A speech therapist recently wrote to me about a child she works 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 an 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. His speech (articulation and vocal quality) is more intelligible when he swallows.
What can I do to help this student? Are there 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 protrude. The tongue thrust may occur 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, revisiting the pediatric otolaryngologist (ENT) may be appropriate.
If you are in NYC, you can find a list of pediatric ENTs here.
As with any oral motor work, start from the bottom up. Make sure his body posture and jaw are strong and stable, as well as the tongue and lips. Weaknesses at any of these levels need to be addressed.
Get Educated
Have you taken any good oral motor courses? Check out Talktools/Sara Rosenfeld Johnson’s level one class to get started.
Ideas for Eliminating Drooling
Once you know his jaw, lips, and tongue are strong and stable:
1. Help him become aware of his mouth
2. Improve his swallowing frequency and efficiency (he needs to fully retract the saliva – say: “Close your lips and swallow”)
3. At rest, his lips should always be closed
Talk to him about wet vs. dry mouth, lips, and chin to build 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 serve as visual reminders to dry his face and swallow. Purchase a few pairs, as they need to be washed daily.
If you or his parents catch him with his lips apart, remind him to keep them together, especially at rest and when 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 do so, and he can tolerate vibration, use a gentle, child-sized battery-operated toothbrush to brush his teeth and the inside of his cheeks and tongue. Use firm pressure (not too hard/not too light) and run the toothbrush over his lips to make him more aware.
Good luck – please let me know if you have more questions.
P.S. A follow-up pediatric ENT visit is recommended should you actively work with this child for four weeks (and speech homework is consistently practiced) and improvement is not observed.
Stephanie Sigal, M.A. CCC-SLP, works with children with articulation and language delays, as well as with children who drool and suck their thumbs on Manhattan’s Upper East Side.
You can contact Stephanie at sigalstephanie@gmail.com.