Today outside of the therapy clinic where I work, I was speaking with an occupational therapist about oral motor exercises. Yes, there is a lot of debate around oral motor exercises and there are definitely reasons for controversy about some approaches. However, I think it’s wise to look at the evidence-based hierarchy, which includes clinical-expertise and expert opinion, and take these into account when we look at our therapy approaches. This way we do not throw the baby out with the bathwater. Nancy, the OT, and I were chatting about how she often sees improvement in speech when she begins intervention for feeding. And she has said that parents report seeing the same at home. In fact, I can very clearly remember a session Nancy and I had together many years ago where we were co-treating a little guy at a pediatric clinic. I was pulling out every trick I had up my sleeve to try to get some vocalization out of this little one: singing, using exclamatory phrases while knocking over blocks, animal sounds, you name it. And then Nancy approaches him to begin her feeding therapy. She uses vibration on his mouth with something very similar to a Z-Vibe. And this little guy started humming. He hummed and then turned those hums into very slight babbles of /meh meh meh/. When Nancy removed the Z-Vibe, there was still an occasional hum coming from him. Although it took me many years to really start considering the oral-motor component, when I studied feeding therapy, I went back down the oral-motor rabbit hole. I came across an interesting article that shows that children with a prior history of feeding-swallowing difficulties have a higher incidence of language learning disabilities. I wanted to share this article.
The relationship between language impairment and feeding difficulties
The article looked at the relationship between difficulties with feeding and swallowing (poor latching as infants, food transition difficulties, food selectivity, salivary control difficulties). The children in the study were not diagnosed with a feeding or swallowing disorder. This was a retrospective analysis where 48% of the children with a language impairment but not an overall gross or fine motor impairment showed prior histories of feeding-swallowing concerns. Children with language impairment were three times more likely to have a history of feeding-swallowing concerns than the general population. Although language impairment and feeding-swallowing difficulties have often been considered unrelated behaviors, there is new interest in whether there is some type of cross over between the two systems. As the authors wrote, “Neurological disease or damage in the adult often results in cross-system impairments in language and feeding and common neurological structures underlying these seemingly diverse behaviors have been implicated.”
Possible Explanations for the Relationship
The authors point to a few explanations about why feeding and speech impairments may be related to language impairment. 1. The difficulties with feeding-swallowing may negatively impact language learning opportunities by possibly decreasing language stimulation and interaction at mealtimes. 2. The oral motor difficulties in chewing and sucking might influence later neurodevelopmental outcomes and as the authors write, “[studies] found that term infants with reduced sucking efficiency at 2 weeks postnatal age had minor to severe neurodevelopmental disabilities at 18 months, as measured by global neuromotor, language, and cognitive assessments. They suggested that sucking proficiency may actually provide insights into the “integrity of the nervous system” of developing infants.”
The purpose of this study is to identify children sooner who may be at risk for language impairment. I think it also brings some interesting questions to the table about the cross-over between what have typically been thought of as two distinct systems (the system of oral motor movements for feeding and swallowing with those for speech and language).
Also, I realize that Nancy’s observations alone do not provide a strong evidence base for oral motor and speech sound production, although she is a keen observer. However, there are many experts who, although not researchers, have gathered evidence to support the relationship between oral-motor differences and speech and language production. Diane Bahr, for example, has excellent materials and research that she very generously shares with all who ask.