APPENDIX 9: Organic Red Flags – Oral Sensorimotor Patterns

Table 25: Red Flags/Facilitating Typical Oral Sensorimotor Patterns

Red Flag

Intervention

Poor jaw stability or low tone

  • provide supportive positioning with hip flexion and midline flexion
  • provide firm, constant external facilitation or support of the jaw and cheek with fingers or hand while mouthing and feeding

Excessive jaw movement

  • provide supportive positioning with hip flexion and midline flexion
  • provide external facilitation or support of the jaw and cheek to reduce or limit jaw movement with fingers or hand while mouthing and feeding

Poor lip seal/poor cheek stability

  • provide supportive postural positioning.
  • encourage lip closure by providing facilitative support of lower lip, cheek or jaw with thumb and index finger.

Tongue retraction

  • provide supportive postural positioning with midline flexion of shoulders or try a well-supported side lying position with head elevation
  • stimulate the rooting reflex prior to all mouthing or feeding activities
  • once rooting reflex elicited practice non-nutritive sucking on finger gradually moving the contact deeper along the palate
  • work finger onto the top of the tongue
  • try jiggling, tapping or stroking the tongue to encourage forward and down placement of the tongue. Do not exceed the infant’s threshold

Tongue thrust/protrusion

  • provide supportive postural support
  • apply firm tapping or touch pressure to the midline of the tongue – start at the tip of the tongue and move to the midline
  • if spoon feeding, use a firm plastic spoon, apply downward pressure on the mid-tongue as the food is tipped off the spoon
  • encourage lip closure by providing facilitative support of lower lip, cheek or jaw with thumb and index finger
  • minimize feeding equipment that may exacerbate tongue thrusting patterns (e.g. nipples and spouts)

Lack of central grooving in tongue

  • stimulate the rooting reflex prior to all mouthing or feeding activities
  • once rooting reflex elicited, practice non-nutritive sucking (NNS) on finger, gradually moving the contact deeper along the palate
  • when NNS cycle complete, bend the finger so that the knuckle places pressure on the tongue
  • slowly rotate finger so that the pad is now on top of the tongue, apply gentle downward pressure, slowly removing finger from mouth

Nasopharyngeal regurgitation

  • this is indicative of palatal dysfunction and should be further investigated by a speech-language pathologist, plastic surgeon or Ear, Nose, & Throat (ENT) specialist.

(NSW Office of Kids and Families, 2016