Early Oral-Motor Skills: Healthy, Happy Mouths and Faces
By: Cathy Lauderbaugh, M.A., CCC-SLP
What are Oral-Motor Skills?
Oral-motor skills refer to how a child uses their lips, tongue, jaw, teeth, and the hard/soft palates; oral-motor skills develop and change as children get older. They are important for eating and for speech.
It is important to remember that eating skills are separate from talking skills! For example, a child may need support with the movements of their jaw. In order to improve eating, these jaw movements need to be directly connected to practicing eating skills. In order to improve talking, these jaw movements need to be directly connected to practicing speech sounds. A child can have difficulty with just eating; with just speech; or with both eating and speech.
Some speech examples:
moving your tongue independently from your jaw to make certain speech sounds;
having your jaw be open the right amount for certain sounds.
Some eating examples:
using your tongue independently from your jaw to drink from a straw or open cup;
using your tongue to move food from one side of your mouth to the other side, or to swallow food safely;
having the sensory awareness of how much food is an appropriate amount to put in your mouth at one time.
Why Do We Care About Oral-Motor Skills?
Inappropriate skills or delayed skill development can result in potential negative impacts to the child’s oral structure and facial appearance.
Prolonged use of certain oral-motor tools (e.g. certain cups; pacifiers, in which the tongue moves forward in unison with jaw movements) can encourage the development of a tongue thrust or lisp. More advanced skills (needed for straw and cup drinking) require the tongue to retract and to move separately from the jaw.
How Do We Help Our Kids?
Use oral-motor tools at appropriate times, and make a plan to transition away from tools meant for younger children.
Be realistic and kind to yourself with your expectations:
Consult with a professional if you feel overwhelmed (OT, SLP, pediatric dentist); see the resources list at the end of this article.
Make a plan that is doable in smaller, achievable steps.
Before introducing any new skill such as food (solids, purees), straw cups, open cups—consult your child’s doctor and/or therapy professional.
Make sure there are no concerns regarding hearing, vision, and/or physical structures (such as tongue tie or other tethered tissues; or large adenoids/tonsils). These physical structures can affect function. Consult a pediatric ENT or dentist, or pediatric therapist (e.g. Speech-Language Pathologist, Occupational Therapist).
The links to some of the products in this article are intended as examples only; these products are not necessarily better than other similar options, and there is no promotional connection to the products linked in this article.
Let’s Look at Some Common Oral-Motor Skills Items:
The Pacifier
The child sucks on it to soothe themselves, the tongue and jaw move together (not independently); the tongue moves forward in the mouth. Using a pacifier at night has been linked to reduced risk of SIDS in infants. However, frequent use of a pacifier past 12 months can encourage too much tongue thrust (forward motion of the tongue), affecting their oral-motor skills and result in changes to the child’s facial appearance and/or quality of speech (potential lisp).
Most therapists and dentists recommend being done with the pacifier by 12 months of age. Some recommend a range of 12-15 months for realistic goals.
Try: introducing stick-shaped chewy teethers at about 4-6 months to encourage an alternate way of soothing during awake moments.
Try: if your child is happy and awake, help them be interested in something active with play. During these times, they do not need to have a pacifier. If your child is unable to be without their pacifier while crawling, walking, or playing, it could be a sign that they need self-soothing and sensory regulation support. A professional may be helpful.
At 9 months of age, evaluate your child’s pacifier use. How are they using it? Do they seem on-track to not need it outside of falling of asleep or soothing moments? Do they still have it in their mouth all night long? Or does it fall out and stay out?
If your child is over 12-15 months and still using a pacifier frequently, explore strategies to reduce and/or eliminate the pacifier. Some ideas include: books about saying good bye to the pacifier, having your child create a plan with you, giving it to baby animals in need. Before taking it away, be sure your child has other means to self-soothe, and consult a professional if they need help with soothing and regulation.
Bottles
The tongue and the jaw work together (not independently) with the tongue moving forwards.
