Tagged "talk tools"

Ask a Therapist: TMJ Sensory Feedback for Calming

Posted by Deborah Grauzam on

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?



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

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Ask a Therapist: Strong Gag Reflex

Posted by Deborah Grauzam on



I am speech pathologist from Finland, took your class about Feeding Therapy: a sensory-motor approach at Helsinki last May. I am sending you an e-mail, because I met a new client shortly after the class and this case really bothers me. I have asked permission from parents, to send this e-mail and pictures/short video when he's eating. So, this boy is 5 years old, he has had feeding issues since he was baby. Nowadays he eats almost anything but no meat. It seems like he doesn't have enough strength at his muscles to bite. When he eats, he puts lots of food into his mouth, only couple of bites and then he swallows. Looks like he's gagging when eating. He uses only couple of words, can't elevate his tongue without gagging. And when pronouncing for example sound /a/, he gags and tongue goes into "cup." He can't reach his upper alveoli with his tongue. The situation is horrible, I have only met him couple of times and it seems like the posterior tongue-tip would be one problem, maybe also tissue around it. I am writing a paper about him because he's going to see a doctor in September. But if it's possible, I would like to get another opinion - yours :-) Thank you so much, if you have time to answer me.




Mrs. R

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Hello R,

You are absolutely correct. It looks like he has a type III posterior tongue tie. He probably cannot contract the lateral borders of his tongue. Chewing meat requires much more than just jaw strength, it requires being able to use the lateral borders of the tongue and cheeks together to stabilize the food. That is probably the problem when he is chewing meat. He cannot collect the bolus, and cannot stabilize the bolus on the molar ridge for mastication. He needs to be referred to an otolaryngologist (ENT) or an oral surgeon who understands the correlation between structure and function. Once his frenulum is released you may need to do the lingual exercises for function, BUT you will be able to facilitate the movements he needs for handling more difficult textures. GOOD OBSERVATION!!!!!!

Lori Overland, MS, CCC-SLP, C/NDT

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Ask a Therapist: A Therapeutic Alternative to Mouthing Habits

Posted by Deborah Grauzam on

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

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Ask a Therapist: Biting and Feeding Improvement

Posted by Deborah Grauzam on

Hi and Good Morning!


I am writing from Israel, I have participated in your course that you have presented in November in Jerusalem. Thank Goodness I have been using many of your techniques to assist my clients and I have seen success.


Sara, I have an important question to ask regarding an adorable child, Charlie. I will describe Charlie and my results of oral-motor exam administered as best as possible so that you may answer us accordingly! Thank you for your time!


I have been seeing Charlie since mid February. Charlie is 3.5 years old. He is developmentally and cognitively delayed (has seizures). According to exam he is both hyper-hypo sensitive, he enjoyed the toothette (with orange juice) in his mouth- at home he constantly requests for the pink, fluffy toothette. He allowed me to go around his mouth and in the mouth after a lot of work. (The second session he only let the toothettes). Charlie's jaw, tongue and lips are weak, and there is not enough dissociation between jaw, lips and tongue. Little grading of jaw, needs jaw assistance to drink from straw #1.


Tongue thrust while drinking. Lip closure, protrusion, rounding is poor. Speech is limited to single syllable words (deletes sounds), or short phrases-he is not so clear. He is being treated by PROMPT therapist since he is 2 years old. I have given them a structured program including many tools you have taught (ice stickchewy tube, etc.). They have been practicing and carrying out exercises every day...he is starting to feel his mouth, they have seen a lot of drooling, sticking hands in mouth constantly and even so more, a lot of biting (siblings, friends). Parents are very concerned, they understand that the exercises will help him feel and strengthen lips, jaw and tongue, better speech and feeding. But, now there is excessive biting and touching of the mouth!


Sara, is this a normal occurrence?

Yes I do see this response when a child first identifies the positive sensory feedback from increased jaw movements. It is actually a positive sign but I can see why the family is concerned. I will make the following suggestions:

1. Make sure they are doing the Bite-Tube Hierarchy set with as many of the 4 tubes he can use, 10 times each day and to do them as soon as he makes the move to bite someone or touching his mouth.

2. Add the Bite Block exercise and the gum chewing exercise.

If you do all of these exercises, everyday, he will not need to bite. I hope this answers your question.

Sara Rosenfeld-Johnson, MS, CCC-SLP

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Ask a Therapist: Pre-feeding Suggestion

Posted by Deborah Grauzam on



I was interested in a couple of your products and what would be suitable for both of my daughters.


Anne is 5 and a half and has Autism. She has been doing a Son-Rise program for over a year. We have seen some great progress with her responsiveness and social skills, but the speech still seems a little stuck. We did speech therapy for over a year and saw no change, so I feel like it is a dyspraxia. She does have some words from time to time, she seems to be trying to push out some speech also but her mouth just doesn't seem to be able to do it.


Erin does not close her mouth much, when she eats off a spoon, she closes her teeth over the spoon not her lips.


We have been using a curly straw and trying to encourage her to blow by practicing in front of her, etc. She breathes through her nose easily when we close her mouth, so we have been advised to try taping her mouth (lightly!!) at night for a period to help her get used to breathing through her nose.

This sounds to me that some pre-feeding steps need to be taken, and that the horns and straws being used are too advanced for her current skill set. For example, we do not introduce "curly" straws until a child is able to drink effectively through Straw #1 in the hierarchy with good posture and dissociation. Jaw stability and jaw-lip-tongue dissociation can be worked on through Lori Overland's pre-feeding exercises, and the bite block program, horns and straws from Sara Rosenfeld-Johnson's three part treatment approach starting at the baseline levels.

So, my second daughter has a few challenges also. Though not autistic, she is delayed in some areas and one is speech. She breathes through her mouth also like her older sister, she has a lot of words and mimics a lot and its getting clearer but I feel she does need a little support.

Since the information you provided is very general, I feel both your daughters need an evaluation to determine baseline oral motor skills to establish a program plan - in addition to a visit to an ear nose and throat specialist to determine a cause for mouth breathing.

I had a look through the products and just felt a little overwhelmed at what product would best suit my girls. Thanks again!! -Lisa

Robyn Merkel Walsh, MA, CCC-SLP

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