Everyday Oral Motor Stimulation

In our work at the Mun-H-Center (MHC) we meet children with rare disorders and their parents. The children often have oromotor impairments that affect their ability to eat, to communicate and to control saliva. Many parents express a wish to stimulate their child’s oromotor development but are often unsure about how to do this.

This publication is intended to provide a theoretical background to oromotor disabilities in children with rare disorders and to suggest practical exercises for stimulating oromotor functions that can be easily integrated in day to
day life.

We have chosen to focus on infants with orofacial disabilities but the information can also be relevant for older children.

Åsa Mogren, Speech-language pathologist

Lotta Sjögren,  Speech-language pathologist

THE FIRST YEAR

By the fourth month of gestation the foetus has already started to practise sucking its thumb and swallowing the amniotic fluid. The face is already formed and all the muscles are in place.

The newborn infant’s ability to feed is controlled by reflexes. Sucking from the breast or a feeding bottle initiates a wave along the surface of the infant’s tongue leading the milk into the throat while the jaws close. An underpressure builds up and the milk is sucked out. The expression reflex in the mother’s breast helps expel the milk. Sucking, swallowing and breathing must all coordinate in an even rythm for the infant to be able to feed.

The anatomy of the infant’s mouth and throat are adapted for safe and effective sucking. The oral cavity is small and filled up by the tongue so it is easier to create underpressure. The cheeks help to stabilize the jaws. The throat is short and the epiglottis is relatively large so as to minimize the risk of swallowing the wrong way.

The mouth cavity grows in size as the infant grows bigger allowing more space for the tongue to move. The infant is ready to start learning to eat purées at the age of 3- 4 months and learns at the same time to accept different tastes. The food is masticated through vertical jaw and tongue movements and the chewed food is actively transferred to the throat with the help of the tongue and cheek muscles. This function is volitional and must be learned. It can therefore take some time before the infant can eat efficiently.

The lips and the tongue become more mobile as the jaws become more stable. Lateral jaw and tongue movements allow the infant to chew soft foods. A lot of children find it difficult to change from smooth purées to lumpier food. For a period they easily gag and get food stuck in their throats. When the teeth erupt biting and chewing become easier. By the age of one the infant can actively close his or her lips and drink from a glass. An interest awakens in eating independently.

Babbling develops inpace with oromotor development and during the second six months of the first year most infants have started producing syllable babbling and the first words start to come.

THE SECOND YEAR

By now children manage most food consistencies. Meat must be cut in smaller pieces but the child can bite off and chew bits of crispbread and fruit. There is more mobility in the jaw and this allows the food to be ground between the molars which have now erupted. Children become more and more independent at mealtimes and can drink steadily from a glass and eat with a spoon. They can lick round their mouths and many have learned to suck from a straw.

FROM THE AGE OF THREE

Oromotor skills continue to develop throughout childhood but are so well developed by the age of three that most children can chew easily and produce most speech sounds. By the age of four the anatomy of the oral cavity and throat are in the same proportions as in an adult. All small children have difficulties in controlling saliva to varying degrees but any drooling should stop after the age of three.

Rare disorders most often have a genetic cause but can also arise from infections or early foetal damage. At the Swedish Mun-HCenter (a Swedish national orofacial center of expertise) we have been observing and charting rare disorders since 1996. We have studied how frequently oromotor functions are affected and how many children have oral problems such as difficulties with eating, speech or drooling. Of over 2000 children, aged 3-19 (MHC database), around half have no speech or speech that is difficult to understand and a quarter have excessive drooling (clothing gets wet). In short the mouth is affected in every second child with a rare disorder.

Oromotor problems appear above all in congenital syndromes with neurological impairments and in neuromuscular diseases. Feeding difficulties may even be secondary to other medical problems such as breathing difficulties, heart disease and stomach and intestinal problems – symptoms that commonly appear in many different groups of diagnoses. Craniofacial anomalies, which appear in 6% of the children, can cause feeding difficulties and affect speech.

HOW OROMOTOR SKILLS ARE AFFECTED MUSCLE TONE

• Muscle weakness (hypotonia) is common in many syndromes.
  Low muscle tone is normally most evident in infants and often
  improves gradually during childhood but seldom disappears
  altogether. The child’s mouth is open, the jaw in a low position,
  protruding lower lip, drooping corners of the mouth and lack
  of facial expression can be due to low orofacial muscle tone.
  The tongue is often in a low position in the oral cavity and s
  ometimes the tip of the tongue lies over the lower lip.
• High muscle tone (hypertonia) is relatively uncommon among
  rare disorders. The increase in muscle tone can lead to clenched
  jaws, lips fixed in a smile and/or a rigid tongue.

