Hey Sara,

 

Recently you had a parent open question meeting in Corpus Christi, TX. I was there with my 8 month old baby. You were talking to a woman who's 5ish son with Down syndrome was repeatedly hitting his chin and you mentioned he was satisfying a feeling that was in his jaw by that action. I have noticed my baby has started doing that with her left hand. What do you recommend to help correct/redirect this behavior now?

 

-L

Hi L,

The sight of stability and calming for an infant is in the temporomandibular joint. This joint is where the upper and lower jaw meet right below the ear. There are more nerve endings going through that joint than any other location in the human body. When a baby sucks his/her thumb, sucks from a bottle, sucks on a pacifier, etc. the nerves in that joint are stimulated and the baby calms or even falls a sleep. If your child is doing other behaviors to stimulate the jaw like hitting the chin or for older children it may be teeth grinding, then it is probably time to introduce the Bite-Tube Hierarchy. You can learn more about this and other activities to increase jaw skills for both feeding and speech clarity in my book, "Assessment and Treatment of the Jaw: Putting it all together, Sensory Feeding and Speech."

If you do decide to purchase that book please read the chapter on Sensory first as it will explain to you in more detail the reason why babies and children with muscle-based deficits develop "habits" to compensate for the jaw weaknesses. I would also encourage you to share this information with your SLP as she may have additional suggestions.

I hope this has answered your question.

Sara Rosenfeld-Johnson, MS, CCC-SLP

Hello, My patient was evaluated by you in June of 2014.  We are currently using the red chewy tube and yellow chewy tube in therapy and at home to improve jaw strength and stability. However, the patient is now seeking ‘input’ orally- especially with chewing, now more than ever before.  How can we support this sensory need without promoting undesirable skills like jaw sliding?  Is there something else she can chew on- unsupervised? Thank you!

The situation you describe is one I see with many of my clients.  Once the clients "feel" jaw mobility using the "Bite Tube Hierarchy" and are thereby receiving the needed temporo-mandibular joint stimulation for calming they often increase their need or desire to mobilize the jaw (seeking oral input).  The Bite Tube Hierarchy will eventually incorporate four tubes as described in the book, "Oral Placement Therapy for Speech Clarity and Feeding."  The goal of the tools is to give the needed stimulation to increase jaw stability so that the client will then transition that skill into feeding and speech thereby eliminating the need for the tool and the need to chew on non-food items.  For this reason I do ask therapists to not give these tubes to the kids as then they may use them with an inappropriate jaw slide or jut.

With that said, however, you do ask an important question, " Is there something else she can chew on - unsupervised?"  Since I do not know the name of your client I cannot refer to the Program Plan I wrote for her/him I can only list for you the additional options: Slow Feed for snacks, Gum Chewing (without swallowing the gum) and Jaw Grading Bite Blocks. Each of these therapy techniques is taught in that same book, "Oral Placement Therapy for Speech Clarity and Feeding."  In addition, they are taught in the class, "A Three part Treatment Plan for Oral Placement Therapy" which will give you the gestalt of why and how to work on muscle-based speech clarity deficits.

Our goal for anyone with jaw weakness and instability is to increase the skill so that the jaw can support the independent movement of the lips and tongue for speech clarity and feeding safety so that is why I am focusing on the therapy suggestions above.

However, I still have not answered your question.  There are many sensory tools sold by TalkTools and other companies that allow the child to hold the tool without supervision as they are not working on jaw grading but are instead focusing on sensory feedback.  They include the Star Vibrator, Chewy Tubes, and ARK products.  As long as you are not using the tools used in the "Bite Tube Hierarchy" your client can hold and chew on any of the other options.

Sara Rosenfeld-Johnson, MS, CCC-SLP

Hi Sara,

 

It has been awhile since we have seen you in Richmond! James is doing well. His speech seems pretty normal to us at this point (maybe some subtle things remaining). I was emailing with a related question, and hoping that you can point us in the right direction.

