Tagged "Frenum"

Ask A Therapist: Feeding Therapy for a Medically Fragile Client

Posted by Deborah Grauzam on

Hello Talktools,


First of all, I cannot tell you how much I enjoyed Lori Overland's conference on Feeding Therapy: A Sensory Motor Approach in Savannah! I learned so much and have been able to apply the new (to me) strategies with many of my clients.


I have a question for Lori about a challenging client. My overall question is: how long after a frenectomy can we begin working on oral-motor therapy?


The client is medically fragile. He has 1/3 of his brain (brain stem, parts of occipital, visual cortex is present). He also suffers from CP and diabetes insipidus among other things. He is adopted, and his parents are EXTREMELY dedicated.


He is surprising us all with what he is able to do so far. He will be one year old in a couple of weeks, but he presents like a 3-4 month old right now.


He is able to consume liquids with a bottle, but his tongue tie is preventing him from being able to efficiently nurse, and he is gagging on pureed solids. His tongue tie is being corrected by an ENT surgeon this week. However, his mother is concerned because the doctor indicated the "easiest" thing to do would be to put in a peg tube.


While this baby is medically fragile, he is making progress in all developmental domains. His mother is realistic about him potentially needing a tube, but wants to make sure he truly has the opportunities to reach his maximum potential.


Any suggestions or insights would be welcome! He is very complex, and I know that without your class, I may not have been as prepared for him!


Thank YOU!




Hi Amy,

Thank you for taking the time to tell me how much you enjoyed the course!

You should be able to begin working on oral-motor therapy with your client within a few days after his frenectomy, but I usually do a two week follow-up, so I can see what the spontaneous results of the surgery will be vs. the impact of the therapy.

It is EXCELLENT to hear that he is surprising you with his abilities and how dedicated his mother is. Reach for the stars, it is nice to be surprised!

In regards to the tongue tie, releasing the tongue will not be a miracle for this little guy, but it will allow you to work on the oral sensory motor skills he needs for feeding. Even if at some point he does need a tube for adequate nutrition, it would be nice for him to do some safe recreational feeding. So...a week to two post-op, start to work on the lateral borders of the tongue, tongue blade stability, and tongue retraction.

I AGREE completely with making sure he has the opportunity to reach his maximum potential!

Good luck and feel free to check in with me if I can help!

Lori Overland, MS, CCC-SLP, C/NDT

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Ask a Therapist: Tongue Thrust

Posted by Deborah Grauzam on

I have been working with a 2, almost 3, year old patient for 10 months. He initially came to me with delayed speech -- one-syllable words with limited vocabulary and reduced intelligibility. He now uses 5-6 word sentences spontaneously, intelligibility has increased, he has added new speech sounds and errors are primarily /th/ and blends. We did a lot of oral strengthening as he was a drooler and that has improved. He had a very restricted lingual frenum, corrected in December. He also has an inferiorly attached upper labial frenum, which limits some range of motion in upper lip movement. My concern:   he continues to exhibit a suckle drinking pattern. We have introduced the straw program, but I can’t get past the first one because of the suckle. Is he too young? Should that improve with the increased range of motion now that he's had the lingual frenectomy? He is at a good point with language and articulation, so I was wondering if there is something I can do to make a difference?

Tongue thrusting should be fully remediated by 24 to 36 months, so suckling at this age is atypical. I would refer the patient to an oral surgeon or ENT to seek medical advice on the frenums. It sounds to me like there may be a structural issue.

Sara Rosenfeld-Johnson wrote an article titled, “Effective Exercises for a Short Frenum,” on how to stretch the frenum (sublingual) with the use of bite blocks which I would recommend you read. See if you can get the client to touch the upper back molar with the tongue tip. If not, you can try Sara's exercises. I do this often to prove that therapy alone may not work. Sometimes you can stretch it, but it depends on length, color and location.

Robyn Merkel-Walsh

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