MUSCLE STRENGTH

• With neuromuscular diseases the muscles are weak and tire
  quickly. If the muscles in and around the mouth are affected
  there is a risk of feeding difficulties (poor sucking ability),
  indistinct speech, lack of facial expression and poor saliva control.
  Chewing can often be laborious and mealtimes can be lengthy.
• Muscles can also be weakened following paresis or inactivity.

MOBILITY

• Voluntary control over the muscles in the jaw, lips, tongue
  and soft palate is important for all the functions of the mouth.
  When oromotor skills are well developed these groups of muscles
  should be able to work both independently and in coordination.
• Limited mobility often appears as difficulty in rounding the lips,
  moving the lower jaw sideways, moving the tongue sideways and
  raising the tip of the tongue. Speech demands fast and precise
  movements that must also coordinate with breathing and vocalization. Efficient chewing demands moving the tongue from side to side and rotating movements in the jaw.
• Low mobility can be caused by underdeveloped motor skills,
  paresis, muscle weakness or dyspraxia, a developmental coordination disorder.

SENSITIVITY

• Sensitivity in the mouth is important for both speech and
  feeding development. By sensitivity is meant both the ability
  to sense one’s own body (proprioception) and the sense of touch.
  Impaired sensitivity can affect many important functions.
  The child’s sensitivity can be affected in various ways.
• Indications of oral over-sensitivity (hypersensitivity) can be
  that the child has an extreme reaction to touch in and around
  the mouth. The child does not want to brush his or her teeth,
  puts nothing voluntarily into his or her mouth and gags easily.
  This is often associated with refusal to eat.
• With oral under-sensitivity (hyposensitivity) the child is very
  tolerant of touch – even far back in the oral cavity. The child will
  often cram his or her mouth full of food. Other indications of
  impaired sensitivity are that the child prefers eating very spicy
  food and highly flavoured food that provides greater stimulus.
  Biting on objects and hands or grinding teeth a lot during daytime
  can also indicate a need for a more powerful oral stimulus.
• With both over- and under-sensitivity there is a risk the child
  will have difficulty in developing the sense of touch, that is the
  ability to feel and identify what is in his or her mouth. Even the
  child’s awareness of his or her own mouth is affected and this in
  turn is expected to have significance for motor learning. Children
  with impaired sensitivity can develop a tactile defence behavior
  to avoid touch. Perhaps the child has had unpleasant experiences
  to do with activities involving the mouth or finds it difficult
  to interpret signals via the mouth. This can cause considerable
  problems for dental and oral hygiene and for visits to the dentist.
  It can also affect the child’s eating and the possibility of carrying
  out oromotor training.

SEVERE MALOCCLUSION

• Oral functions can be affected if the child has a congenital
  deformity affecting the oral region or a malocclusion.
  Sometimes the child has well developed oromotor skills that
  can wholly or partly compensate for the structural anomalies.

GENERAL STATE OF HEALTH /MEDICAL CAUSES

• Children who have medical problems in the form of breathing
  difficulties, congenital heart disease or stomach and intestinal
  problems or who are medically frail for other reasons run a higher
  risk of having feeding difficulties with delayed eating development
  as a result.

RELUCTANCE TO EAT

A child may develop a so-called reluctance to eat or reluctance to
try new tastes and textures for many different reasons. There can
be deviations in perception (sensations). The child may also have
had negative experiences of eating, perhaps in connection with a
serious illness as an infant or a congenital anomaly, and therefore
avoids food. Some children who have been fed with a feeding tube
as infants can find it difficult to learn to eat with their mouth. We
don’t really know why some children find eating unpleasant. We do
know from experience that it is important to stimulate the mouth
and the area around the mouth in all children who have been fed
with feeding tubes so as to preempt eating difficulties.

CHEWING DIFFICULTIES

There is a risk that children who do not chew will have weak
chewing (masticatory) muscles. Children with weak muscles don’t
have the strength to chew. If the chewing muscles are so flaccid
and weak that the child cannot keep the jaws closed there is a risk
of deviant skeletal growth in the face resulting in an open bite. An
open bite means a vertical opening between the front teeth when
the child bites. The malocclusion leads in turn to greater difficulties
in biting and chewing.