 

James has had some issues in the past with "mouthing" things (for lack of a better word). This seems to wax and wane, but in the last few months, it seems to be significantly worse. He will either have his hands/fingers/thumb in his mouth, or water bottle, pencil, swim cap and goggles, etc depending on the situation. It seems to be something that he does unconsciously, despite our attempts to call his attention to it, even trying "penalties" for having his hands in his mouth. Lately, I have noticed him doing even while talking to his friends, while playing soccer (when there isn't any action near him), etc. He is 11, so it is an increasingly odd behavior than it might have been at age 2. (We haven't noticed any other odd behaviors or habits, just this one...and otherwise he does well in school, socially and in sports).

 

We aren't sure what the next right step is to help him be able to stop this habit. Deterrents don't seem to work, other than to stop it while it is happening, and I wonder what the root cause of it actually is. I am not sure that a regular speech therapist would be there right person. Do you have any thoughts on how to help him?

The situation you describe is often seen with individuals who have innate muscle weakness. The habits seem to come and go and can take many forms as you mentioned above. Last time I saw him (May 27, 2012) I recommended a gum chewing program. I use gum chewing as outlined in the book Assessment and Treatment of the Jaw for both improving muscle skills in the muscles of the jaw and as an alternative to the "habits" you describe. There are more nerves going through the Temporo-mandibular joint (TMJ) than any other place in the human body. It is where we go for calming. Babies suck their thumbs, bite on their fingers, rely on a pacifier, etc, to give stimulation to that joint.

James may also need to give stimulation to that joint for calming and that is where gum chewing comes into play. If he does not know how to chew gum without swallowing the gum you will have to teach him this motor plan by going to that activity in the book Oral Placement Therapy for Speech Clarity and Feeding. In it you will be given a step-by-step program which I have used with children as young as 2 years of age.

Once​ ​ he can chew independently​ use the gum chewing as an alternative to the "mouthing." I hope this answers your question. Please tell him I said "hello."

Sara Rosenfeld-Johnson, MS, CCC-SLP

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

Hi,

 

My 7 year old son with Down Syndrome used to grind his teeth and had grown out of it (we thought). He recently had surgery and the grinding has returned with ferocity. It’s only during the day and is worse than before. His teeth have been ground down to next to nothing. I’m at a loss as to what to do and try, but I would really like to nip this in the bud before his permanent teeth come in – he as 2 bottom ones so far.

 

Do you have any suggestions of strategies I could try?

Hi,

It is not uncommon for children with jaw weakness or jaw instability to teeth grind, stop and then renew the habit when they are under stress.  Surgery can certainly be considered a stressful situation.  As I had mentioned above and reiterate in my book, Assessment and Treatment of the Jaw: Sensory, Feeding and Speech, the TMJ (temporomandibular joint) is the site of organization within the human body.  What your son is telling you, without using the words, is that he wants stimulation in that joint to calm himself down (to satisfy a need).  Once teeth grinding begins and the dentition becomes uneven the habit may continue after the stress has left.  The grinding continues to even out the biting surface of the teeth for chewing or may continue just because the child learns the grinding "feels good."  In either case, we know the grinding is detrimental to your son's teeth and we need to find a way to help him to stop doing it.

You asked for specific suggestions and here is what I would like you to do.  Since your son has the diagnosis of Down syndrome it is likely that he also has jaw weakness.  The activities taught in the book Assessment and Treatment of the Jaw: Sensory, Feeding and Speech are used as an alternative to the teeth grinding while addressing the root cause.  The activities will improve jaw symmetry, stability and grading.  Each of these jaw goals will also improve his feeding skills and his speech clarity.  If possible I would ask you to find a Speech-Language Pathologist in your area who has been trained in the TalkTools approach to muscle-based feeding and speech deficits.  She or he would be able to direct you through the two primary activities: "Jaw Grading Bite Blocks" and the "Bite Tube Hierarchy."  Used together these should reduce and hopefully eliminate the teeth grinding.  Additional activities in the book include: teaching him to chew gum without swallowing the gum, chewing on his back molars and a variety of other activities to address the identified jaw muscle needs.  

As in all cases it is best to read the entire book first to identify your son's specific needs and then to choose the activities that he enjoys.  An ideal time to practice each activity would be when he is teeth grinding.  In this way you will give him an alternative that will help him while acknowledging the fact that he needs stimulation to the TMJ. 

I hope this helps.

Sara Rosenfeld-Johnson, MS, CCC-SLP