As parents, we want the best for our children, especially when it comes to their health and well-being. While we often pay close attention to their physical development and overall growth and follow along with the developmental milestones expected for their age, we may be missing signs of certain disorders or growth differences that can affect their oral health and speech. One such condition is orofacial myofunctional disorders ("OMDs").  In this blog post, we aim to provide parents with an understanding of OMDs, their common signs and symptoms, and the importance of early recognition and intervention.

What are Orofacial Myofunctional Disorders (OMDs)?
Orofacial Myofunctional Disorders refer to a group of functional and structural disorders that affect the muscles and functions of the face, mouth, and throat. These disorders can impact various aspects of a child's oral health, including swallowing, breathing, speech, and facial growth (including the palate and other important oral/facial structures). OMDs sometimes arise from improper or dysfunctional oral habits, such as thumb sucking, tongue thrusting, or mouth breathing, which can disrupt the normal development of the orofacial structures.  OMDs can also be a result of the orofacial physical structure.

Recognizing the Signs and Symptoms:

• Speech Difficulties: Children with OMDs may exhibit speech issues like speaking with a lisp, difficulty pronouncing certain sounds, or persistent open-mouth posture.
• Breathing Irregularities: Chronic mouth breathing, snoring, or frequent congestion can be indicative of an orofacial myofunctional disorder.
• Dental Malocclusions: Misaligned teeth, open bite, overbite, or crossbite may be a consequence of improper tongue posture or swallowing patterns.
• Thumb Sucking and Oral Habits: Prolonged thumb sucking, pacifier use, or excessive bottle feeding beyond infancy can be correlated with OMDs.
• Facial Muscle Weakness: Weakness or imbalance in facial muscles can manifest as difficulty closing lips fully, drooping mouth corners, or poor oral muscle control.
• Swallowing Dysfunction: Swallowing difficulties, such as food or liquid spillage, frequent choking, or a noticeable swallowing pattern, can be signs of an OMD.

Why Early Recognition and Intervention Matters:
Recognizing and addressing OMDs early on is crucial for several reasons:

1. Promoting Proper Growth and Development: Timely intervention can help correct orofacial muscle imbalances, which can lead to proper facial growth, better oral posture, and alignment of teeth and jaws.
2. Enhancing Speech and Communication: OMDs can significantly impact a child's ability to speak clearly. Early intervention can help improve speech patterns and articulation, allowing for better communication skills.
3. Preventing Dental Issues: Correcting oral habits and improving oral muscle function can reduce the risk of dental malocclusions and other related dental problems, thereby saving your child from potential orthodontic treatments later in life.
4. Improving Overall Well-being: Proper oral muscle function and nasal breathing contribute to better sleep quality, enhanced focus, and improved overall health and well-being.

If you suspect that your child may have an OMD, it is advisable to consult a qualified orofacial myofunctional therapist or a speech-language pathologist with specific OMD training. These professionals specialize in assessing and treating OMDs, tailoring therapy programs to address specific needs and goals.

Recognizing orofacial myofunctional disorders in children is crucial for their oral health, speech development, and overall well-being, especially as they can impact breathing, eating, and sleep (very important things for happy and healthy children and teens!).  By understanding the signs and symptoms of OMDs and seeking professional guidance, parents can ensure early intervention and provide their children with the opportunity for improved oral function and a healthier future. Remember, identifying and addressing OMDs at an early stage can make a significant difference in your child's life, setting them on a path towards optimal health and successful communication skills.   Seeking professional help when needed can be an important way to support your child in their journey towards a healthy and functional body.

What is Pragmatics? 
Pragmatics is using social communication when we interact with other people. There are norms that we follow when we talk to people. We use facial expressions, gestures, tone of voice, and words to convey our thoughts and feelings to our communication partner. 
 
When children or adults have difficulty understanding social conventions, it makes it difficult to socialize.  
  
According to the American Speech-Language Hearing Association, social communication includes three skill sets. 
1. Using language for different intentions such as: 

• Greetings. Saying “hello” and “goodbye” 
• Informing. “I’m going to get a cookie” 
• Demanding. “Give me a cookie” 
• Promising.  “I’m going to get you a cookie” 
• Requesting. “Can I have a cookie, please?” 

 
2. Following social conventions when conversing with a communication partner: 

• Taking turns when talking 
• Letting others know the topic when you start talking 
• Staying on topic 
• Trying another way to say something if another person doesn’t understand you 
• Using gestures and body language (e.g., pointing, shrugging) 
• Knowing how close to stand near someone 
• Using facial expression to convey thoughts and eye contact 

 
3. Changing language and tone depending on the listener or situation 

• Talking differently to a baby versus an adult 
• Giving more information for someone who doesn’t know the topic or less information for someone who already knows the topic 
• Talking differently in the classroom than on the playground 

What are some signs that my child has difficulties with social communication? 

