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.