Differential Diagnosis: Orofacial Myofunctional Disorders (OMDs) & Pediatric Feeding Disorders (PFDs)

By Hallie Bulkin, MA, CCC-SLP, CMT®, COM

How can we differentially diagnose Orofacial Myofunctional Disorders (OMDs) and Pediatric Feeding Disorders (PFDs)?

One of our Feed The Peds® members asked a great question during the Module 8: Orofacial Myofunctional Disorders (OMD) case study call last Thursday.

She wanted to know HOW we can differentially diagnose OMDs in children that present with other potential diagnoses.

I LOVE this question!

Here are my thoughts when it comes to the differential diagnosis of OMDs & Pediatric Feeding Disorders (PFDs) primarily involving the oral phase of the swallow…

First, it is critical that a child who presents with feeding challenges be assessed by an SLP, OT, or at times PT who has specialized training in pediatric feeding, myo, and tethered oral tissues.

Second, we need to know some hallmark symptoms of OMDs that may exacerbate a PFD. News flash: THEY OFTEN CO-OCCUR and this needs to be addressed in assessment & treatment.

3 main areas that often get overlooked in the assessment and treatment of Pediatric Feeding Disorders (PFDs)

To make a differential diagnosis and rule out an OMD we need to consider the following:

🔹Upper Airway issues 

Open mouth posture, mouth breathing, noisy/audible breathing, chronic congestion, snoring, sleep issues second to airway

🔹Soft tissue challenges

 Tethered Oral Tissues like Tongue/Lip Ties, lips apart leading to drooling/liquid loss when drinking

🔹Hard tissue (Dental) challenges

Teeth crowding, delayed eruption of teeth, malocclusion, high/narrow palate, oral habits impacting dentition, jaw position/posture

NOTE: This is not an exhaustive list, it’s just the tip of the iceberg and what most frequently gets overlooked in this age group.

So next time you have an infant or toddler struggling to breast or bottle feed, transition to solids, expand their food repertoire, move beyond the “picky eater” stage, or experience impaired digestion or elimination…

Put your myo eyes on.

We can’t properly treat PFDs without ruling out OMDs. And like I said, they typically CO-OCCUR so we need to integrate our treatments and work from a holistic lens.

I call this pediatric feeding with a twist of TOTs and myo.

And this is what I teach in Modules 7 & 8 of Feed The Peds®.

My mission since July of 2019 remains. I want to uproot the current medical system and allow our children to move from SURVIVAL mode to THRIVING and functionally optimally.

But first, we need to get these little ones off waitlists and help educate their caregivers so they KNOW when, how, and to whom to reach out for help.

I’ll leave you with a simple question today:

Do you want your patients to SURVIVE or THRIVE?

AKA SURVIVE by ignoring OMDs and TOTs…or THRIVE by assessing and treating through a holistic lens that considers the whole child and what they need to function optimally?

I choose THRIVE

What do you choose?

You can also listen to the full podcast episode here.