• Difficulty remaining on topic 

• Not trying to gain the attention of an adult 
• Decreased eye contact 
• Unaware of personal space 
• Dominating conversations and not asking their communication partner relevant questions 
• Difficulty making friends 

• Difficulty understanding another person’s perspective 
• Unable to understand or use various voice tones 
• Difficulty understanding and using different facial expressions 
• Does not ask for clarification when they don’t understand something  
• Use language in limited ways (e.g., may not greet a person or ask a question but will comment on a topic) 

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Helpful tips to work on social communication  

• Use visual supports such as pictures  
• Model communication skills 
• Role play situations (e.g., going to the supermarket, asking a friend to play, etc.)  
• Use puppets, dolls, action figures, stuffed animals to role play 

• Create social stories 
• When reading stories, talk about how the person may feel and what their facial expressions mean ​ 

​References: 
American Speech-Language-Hearing Association. Social Communication. Retrieved from https://www.asha.org/public/speech/development/social-communication/. 

Alternative and Augmentative Communication (AAC) refers to a range of communication methods used by individuals who are unable to effectively communicate using traditional spoken language. This can include individuals with disabilities, such as autism, cerebral palsy, and developmental delays, as well as individuals with speech and language disorders, such as severe apraxia of speech.
The goal of AAC is to provide individuals with the means to communicate their needs, wants, and thoughts, regardless of their ability to speak. There are a variety of AAC devices and technologies available, each designed to meet the specific needs and abilities of the individual.

1. Picture Communication Boards: Picture communication boards are a type of AAC device that use pictures or symbols to help individuals communicate. These boards can be simple or complex, and can be used to communicate a wide range of messages, from basic needs, such as "I want a drink," to more complex thoughts and emotions.
2. Speech Generating Devices: Speech generating devices are electronic devices that allow individuals to communicate through a synthesized voice. These devices typically use touch screens or buttons to select pre-recorded or programmed messages, or allow individuals to type or write their message using an on-screen keyboard.
3. Augmentative and Alternative Communication Apps: There are many AAC apps available for smartphones and tablets that allow individuals to communicate using a variety of methods, including symbols, pictures, text-to-speech, and voice recognition. These apps can be customized to meet the specific needs of the individual and are often portable, making them a convenient option for on-the-go communication.
4. Eye Gaze Technology: Eye gaze technology is a type of AAC device that allows individuals to communicate using eye movements. This technology is often used by individuals who have difficulty using their hands or who have severe physical disabilities.

It is important to note that the most effective form of AAC will vary from individual to individual, and it is important to work with a Speech Language Pathologist to determine the best type of AAC for each individual's needs.
Please reach out if you're interested in learning more, or wondering if this could be a good fit for your child. We are happy to help!

Feeding therapy is a type of therapy that focuses on helping individuals with difficulties related to feeding and eating. This can include difficulties with trying new foods (touching, smelling, texture differences, etc.), chewing, swallowing, and establishing healthy eating habits, among other things. Feeding therapy is designed to improve the ability to eat and drink, and to promote healthy growth and development.

Feeding therapy is accomplished through a variety of techniques and strategies, including exercises to improve oral motor skills, strategies for improving chewing and swallowing, and training in healthy eating habits.

In some cases, feeding therapy may also involve working with a team of healthcare professionals, such as occupational therapists, speech therapists, and dietitians. This multidisciplinary approach can help to address a range of feeding difficulties and ensure that individuals receive the most comprehensive and effective treatment possible. At Columbia Pediatric Therapy, we have both SLPs and OT's trained in feeding strategies, depending on the child's presentation. Referrals are made out of clinic for dietitians and other specialists, if needed.
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For children, feeding therapy can be especially important for addressing feeding difficulties that are impacting their growth and development. Children with feeding difficulties may have difficulty gaining weight, may struggle to eat a variety of foods, or may experience discomfort or distress when eating. Feeding therapy can help to address these difficulties and promote healthy growth and development.
Feeding therapy is one of our favorites, as we hope to help children discover how enjoyable their relationship with food can be. 

Why is play important for speech and language skills? 
Play is primarily how children learn. According to the American Academy of Pediatrics (2007), play teaches children how to interact in their environment and promotes cognitive, motor, speech, language, and social emotional development. Play lets children practice language skills that they have learned and also expand on their vocabulary. When playing with your child, they hear the speech sounds you are using, which will help them refine their own speech sounds.  

How can I play with my child? 
Playing is important for children and often your child wants to play with you. Playing with your child promotes a closer relationship with you. Playing provides opportunities for you to model behaviors, problem solving skills, values, and real life situations. Here are some strategies when playing with your child: 

• Follow your child’s lead. See what your child is looking at or playing with. A child will be more engaged with a toy that they want to play with.  
• Practice taking turns. Turn-taking games and routines facilitate language skills. When turn-taking with your child, pause when it is their turn. This promotes anticipation, initiation, and communication. Activities depend on age and can include:
  
  • ​Babies:  looking at your baby and cooing then pausing and giving the opportunity for your baby to coo back.  
    
