Oral-motor stimulation
The following text is a review of the literature on exercises that aim to encourage a baby to use the muscles around their lips, tongue and jaw. This text is for educational purposes only and these exercises should ONLY be carried out under the supervision of an appropriate healthcare practitioner. Before following ANY advice on the management of a particular condition you should first consult an appropriate healthcare professional to avoid risk of injury or health complications. Whilst every effort has been made to make this advice safe and clearly explained, it is impossible for this type of generic advice to be complete, safe and effective in every individual case.
Oral motor exercises aim to improve the strength, control and coordination of the oral muscles (including those of the lips, tongue and jaw). This can help in activities, such as feeding, that requires the baby to use the muscles in their neck, jaw, tongue and throat to synchronise rhythmic patterns of sucking, swallowing and breathing. Repeatedly practising these exercises aims to enable the baby to become ‘unstuck’ in their faulty habits and progress by learning how to optimally use their oral muscles to help coordinate these activities.
The following exercises should be performed gently, slowly and non-forcibly. The exercises that require the finger to be inserted into the baby’s mouth (exercises 1b and 6 to 8) are ALL performed using a SINGLE finger either around the gums, cheeks or the FRONT of the mouth. You should NEVER use more than one finger and the finger should NEVER be inserted deep into the back of the baby’s mouth or near their throat. At NO time should the baby experience any distress, and if they do, you should cease performing the exercise you are carrying out.
Before performing these exercises ensure your hands have been sterilised with soap and water and try them out on yourself first. Carrying out these exercises on yourself before you do them on a baby makes you aware of the sensations the baby will be experiencing and helps ensure that you are comfortable and confident with performing them.
Exercise one: cheek massage
Figure 1a: gently massage the baby’s cheeks in a clockwise (as illustrated above) and then anticlockwise direction.
Figure 1b the cheek muscles can also be gently massaged from inside of the baby’s mouth using just ONE single finger (your index finger). Run your index finger in front (NOT behind) of the baby’s teeth and gums so the tip of your finger rests on the inside of the baby’s cheek (as illustrated above). Unlike the last movement (Figure 1a) you don’t have to move your finger in a clockwise or anticlockwise direction. Just gently sweep your finger across the inside of the baby’s cheek WITHOUT running your finger into the back of their mouth or near their throat.
Only ONE sweeping movement along the inside of the baby’s cheek should be performed before removing your finger from their mouth. Once your finger has been removed from their mouth the movement can be repeated. This should be a light, gentle, comfortable manoeuvre, however, if the baby shows ANY signs of distress remove your finger from their mouth.
Exercise two: ear to mouth massage
Figure 2: gently massage from the baby’s ears to the corner of their mouth.
Exercise three: top lip massage
Figure 3: gently massage from the base of the baby’s nose to their upper lip.
Exercise four: bottom lip massage
Figure 4: gently massage from the baby’s chin to their lower lip.
Exercise five: resisted jaw opening
Figure 5: place your index finger gently under the baby’s chin. Do NOT have your hand near their throat. Try and encourage the baby to open their jaw, by, for example, mimicking yourself opening your mouth or teasing them with a dummy. Your finger should NOT be stopping their mouth from opening but just be GENTLY resting under their chin as they open their mouth.
Exercise six: gentle massage of the hard palate
Figure 6a: this is a view from the inside of the mouth. The hard palate (green arrow) is just behind the top teeth. It forms the front part of the roof of the mouth.
Figure 6b: place your index finger just behind the baby’s top teeth (refer ’Figure 5a’) and gently massage the roof of their mouth in this area. NOTE: DO NOT place your finger right at the back of the baby’s mouth OR near their throat. This should be a light, gentle, comfortable manoeuvre, however, if the baby shows ANY signs of distress remove your finger from their mouth.
Exercise seven: gum massage
Figure 7: gently massage around the baby’s gums with your index finger. If the baby shows ANY signs of distress then remove your finger from their mouth.
Exercise eight: massage the FRONT of the baby’s tongue
Figure 8: gently massage the FRONT of the baby’s tongue using JUST your little finger. Try and massage both the sides and the centre of the tongue. DO NOT stick your finger down the back of the tongue OR near the baby’s throat. If the baby shows ANY signs of distress remove your finger from their mouth.
References
Chandran R, Alagesan J. Oro-Motor Intervention Protocol to Improve Sucking Behavior among Neonates with Immature Sucking: An Experimental Protocol. Int J Surg Protoc. 2021 Jul 23;25(1):129-134. doi: 10.29337/ijsp.152. PMID: 34327289; PMCID: PMC8300586. (Accessed May 25th 2023).
Manno CJ, Fox C, Eicher P, Kerwin M.Early Oral-Motor Interventions for Pediatric Feeding Problems: What, When and How. JEIBI. 2005 VOLUME 2, ISSUE NO. 3, Fall.