If the chewing muscles are weak the child can also develop a deviant
muscle pattern where the jaw is held in a low resting position, the
mouth is open and the tongue rests on the lower lip and between
the teeth.

Tongue and cheek muscle mobility is essential for effective
chewing and masticating. When we eat the tongue moves the
food sideways to the molars for chewing. If the child has a poor
chewing ability there is a risk that compensatory behaviour will
develop, for example the child uses the tongue to masticate the
food against the palate instead of chewing or swalllows the food
before it is properly masticated. Chewing difficulties can also lead
to collecting food in the cheeks and delayed swallowing.

Chewing training is important for developing the ability to
masticate food efficiently and safely. Food must be chewed to
assist digestion and for feeling satisfied.

REDUCED SALIVA CONTROL

Children with reduced saliva control don’t usually produce more
saliva than other children. Children with reduced saliva control
usually swallow the saliva less often and less efficiently. The causes
behind saliva leakage can be low core stability and head control,
reduced sensitivity in the oral cavity and reduced oromotor skills.
Enlarged glands behind the nose, enlarged tonsils and malocclusion
can make it difficult to close the lips and can contribute to difficulties
in swallowing. Sometimes medication that causes fatigue may
affect the ability to control saliva. For a lot of children this problem
disappears as they grow older. Drooling is often felt to be a major
problem for both the child and the family and help should be
sought.

The aim of the treatment is to improve the child’s abiltity to control
saliva and reduce drooling. This must usually be combined with
measures to reduce irritation from drooling that persists such as
chapped skin and wet clothes. A multiprofessional team is needed
for treatment.

SUCKING AND BITING

Small children often bite or suck on their hands or on objects.
The mouth is central to sensory experience. The infant explores the
world using his or her mouth and putting things into the mouth to
examine them is a natural developmental stage. The infant’s need
to suck can also be satisfied by sucking on a dummy or a thumb.
Sucking calms and soothes the infant. The mouth is associated
with something positive and the sensory stimulance the child gets
through the mouth can in turn calm and soothe. As the child grows
older the primary sucking need disappears and is replaced by other
functions demanding more motor skills like chewing, biting and
speaking. Many children however continue to have a need to suck
on a dummy or on a thumb and may need help to break this habit.

The habit of biting can be a major problem as it is not seen as
socially acceptable. What is more there is a greater flow of saliva
when there is always something in the mouth and this can increase
drooling problems. Biting can also damage hands and fingers. In the
worst case the teeth can be damaged if for instance the child bites
on hard objects. The child’s bite can also become deformed if this
habit continues throughout long periods of the day.

Children with low muscle tone often have reduced sensitivity
(hyposensibility). The reduced sensitivity leads to a greater need for
sensory information. Biting on hands and objects gives a stong
sensory experience which the child needs and which contributes to
the child’s feeling of well-being. Perhaps the child uses biting as a
way to soothe him/herself when feeling anxious or nervous.

MOTOR SPEECH DISORDERS

Speech is a complex motor acitivity which puts different demands
on neurological control than for instance chewing and swallowing.
A complex integration between cognitive, speech and motor
processes is necessary to produce speech. Speech results from the
movements of lips, tongue, jaw, soft palate, vocal chords and
respitory organs and intelligible speech demands timing and
correct placement of all these structures.

The child’s speech development starts in the womb where the foetus
can distinguish the mother’s voice from other sounds. Babbling
is an important part of speech development. Babbling and motor
skills develop hand in hand during infancy. When the child can
move the lower jaw independently from the upper jaw the sounds
made with the lips together can be produced: /m/, /b/ and /p/.
It is not by chance that the sounds /m/ and /p /are found in the
words for mama and papa in so many languages. When the tongue
can move independently of the jaw, sounds made with the tongue
against the palate such as /d/ and /t/ can develop. The stop or plosive
consonants develop earlier than the fricatives, sibilants, as the
more extended sibilants demand greater control of the airflow. The
sounds demanding that the child can move the lips independently
of each other and independently of the jaw are developed later, such
as /f/ and /v/. The sounds demanding the highest level of fine motor
skills are /r/ and /sh/ and many children have difficulties up to six
years of age. Research shows a clear link between oromotor and
speech development in children at 21 months with typical development.
Syllable babbling by 10 months is seen as an important
milestone. If syllable babbling has not developed by the expected
age there is reason to test hearing and monitor continued speech
and language development.

