Ask a Therapist: Bite Tube Hierarchy for TMJ stimulation

Posted by Deborah Grauzam on

Dear TalkTools,

 

My son, David, is 4 years old and has Down Syndrome. He has in the last year started chewing on his tongue. I have tried giving him the P & Q to chew on and also the Gator Jiggler. The Gator works for a time and the P's and Q's do not seem to help at all. I looked on your website for potential ideas to no avail and was wondering if you have additional thoughts/ideas. We are a very oral family -- I chew on my pens (usually when I'm thinking), my two oldest daughters were thumb suckers until older, my 2nd daughter bites her nails, my 3rd daughter chews on her shoelaces...thanks for any ideas that you may have!!

 

Robyn

 

P.S. Sara has seen David informally the last two years at NDSC.

Hi Robyn,

I am so pleased you decided to email TalkTools with this question. I must say this tongue chewing is often seen in kids with the diagnosis of Down syndrome as well as with other children with low tone and associated muscle weakness. In my second book, Assessment and Treatment of the Jaw - Putting it all together: Sensory, Feeding and Speech, I devote an entire chapter as to why children with jaw weakness find these habits: tongue sucking is only one of them. Other kids choose teeth grinding, finger sucking, sucking on clothing, biting themselves or other, prolonged use of pacifiers or sippy cups and nail biting. What all of these "habits" have in common is the need for stimulation to the temporomandibular joint for calming. This is the joint where the bones of the upper jaw and the bones of the lower jaw meet right below the ears. This joint has more nerve endings than any other place in the human body. It is where we go to relax. In your email you mentioned you bite on a pen and your daughters bite on shoe laces or nails. The up-and-down movement of the jaw relaxes us and helps us to organize our bodies.

Because your son needs stimulation directly to the joint the two techniques you listed: P&Q and Jiggler vibrator are not giving him the correct input. The muscles that need to be activated are the masseter muscles and the tools you are using are not reaching those muscles.

We, at TalkTools, have developed many techniques to give this necessary TMJ stimulation. One which seems very appropriate for your son would be the Bite Tube Hierarchy, in which four tubes are used to not only satisfy the need for TMJ stimulation but also are used to improve speech clarity and chewing skill levels. The instructions for how to implement the technique is included with the therapy tools. There are many more options to substitute for the tongue sucking and these can be found in the book I mentioned above.

I hope this answers your question,

Sara Rosenfeld-Johnson, MS, CCC-SLP

Ask a Therapist Chewy Hierarchy Chewy Tubes Down syndrome Feeding Feeding therapy low muscle tone low tone muscle weakness oral habits Oral Motor Therapy Oral Placement Oral Placement Therapy Oral-Motor talk tools TalkTools temporomandibular joint TMJ TMJ stimulation

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