Oral Hypersensitivity or Defensiveness, An Oral Motor Perspective

Have you said or heard the following comments about your loved one? "He gags all the time." "She fights me when I brush her teeth." "He hates it when I wash his face." "She won't let me wipe her nose." "He is a picky eater." "She overstuffs her mouth." "He grinds his teeth." "She chews on her fingers until there are calluses." "He drools all the time." "She won't chew her food." If so, your loved one may be identified as having oral hypersensitivity or as being orally tactually defensive. Underlying the poor response to touch and movement on the face and inside of the mouth may be specific oral motor problems that occur if the muscles of the orofacial area lack adequate range of movement, strength of movement, and variety of movement. This affects control of movement and response to pressure and movement.

By the third month of gestation, humans seek oral stimulation. The infant first finds this oral input from the amniotic fluid as the fetus sucks and swallows in the womb. The fetus also has been seen on ultrasound images placing the thumb into the mouth. The pressure and movement within the oral cavity tell the brain where the mouth begins and ends. Without such input, the location and boundaries of the mouth are uncertain to the infant. All that lip, cheek, jaw and tongue movement keep the eating machine in peak muscular condition. Movement against resistance is the best was to build strength. Repetition of movement is the best way to refine and develop muscle control.

At birth, the infant frantically searches for something, preferably the breast, on which to suck. It is a reflexive pattern to insure nutritional intake. The mouth is equipped with lots of sensory receptors, ready for and craving stimulation. The mouth is the exploration cave of an infant. Since vision is not yet well developed, the mouth is the place for touch, taste, texture, with the added bonus of smell accompanying the oral experience. Early on, anything that can fit into the mouth is accepted for exploration.

As the infant matures, discrimination of edible from non-edible items develops. Keep in mind that even as adults, we all continue to receive pleasure and comfort from a multitude of oral and facial stimuli. As you are reading this, you are probably touching your face, or receiving input another way, such as chewing on a pen or pencil, or fingernail. You might be giving yourself input by changing the position of your jaw, or closing your lips together with intermittent pressure. Chewing gum or drinking a beverage are other popular adult ways to get oral stimulation.

Baby ways to get stimulation are to suck or chew on things that are easy to reach, such as thumbs and toes. Pacifiers provide opportunities for non-nutritive sucking. Often pacifiers provide more comfort to the caregiver; since the baby's mouth is full, the crying is reduced. Body parts (thumbs and toes) are dynamic; moving and changing shape in the baby's mouth, providing a wide variety of pressure and movement. Pacifiers have a static shape. The stimulation from a pacifier is constantly at the center and front of the mouth. Because the movement of the lips and tongue stay the same while the pacifier is in the mouth, the baby can not practice the variety of movements so necessary for the continued development of internal jaw stability and muscle strength, which are needed to chew and later to speak.

For an infant with normal muscle tone, development occurs without any major interventions by the caregivers. Skills which begin at the front and center of the mouth gradually change to include movement at the lateral and posterior areas of the mouth. For the infant with abnormal muscle tone, development of oral motor skills becomes more problematic, often with abnormal patterns of movement used to complete every day activities such as swallowing secretions, drinking, eating, vocalizing, chewing, and speaking in words or phrases. Because the muscles do not work together and do not give consistent pressures within the mouth, the individual may seek such input from external sources, such as clothing, toys, or other items. Many of these individuals have not progressed from pureed or soft foods, and so, are not receiving input on the jaw through chewing. The posterior area of the mouth may be receiving little or no input. Gagging (with or without vomiting) may result.

The sensory input for the mouth is important, and the craving of such input does not decline for individuals on pureed diets or for those individuals with non-oral intake. It may be increased, resulting in pica - the eating of non-edible objects. Some individuals attempt to increase sensory input at the mouth by biting themselves, or others within their reach. Telling someone to stop putting everything into his or her mouth, or punishing him or her for doing so, does not address the underlying sensory motor needs. If the individual is hypersensitive, telling that person to stop gagging, or becoming angry when the individual refuses to do certain oral activities, does not address the underling sensory motor needs. By completing the Beckman Oral Motor protocol, the right kind of input can be provided in a safe way to enhance the muscle balance and internal muscle pressures the person should have, thereby reducing the constant craving for additional external input (mouthing of non edible items). Providing the right kind of input also normalizes oral sensitivity, so that the individual's response to pressure and movement is a functional movement, such as swallowing or moving the lips or tongue, instead of gagging, crying and screaming.

Work with the therapist to develop the best intervention program to use at home for your loved one. By providing specific pressure and movement a little at a time (for three to five minutes) several times a day, significant changes can occur. This will make every day happier for you and your loved one.

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What Therapists say...

Nothing has ever worked like your Oral Motor Protocol. It helps better than anything I have ever used. Thank you so so so much for sharing your work with all of us. ...I wish I had learned this in school instead of midway through my career.

MS, CCC-SLP Albany Georgia