Daily Oral Motor Routines: Developing Awareness & Improving Feeding

“Speech is movement made audible…, oral-motor therapy, as it is practiced today, can be defined as the process of facilitating improved oral (jaw, lip, tongue) movements.” Oral-Motor Techniques in Articulation & Phonological Therapy by Pam Marshalla, M.A., CCC-SLP

Sometimes, children need a little more than auditory and visual cues to make sequenced movements for speech.  We know that making these movements brings them one step closer to pairing sounds with those motions.  Adding tactile learning can be an essential piece in the puzzle for children who need to feel more information in and around their mouths before producing a sound.

Developing a new speech movement takes time, successful practice, supports, and extinction of inaccurate movements.  This comprehensive oral motor wake up routine for home intends to support caregivers in using oral motor tools sold through Ark Therapeutic to prepare the mouth for feeding and/or speech.

Years ago, I connected with Ark and they graciously gifted me several products to try with clients on my caseload.  I do not advocate purchasing or implementing oral motor products unless a speech pathologist has recommended these specifically.  Comprehensive assessments support appropriate treatment planning and identify other medical, contributing factors like hearing loss or tongue tie that may need intervention prior to initiating speech-language therapy.

Oral Awareness

Before a child can develop sequenced movements for speech, he needs to be able to feel and attend to the structures of his mouth.  Without this knowledge, he may not be able to perform tasks like putting lips together, moving the tongue, or chewing.  As a result, these children do not comprehend an auditory (verbal) direction to “Lift the tongue up and make the /d, t, n/ sound,” even when you show them how it is done.

Oral awareness through “wake-up” practice helps children feel the boundaries in and around their mouths.  One tool that I have used over the last two decades in private practice is the Z-Vibe by Ark Therapeutic.  You can purchase this instrument alone or as part of a grabber in the form of the Z-Grabber.  For more information on the Z-Grabber, please see my post on jaw work.

Oral Motor Tools

Ark’s Z-Vibe Oral Stimulator

This single probe tip instrument provides intense vibration input to support stimulation, improving awareness, and exploration.  In other words, it helps “wake-up” the mouth before feeding and/or speech practice.  While you can only use one tip at a time, there are over 35 different ones that you can twist and secure on the Z-Vibe.

Ark’s 10-Tip Kit Set for the Z-Vibe

This kit includes the following tips for the Z-Vibe:

• Preefer
• Probe
• Mini
• Hard Fine
• Bite-n-Chew
• Textured Bite-n-Chew XL
• Hard Spoon
• Soft Spoon
• Hard Brush
• Soft Brush

I will be describing a “wake-up” routine using the first, four tips in the list above: Preefer, Probe, Mini, and Hard Fine.  You can read more information on the Bite-n-Chew and Textured Bite-n-Chew XL in my post about the jaw. The hard and soft spoons are helpful in transitioning infants to textured foods.  These spoons are especially useful if your child stuffs his mouth full as this is a sign that he needs more information and input before being able to chew and swallow.

The Z-Vibe vibration with spoon tips give oral musculature appropriate sensory input and ensures safety while eating.  Finally, the brush tips support oral hygiene and dental care.  These are both good options for getting ready to use a regular toothbrush.  Consult your child’s speech pathologist about appropriate tips.

Wake-Up Routine

ALWAYS maintain control of the Z-Vibe and refrain from letting your child hold the tool itself to place on his face.  We do not want the child to use this tool like a toy and/or place it on bones like the nose or ears as this is a useless, sensory stimulation experience.  You may allow your child to hold the device with you, but never independently.

Step 1:

When you first introduce oral motor tools, you will need to begin by having your child feel the gentle vibration on his hands, gradually moving up his arms and towards his mouth.  We want to make every step of this stimulation a positive experience and starting at someone’s face is too intrusive.  Hold and count from 3-5 on your child’s hands, arms, then cheeks using the Z-Vibe with Preefer Tip.

Preefer Tip:  This particular tip was designed to roll along inner cheeks and/or lips to increase oral awareness.  The ridged surface of this tip was a brilliant idea because it provides the perfect amount of stimulation without being overbearing.

Step 2:

Continue proceeding with caution and positive acceptance by alerting the outside of your child’s face before moving inside the mouth.  Stroke the outside of your child’s cheeks in a downward motion, starting near his ears and moving towards the lips in three rows on each cheek, counting from 3-5 each time.

Step 3:

For lip awareness, you can continue using the Preefer tip or switch to the Probe or Mini Tip.

Preefer Tip: Hold vertically at one lip corner and roll it moving towards the opposite corner.  If age appropriate, you can sing a song while you move back and forth 3-5 times or simply stretch out your counting.

Probe/Mini Tip: These removable tips have three surfaces: bumpy, striated, and smooth.  Start out introducing the smooth side and then take baby steps towards trying the textured ones. Stroke the lips using one surface at a time applying gentle pressure and counting for 3-5 seconds.  Please note that the Mini Tip is great for smaller mouths and infants.  

Step 4:

Start moving inside your child’s mouth using the Preefer, Probe, or Mini Tip to alert the inner cheeks.  This area is a boundary cue for moving foods towards the molars for chewing.

Preefer Tip: Roll the tip inside each cheek with an up-and-down motion while and counting for 3-5 seconds.

Probe/Mini Tip: Position the Z-Vibe Probe or Mini Tip horizontally on the bottom of your child’s cheek inside his mouth and then walk it up using counting or a song.

Step 5:

The last step is to alert the tongue.  You may use the Preefer, Probe, Mini, or Fine Tip for this final part of the routine.  The only area overly sensitive to vibration is the palate, or top of your child’s mouth.

Preefer Tip: Roll this across the middle of the tongue from side to side while counting from 3-5 repetitions.

Probe/Mini Tip: Start with the bumpy side for the first round of 3-5 repetitions and then repeat this count using the striated end. Place the Tip of the Z-Vibe a few centimeters from your child’s tongue tip, holding and gently pressing as you move the tip vertically back and forth.  The Z-Vibe should maintain contact with the tongue during each of the 3-5 repetitions.

Fine Tip: To build awareness at the sides of the tongue, use the Fine Tip to gently stroke with a back and forth motion for 3-5 repetitions on each side.

Take Away Points

1. I use a variation of the “wake-up” routine at session starts to build muscle awareness for feeding and speech.
2. Tactile sensation is part of my comprehensive plan for children with feeding and speech delays.
3. A multi-sensory approach includes auditory, visual, and tactile cues, supporting overall progress with caregiver training.