  • Toddlers and preschoolers: building blocks and taking-turns on who puts a block on top. Passing a ball back and forth. 
    
  • Older children: turn-taking becomes more organized such as playing board games or sports. 
• Model language. Modeling language increases your child’s exposure to words. Modeling language while playing keeps children engaged and it is also fun! To do this, you can comment on what your child is doing and expand one or two more words to what your child said.  
  
  • For example, if your child said, “apple” you can respond and say “Yes, red apple” or “big apple.”  
• Sing songs. Songs are fun ways for your child to use language and to interact with you. Singing songs are also great because they can be made up, changed, and be sung anywhere. Some helpful tips are: ​
  
  • Pause during certain parts to give your child the opportunity to fill in the phrase or word. For example, “the wheels on the bus go round and round round and round round and ____.” Pause and see if your child fills in the blank. It is alright if they don’t and you can continue on singing and giving your child another opportunity at another time. 
    
  • Sing songs fast, slow, loud, or whisper. 
    
  • Pair singing with gestures such as moving your arms in circles for “Wheels on the Bus.” 
• Read books. Books are wonderful opportunities to create language! When you reread books, it helps children anticipate what will be next and helps with memory skills. Here are some helpful tips when reading: 
  
  • If they are unsure of what book to get, offer your child just two books to pick from. 
    
  • For young children consider books with simple pictures and simple text.  
    
  • When reading, it is not necessary to read every page word-for-word. Instead, you can shorten the phrases, change the wording, add words, or even paraphrase. 
    
  • Talk about the pictures. Make comments on what you see on the pages. If your child makes a comment and says “cat,” you can say “big cat.”  
    
  • When turning pages you can comment and say, “turn the page.” 
    
  • Repeat phrases, names, words each time you read the book. Repetition is important for children as it helps with memory, sequencing, sentence structure, and language. 
    
  • If your child is familiar with the story, pause at predictable and exciting parts and see if they can explain what will happen or fill in the phrase. If they don’t respond, that is alright. Just continue the story.  You can also ask, “what will happen next?” 
    
  • Try to limit the amount of questions you ask. Asking questions is fine but too much can be overwhelming to your child. 

 
Disclaimer: This website does not provide medical advice. This information is for educational purposes only and does not substitute for professional medical advice, diagnosis, or treatment. Always seek advice from your pediatrician or other health care providers with any questions you have regarding medical condition or treatment. Never disregard professional medical advice or delay in seeking because of something you read on this site. 
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Citations/Resources: 
https://www.theministryofparenting.com/wp-content/uploads/2018/05/The-Importance-of-Play-in-the-Development-of-Language-Skills.pdf 

What is teletherapy?
Teletherapy is using video technology to deliver speech and language services by connecting the clinician and client for treatment, assessment, and/or consultation.  Both adults and children can participate in teletherapy. 

What is the difference between telepractice, teletherapy, telehealth, and telemedicine?
There is no difference between telepractice, teletherapy, and telehealth. However, telemedicine is the practice of medicine using technology to deliver care. A physician will use telecommunications to deliver care at a distance to their patients. 

The American Speech-Language-Hearing Association uses the phrase “telepractice” because not all services are being provided in healthcare settings.  

Why use telepractice?
Research has shown that telepractice is as effective and equivalent to in-person therapy. 

Some benefits of telepractice include:

• Being able to stay in the comfort of your own home or anywhere else
• Convenience - as there is no time traveling distances to a therapy office
• An advantageous option for medically fragile clients 
• Promotes family involvement
• Accessible for families living in rural and urban areas

How does telepractice work?
Telepractice uses video to connect your child and the clinician. A link will be sent to open the video to start the telepractice session. There are many different video sources that follow HIPAA regulations. 

How can I support my child during a telepractice session?
As the parent/caregiver, you will be helping support your child during the telepractice session. Your therapist may provide parent coaching and guidance on how to use materials and how to prompt your child verbally or physically.

Some helpful tips are:

1. Position the camera and help your child stay in front of the screen
   
2. Find a quiet room with no background noise
   
3. Stay with your child for the session, or for an older child, stay close by to help with any technical difficulties
   
4. Gather needed materials before the session if the therapist asked for them
   
5. Provide reminders and positive encouragement
   
6. For play-based therapy, have your child’s favorite toys nearby that are easily accessible

At Columbia Pediatrics, we offer a flexible approach to our therapy sessions. Whether you are interested in teletherapy, in person therapy, or both, please contact us at (360) 989-7347.