Oral Motor Series
Oral Motor Skills and Breastfeeding
What You Don't Know Could Help You
by Caroline L. Bias, M.S., CCC-SLP, Susan Chick, and Beverly Morgan, IBCLC
Part 1 in a 3 Part series written for MOBI Motherhood International
This article provides basic information about oral motor skills and their relationship to breastfeeding.
Mothers struggling to overcome breastfeeding issues such as low supply, tongue tie, poor latch, slow infant weight gain, breast refusal, etc. may see improvement by addressing their baby's oral motor skills with a specialized therapist. Oral motor challenges often impede breastfeeding relationships and may even lead to their failure. In many cases, oral motor skills can be taught to very young infants. Treatment strengthens the muscles of the lips, tongue, jaw, and cheeks, and coordinates the swallow mechanism for safe and effective nursing. Later in a child's development, oral motor skills are the foundation for a baby to eat solids, drink with a cup, and finally, to produce intelligible speech sounds.
Therapy for infants
For many years, oral motor therapists thought that their ability to improve oral motor skills was limited to preparing the muscles for action and to improving coordination, and that this could only be done with persons who could follow directions well. In recent years, experts have learned that strength, coordination, range of motion, and sensitivity can be improved using specific exercises for stabilization, stimulation, coordination, and strengthening. Research has shown that infants are responsive to current oral motor methodologies.
A typical full term infant develops sucking motions in the uterus and arrives in the world equipped with all the necessary skills to obtain adequate nutrition. At birth, he can coordinate his movements in order to suck, swallow, and breathe in an efficient manner. Prematurely born infants, those with developmental delays and disorders, and also otherwise typical infants can be born with an oral motor problem that affects their ability to eat. In addition, some babies who are not born with oral motor issues go on to develop difficulties due to birth injury, the pain of reflux, or other painful conditions. These conditions create a feeding situation that can cause the oral mechanism to "malfunction" in an attempt to protect the child from pain.
The related components of oral motor skills include strength, coordination, range of motion, and sensitivity. Strength refers to the strength of the muscles of the lips, cheeks, and tongue. Coordination is the ability to use the muscles in synchrony to efficiently suck the milk, initiate the swallow, swallow safely, and get a breath. Range of motion refers to the distance the lips, jaws, cheeks, tongue, and swallow mechanism can move. A baby needs to be able to open his mouth wide enough to take in the nipple, to round the lips in order to get a good seal and a comfortable latch, and to raise and lower the tongue to effectively extract the milk. Sensitivity is an often overlooked piece of oral motor skills. Babies can actually desensitize themselves in order to not feel pain or discomfort, such as from a nasogastric tube, from reflux, etc. Hyposensitivity means that the baby has decreased oral feeling and is not aware of where things are in his mouth. Hypersensitivity means the baby is overly aware of anything near, on, or in his mouth. Babies with hyposensitivity or hypersensitivity often become aversive to oral feeding and resort to breast refusal and prolonged nursing strikes. Left untreated, the problem remains or intensifies, and can show up in other areas of development as the baby matures.
Impact on breastfeeding
Poor coordination of the suck-swallow-breathe pattern, oral muscular weakness, limited range of motion, and hypersensitivity or hyposensitivity can all have a significant impact on the baby's ability to breastfeed. In some cases the impact will be obvious: the baby will not gain well, milk will drip out of the baby's mouth or come out the baby's nose. In other, less obvious cases the mother may experience soreness and pain while nursing, have insufficient milk supply, frequent plugged ducts possibly leading to mastitis, or a hindmilk/foremilk imbalance. This is where the mother has an ample supply but the baby is not able to drain the breast well and receives only foremilk. A hindmilk/foremilk imbalance can contribute to a baby's digestive problems such as colic or reflux and compound his difficulties.
Signs of possible oral motor issues
If you are having breastfeeding challenges, signs to suggest oral motor issues include:
Remember, if your baby is doing some of these things it does not necessarily mean that your baby has oral motor problems. However, these signs, while not a comprehensive list, may alert you to investigate the matter further. An evaluation could be the beginning of relief or give you the peace of mind that everything is going well. Early intervention with therapy may save a breastfeeding relationship, and creates benefits for years to come by positively impacting a child's future feeding and speech development.
How to locate a professional
You may find the quickest way to locate the professional you need by making a call to your closest elementary school. Often they will be able to get you the contact numbers you need. You may also try these resources:
Locate an Early Intervention Program in the USA NICHCY 1-800-695-0285 (Voice/TT) for contact information for your local early intervention program.