Most therapists and dentists recommend a similar range as with the pacifier, to eliminate bottle use by 12-15 months to develop correct oral-motor skills.
Try: introducing straws and open cups by about 6 months so that your child can practice the skills gradually. Eliminating the bottle is easier if the child has good skills in using a spoon, open cup, and straw cup—as well as some early chewing skills.
Pouches
Baby food now comes in extremely convenient “on the go” pouches! When babies eat directly from the pouch, they often suckle with a tongue forward motion just like on a bottle.
If babies eat from pouches frequently, they are practicing the same immature skills as are used on a bottle or pacifier.
Try: Put the pouch, spoon, and bowl into a linen bag, and toss the bag in your diaper bag. Squeeze the pouch into the bowl and practice spoon feeding. Throw the dirty items in the linen bag and wash when you get home. Using a spoon for eating the puree supports the tongue moving backwards in the mouth, and sets the child up to be ready for more mature eating opportunities.
“Value-Added Packaging” is where children (and adults!) choose certain foods because of how the packaging looks, instead of thinking about the actual food they are eating. Help your child learn about foods and flavors by removing the packaging of the pouch from their eating experience—talk to them about what is in the puree, and the colors, smells, taste. Not only do they get to practice spoon feeding skills, but they are also exploring foods in a way that is less linked to picky eating.
Sippy Cup (hard-spouted)
Cup companies have marketed this cup as a “next step”; unfortunately, the child’s tongue and jaw work exactly the same as when using a bottle. Using a hard-spouted sippy is similar to using a bottle, and prolonged use can delay skill development and encourage a tongue thrust.
Avoid the sippy cup altogether and introduce straw and open cups instead.
The 360 Spill-Proof Open Cup
This tool is a great transitional tool since it avoids the suckling of the sippy cup and bottle. However, it’s still important to teach straw and open cup drinking, since the 360 Cup requires you to bite down on it (which is not true of actual open cup drinking). Use this cup until 24 months of age if needed.
Straw Cups
Try the Honey Bear Cup (you squeeze it to send the liquid up the straw, and once the child rounds their lips on the straw, you pull the cup away—the child associates lip rounding and tongue retraction with getting liquid, and they learn to straw drink).
Open Cups:
Small ball jars; ezpz mini cups; cut-out cups; Talk-Tools Recessed Lid Cup.
If spills are a concern, create a rule early in your house that liquids stay at the dining table (kitchen counter, any place that makes sense in your house). Melanie Potock (a local SLP) has an article to consider regarding injuries when children are walking around and drinking at the same time.
What about Baby Led Weaning?
If Baby-Led Weaning feels right for your family, you can do all of the above AND do baby-led weaning. Spoon feeding can be done in a way that asks your child’s permission and follows the child’s lead. You can incorporate as much spoon-feeding into your approach as you like —whatever feels best to you and your family.
What about Thumb and Finger Sucking?
This is a bigger topic that is related to a child’s self-soothing skills. Introducing stick-shaped chewies (see above under “The Pacifier”) can help children transition to other soothing tools; however, some children really like their thumb or fingers when they find them! There are behavioral approaches, sprays, and sensory approaches to support the elimination of thumb-sucking. An early childhood therapy professional can help you navigate the options; one good resource is also Diane Bahr’s Nobody Ever Told Me (Or My Mother) That!.
Additional Resources:
-Early Intervention Services through Imagine! for Boulder County;
-Private Practice Early Intervention Therapists in the Boulder-Denver Area;
-Colorado Early Intervention Part C Services outside of Boulder County
About the Author:
Cathy Lauderbaugh, M.A., CCC-SLP, is a local speech and feeding therapist in Boulder. She is passionate about working with families of young children (birth to 3 years; and preschool) and developing strategies that honor the whole child as part of the family. She works to help children learn through play and movement, and to find their own internal motivation to learn and curiosity about learning. Learn more and connect at www.CreativeStrategiesTherapy.com