech clarity in conversation, rather than simply at the word level.
If you have concerns about your child’s articulation skills and you live in Manhattan, please contact Stephanie at email@example.com. Stephanie visits children in their Upper East Side Manhattan homes.
I’m ready to wean my child from a bottle. Should I use a Sippy Cup?
A Sippy cup is simply a bottle in disguise – there is nothing functionally different. Parents should pursue bottle weaning by age one, as suckling on the bottle promotes a variety of potential issues, including poor development of mouth muscles for speech.
The shape of the Sippy cup spout and the suction / resistance that the no-spill feature provides are just as harmful as the bottle. Skip the hassle of transitioning to the Sippy cup, teach your child to drink from an open cup (you can begin when your child starts solid foods) and properly from a straw to avoid another (painful) transition down the road.
I teach children how to drink properly from a straw via the Talktools Straw Kit, created by Sara R. Johnson.