If a child does not develop intelligible speech it is important that
a thorough evaluation is made and the child’s difficulties mapped.
This evaluation will determine the method of treatment. Sensitivity,
muscle function and motor planning must be assessed besides looking
at speech and language development and hearing.

For a child with speech and language delays it is extremely important
to stimulate and develop communication skills even if
there are difficulties in using speech. If the child has difficulty in
communicating through speech then he or she must be given access
to alternative communication systems. Manual signing as a complement
to speech is one of the most usual and succesful strategies.
Manual signing can be used to help the child understand language
but above all, manual signing can be used by the child him/herself
to express feelings, thoughts and needs when speech does not
suffice. Those interacting with the child must serve as models and
use signs before a child will start using signs spontaneously. It is important
that parents and nursery staff have access to training in the
use of manual signing. Language development can often be boosted
through using manual signing and there is research indicating that
using the hands to sign also stimulates speech development. When
the child has gained more intelligible language he or she will usually
choose speech rather than manual signing.

Using manual signing stimulates speech and language skills!

Pictures and computer programmes with speech synthesis can
also be used to complement manual signing and speech. It is important
that families whose children have delayed speech and language
development are given extensive support from habilitation and
speech-language pathology departments for testing and training
in augmentative and alternative communication (AAC).

A child gains an incredible number of skills during the first year
of life without any directed training. Everyday activities provide
a natural opportunity for repitition and learning. At the same time
some skills like learning to ride a bike or to swim often require
specific training before they are mastered. The child must have
reached a certain level of motor maturity before it is worth even
trying to learn these skills. Each child is different. Some learn to
ride a bike when they are three years old and others when they are
seven years old. Children who do not follow typical development
can need more training and more stimulance to develop skills.

For the infant all everyday activities involving the mouth are part
of oromotor development. The first time a baby tastes gruel or
purées most of it will be pushed out with the tongue but after only
a few tries the child will master a new and more efficient tongue
pattern. For others it can take longer. We don’t offer the child a
new consistency until he or she has reached a certain level of motor
maturity. To learn new motor patterns the child must however be
presented with new situations. If we never offer consistencies that
need chewing then the child won’t learn to chew.

USING THE PRINCIPLES OF MOTOR LEARNING

For motor stimulance and training to have a general effect on functions
such as chewing and controlling saliva, the movement pattern
must become automatic. For a movement sequence to become automatic
it must be repeated many times in different situations. Using
a lot of positive reinforcement and providing the right kind of
feedback can help learning and generalization. Research has shown
that positive reinforcement and providing a model for the child
showing the correct movements are both important components
if behaviour is to be changed. There are several treatment concepts
where imitation is an important feature based on what we know
today about how mirror neurons in the brain are activated when we
see a movement demonstrated.

Treatment concepts based on principles for motor learning have
shown success in research studies inolving children with speech
motor planning difficulties (verbal dyspraxia). Using principles for
motor learning makes it easer to transfer the training situation to
a skill that can be used spontaneously in other contexts.

Some factors that make motor learning easier:

• The child’s motivation
• Frequency and intenstity of training
• How and when the child is given feedback during training.
  At the start feedback should be frequent and direct and later
  can be less frequent and at longer and longer intervals
• Using a slow pace

What can I do to stimulate my child’s speech development?

• Introduce signs as early as possible
• Direct the child’s attention towards your mouth when you are
  playing with sounds or “practising” words. Giving the child a
  correct model is important. Imitation is an important factor for
  learning. Sit opposite and close to each other. Speak slowly and
  clearly with distinct lip movements
• Give the child positive reinforcement when he or she produces the
  right sound or pronounces a word correctly. Make sure the child is
  aware of what it was that was correct. For example: “That was a
  really good sound you made with your lips together, /m/- /mamma/.”
• Help the child to find the correct position for speech sounds with the help of your hands and fingers. The sounds made with the lips are the easiest to guide to. For example hold the child’s lips together for the sound /m/ by placing your index finger and middle finger on the lips

SITTING POSITION

For succesful eating and training the sitting position is crucial.
A good core stability is necessary for a good mouth function.
The child should sit with support for the feet and with a 90 degree
angle at the hips, knees and ankles. Both when feeding the child
and when training it is important to sit in front of the child, face
to face, so that if needed you can help the child to return to a good
stable sitting position. You can also easily show the child how to
make the movements. It can sometimes be a good idea to let the
child sit on anti-slip material to stop the child’s hips slipping forward.

If the child has motor skills disorders it is important to get help
from a physiotherapist and an occupational therapist who can help
find a sitting position that works for the child.

STIMULATING SENSITIVITY

It is important to offering the child positive experiences with his
or her mouth and thereby stimulate the child’s sensitivity to touch.
This can be started very early on and need not be perceived as
demanding or hard, neither for the child nor the parents. It can be
massaging the body regularly and finishing by massaging the face
and in and around the mouth. If you accustom the child to touch
at an early age and make this a positive and daily activity, the child
will hopefully develop a stronger body perception and sensitivity to
touch. Ordinary mouth toys made for infants stimulate sensitivity
and provide experiences and sensations important for the child’s
development. It is also important to stimulate the child’s sense of
smell and taste at an early age. Many children appreciate food that
has a little stronger flavour like cinnamon on porridge.

If the child accepts being touched on the face and is positive to
tooth brushing it can be a good idea to use a toothbrush to stimulate
sensitivity in the mouth by brushing the lips, tongue and the
inside of the cheeks as well. Stimulation with vibration can be
introduced at an early stage. Vibrations from for instance an electric
toothbrush or a Z-Vibe activate the muscles and develop sensitivity.

EATING

If the child accepts food in different consistencies then different
ways of presenting food and varying how the food can be eaten
can offer lots of opportunities for training. There is a lot you can
do even for children who are more selective in their eating. The
important thing is to remember what you want to achieve through
your strategies. By thinking about how we position the spoon and
the food we can encourage lip closure, lip mobility, using muscles
for chewing and tongue mobility. If the child has weak lips and does
not use the lip muscles actively you can think about how the spoon
can be placed so as to make the child use the lips more actively.
A spoon placed with the bowl of the spoon from the side can
encourage closing the lips. A relatively small spoon placed straight
in front can encourage rounding the lips. Changing the amount
and shape of the food and placing it on the molars can encourage
chewing and develop chewing ability. It can be difficult for children
with low tongue mobility to move the food themselves to the
molars to chew it. There is a risk that the child will instead develop
a negative tongue movement pattern where the tongue moves too
far forward so as to stop the food getting stuck in the throat. You
can teach the child to put the food on the molars him/herself. If
the child is an infant and you anticipate difficulties with chewing
and masticating you can start chewing practise early on (at around
five months) by letting the child chew on a finger, or on a z-Vibe
brush or bite-n-chew tip. By applying pressure, massaging or using
some type of gently vibrating device you can help the child find a
chewing motion.

DRINKING

A more favorable movement pattern can also be encouraged for
drinking. It is important as far as possible to avoid using sippy cups
or feeding bottles as the child grows older. To maintain a sucking
behaviour when the child no longer needs to suck for nourishment
will encourage tongue protusion and the lips will be inactive.
Teaching the child to use the lips actively when drinking with the
tongue inside the mouth can be very beneficial. The early introduction
of straws can also be a good way to use drinking as oromotor
training. Drinking from a straw in the right way trains both jaw
stability and lip rounding as well as stability in the back of the
tongue. It is however important to differentiate between drinking
from a straw so as to train and drinking from a straw so as to drink
liquids. If it is difficult for the child to drink from a straw you can
start by using a soft feeding bottle with a silicone tube and help by
pushing the liquid up and successively teach the child to coordinate
the movements. If drinking from a straw is to give the desired effect
on oromotor skills the following must be kept in mind:

• The jaw should be stable and still. You might need to support
  the child’s jaw with your hand
• The lips should be lightly rounded and not tense. The hand
  supporting the jaw can also be used to help push the lips and
  cheeks forward to make it easier to round the lips
• Only a small part of the straw, a few millimetres, should be
  between the lips. The child should not use the tongue to suck

ORAL HABITS

If the child’s need to put objects or fingers in his or her mouth
becomes a problem, strategies to reduce this behaviour may be
needed. Our first impulse is often to say to the child to stop or to
try to prevent the child from biting. But if we remember that biting
fills an important function for the child then these strategies will
not be succesful. We must instead offer other alternatives such as
encouraging the child to chew something made for chewing, for
instance a Chewy tube, a Grabber or a mouth toy. Stimulating the
child over the jaw with a vibration device to provide more sensory
stimulus can be another way of trying to break a biting habit. It
can also be a good idea to consider giving the child food that needs
longer chewing, naturally under supervision, and to teach the child
to chew more efficiently

WHAT DO WE MEAN BY OROMOTOR TRAINING?

Oromotor training involves exercises using the muscles in the
mouth: the jaw, the lips and the tongue. The soft palate and breathing
muscles can be included. Training is aimed at improving muscle
sensitivity and mobility. Sometimes we use the term sensory motor
training to emphasize that this training includes both muscle sensitivity
(sensory) and mobility (motor). Training can for example
be aimed at strengthening the chewing muscles to make chewing
and eating easier or at increasing strength and endurance in the lips
so to make lip closure easier. As in all training it is important that
this training has a defined goal and purpose. It is also important
to remember that there is a difference between improving how
something works (for instance increasing strength) and training the
function directly (for instance repeating speech sounds that demand
closed lips). These are different steps on the training ladder and the
aim with all training is of course to improve the actual function.
There is no direct transfer between muscle training and the ability
to produce different speech sounds.

DIFFERENT TREATMENT METHODS

Over the years many different methods of treatment have been used
and various professions have contributed to their further development.
Early in the growth of the field of speech-language pathology
around the middle of the twentieth century tools and exercises were
used to guide the muscles into the correct position for the articulation
of different speech sounds. What many of these methods
have in common is that they emphasize the importance of the
interplay between sensation and motor function. Among the best
known are Rodolfo Castillo Morales Orofacial Regulation Therapy
and Sara Rosenfeld Johnson OPT-Oral Placement Therapy. It is important
to point out that there is no one method that suits everyone
and that each therapist needs a “toolbox” with knowledge of many
methods of treatment.

EVIDENCE-BASED MEDICINE

It is of the utmost importance that treatment offered to children
with orofacial dysfunctions is based on research and clinically tested
experience. There is not yet sufficient research into the effects of
oromotor treatment as very few studies have been made. There are
a number of difficulties connected with research into oromotor
training. It is difficult to measure children’s capabilities and there
are considerable differences among children with orofacial dysfunctions
which makes it difficult to find large comparative groups.
For preemptive training for developing children it is also more or
less impossible to evaluate how their functioning would have been
if they had not undergone training. In spite of the lack of research
there are many examples of clinical experience and case studies
where training and stimulance appear to have helped the children
improve their capabilities. It is important that the treatment
methods used are based on an established and accepted theoretical
background. Example of established theoretical concepts are
theories about neuroplasticity and theories about motor learning.
It is also important that the professional caregiver who recommends
the training documents and follows up the training at regular
intervals so as to check that the child is developing his or her
capabilities and that the functions are improving. Adjustments
must be made to the treatment recommendations if the child does
not respond to the training after a few months of regular training.

WHAT IS IMPORTANT TO THINK ABOUT WITH OROMOTOR TRAINING?

Assessment and mapping of the child’s needs by a speech–language
pathologist or other professional with good knowledge of orofacial
functions should be the basis for any training. There should always
be a defined goal with the training. What is to be trained and why
must be established. If you don’t know what an exercise is intended
to achieve then it shouldn’t be used! When training correct positionings
for speech sounds these must later be transferred to speech
and language. There is no automatic transfer. As with all muscular
training this must be done regularly, at home or at school, at least
three times a week. The training must be continuously followed up
and documented by the caregiver who has recommended it.

WHERE CAN I GET HELP?

Orofacial dysfunctions usually demand multi-professional care.
There is no one profession that can take total care of saliva control
or eating difficulties for example. It can be of immense importance
for succesful treatment that doctors, physiotherapists, occupational
therapists, dieticians, speech-language pathologists and dentists
cooperate. Start by contacting a speech-language pathologist, a
dentist or an ear, nose and throat specialist in your area. If the child
is being cared for by a habilitation team there is every likelihood of
multiprofessional care.

Everyday Oral Motor Stimulation
For Children with Orofacial Dysfunction

Authors: Åsa Mogren, speech-language pathologist and Lotta Sjögren,
speech-language pathologist, Mun-H-Center, Public Dental Service,
Region Västra Götaland, Sweden

Text revision: Lisa Bengtsson, speech-language pathologist, Mun-H-Center

Illustrations: Anders Nyberg

Layout and design: www.logiken.se

Year of publication: 2014

Year of printing: 2023

ISBN: 978-91-988693-7-8

With thanks to the Märtha and Gustaf Ågren Trust for contributing financial support to this publication.

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