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.

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This month`s CE Training in The Myo Membership® was absolutely awesome! We were thrilled to welcome renowned speech-language pathologist, author, seminar presenter, and president and co-founder of Speech Dynamics, Inc, Char Boshart, M.A., CCC-SLP. 🎖️

Her presentation, MYO Components & Comparisons: Swallowing, Speech Production, and the Essentials of /s/ and /r/ Therapy, delivered a wealth of knowledge you won`t want to miss. 🧠

Our takeaway? Char`s insightful quote: "Wherever the lips, tongue and jaw rest is where they work." This simple concept unlocks a deeper understanding of speech and swallowing function.

Interested in joining August`s CE Training but not a member yet? Send me a DM!

#speechlanguagepathology #speechlanguagepathologist #speechlanguagetherapist #registereddentalhygienist #dentist #dentists #pediatricdentistry #physicaltherapist #occupationaltherapist #occupationaltherapy #myofunctionaltherapist #continuingeducation #physicaltherapy #slpsofinstagram #myomembership #speechtherapy #speechtherapists #membershipprogram

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This month's CE Training in The Myo Membership® was absolutely awesome! We were thrilled to welcome renowned speech-language pathologist, author, seminar presenter, and president and co-founder of Speech Dynamics, Inc, Char Boshart, M.A., CCC-SLP. 🎖️ Her presentation, MYO Components & Comparisons: Swallowing, Speech Production, and the Essentials of /s/ and /r/ Therapy, delivered a wealth of knowledge you won't want to miss. 🧠 Our takeaway? Char's insightful quote: "Wherever the lips, tongue and jaw rest is where they work." This simple concept unlocks a deeper understanding of speech and swallowing function. Interested in joining August's CE Training but not a member yet? Send me a DM! #speechlanguagepathology #speechlanguagepathologist #speechlanguagetherapist #registereddentalhygienist #dentist #dentists #pediatricdentistry #physicaltherapist #occupationaltherapist #occupationaltherapy #myofunctionaltherapist #continuingeducation #physicaltherapy #slpsofinstagram #myomembership #speechtherapy #speechtherapists #membershipprogram

Do tongue and lip ties cause any issues beyond struggles with infant feeding?

Are there really any other lasting complications that spill over into other areas of health?

Find out in our latest blog post: https://halliebulkin.com/tongue-lip-ties-health/ or comment `BLOG` below to get the link in your DM.

#tongueties #lipties #infantfeeding #pediatricfeeding #halliebulkinblog

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Do tongue and lip ties cause any issues beyond struggles with infant feeding? Are there really any other lasting complications that spill over into other areas of health? Find out in our latest blog post: https://halliebulkin.com/tongue-lip-ties-health/ or comment 'BLOG' below to get the link in your DM. #tongueties #lipties #infantfeeding #pediatricfeeding #halliebulkinblog

Don`t forget to listen to this week`s podcast. Episode 277 is all about TOTs and Feeding in Clinical Practice & Public Health Initiatives

This week, I discuss the gaps in our understanding of the relationship between tethered oral tissues and food aversions.

I talk about the need for more research on how these tissues affect sensory processing during eating, the importance of early identification and interventions, and the effectiveness of tongue tie release procedures.

I also explore the neurological aspects and long-term impacts on dietary preferences, emphasizing the role of awareness in clinical practice and public health.

You can catch the full episode here https://untetheredpodcast.com/ or comment `PODCAST` below to get the link.

If this episode has resonated with you in some way, take a screenshot of you listening, post it to your Instagram Stories, and tag Hallie @halliebulkin

#tetheredoraltissues #theuntetheredpodcast #foodaversions #pediatricfeeding #certifiedpediatricfeedingtherapist #feedingtherapist

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Don't forget to listen to this week's podcast. Episode 277 is all about TOTs and Feeding in Clinical Practice & Public Health Initiatives This week, I discuss the gaps in our understanding of the relationship between tethered oral tissues and food aversions. I talk about the need for more research on how these tissues affect sensory processing during eating, the importance of early identification and interventions, and the effectiveness of tongue tie release procedures. I also explore the neurological aspects and long-term impacts on dietary preferences, emphasizing the role of awareness in clinical practice and public health. You can catch the full episode here https://untetheredpodcast.com/ or comment 'PODCAST' below to get the link. If this episode has resonated with you in some way, take a screenshot of you listening, post it to your Instagram Stories, and tag Hallie @halliebulkin #tetheredoraltissues #theuntetheredpodcast #foodaversions #pediatricfeeding #certifiedpediatricfeedingtherapist #feedingtherapist

Does your tongue have wavy edges?

This wavy pattern, sometimes called a "scalloped tongue," can appear along the sides of the tongue and resemble the ridges of a scallop shell. While not necessarily a cause for alarm on its own, a scalloped tongue can be a sign of an underlying condition called an orofacial myofunctional disorder (OMD).

Other symptoms to look for may Include:

👅 Tongue resting low/forward/against/between the teeth
👅 Tethered Oral Tissues (e.g., tongue tie)
👅 Sleep Disordered Breathing (e.g., UARS, Sleep Apnea, OSA)
👅 Malocclusion
👅 TMJ

Other causes are said to include:

👅Dehydration
👅Smoking
👅Nutritional Deficiency or Disorder

As myofunctional therapists, our job is to work with the client and their interdisciplinary healthcare team to assess and determine if the root cause of a scalloped tongue (and other symptoms present) is an OMD.

When an OMD is present with a scalloped tongue, we can formulate an individualized care plan to help treat the client and address proper oral rest posture. If the palate is large enough to accommodate the tongue and the tongue is not restricted, orofacial myofunctional therapy may be a sufficient approach. If structural concerns exist (e.g., narrow palate, restricted tongue, etc.) other providers will need likely need to be consulted early in the treatment plan.

P.S. If you`re an SLP, OT, PT, RDH, or DDS and you want to learn more about different OMDs and how to properly assess them, check out www.themyomethod.com or comment `MYO` below and I will send more info your way!

#speechlanguagepathology #speechlanguagepathologist #speechlanguagetherapist #registereddentalhygienist #dentist #dentists #pediatricdentistry #physicaltherapist #occupationaltherapist #occupationaltherapy #myofunctionaltherapist #continuingeducation #physicaltherapy #slpsofinstagram #myomembership #speechtherapy #speechtherapists #membershipprogram #themyomethod #myomethod

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Does your tongue have wavy edges? This wavy pattern, sometimes called a "scalloped tongue," can appear along the sides of the tongue and resemble the ridges of a scallop shell. While not necessarily a cause for alarm on its own, a scalloped tongue can be a sign of an underlying condition called an orofacial myofunctional disorder (OMD). Other symptoms to look for may Include: 👅 Tongue resting low/forward/against/between the teeth 👅 Tethered Oral Tissues (e.g., tongue tie) 👅 Sleep Disordered Breathing (e.g., UARS, Sleep Apnea, OSA) 👅 Malocclusion 👅 TMJ Other causes are said to include: 👅Dehydration 👅Smoking 👅Nutritional Deficiency or Disorder As myofunctional therapists, our job is to work with the client and their interdisciplinary healthcare team to assess and determine if the root cause of a scalloped tongue (and other symptoms present) is an OMD. When an OMD is present with a scalloped tongue, we can formulate an individualized care plan to help treat the client and address proper oral rest posture. If the palate is large enough to accommodate the tongue and the tongue is not restricted, orofacial myofunctional therapy may be a sufficient approach. If structural concerns exist (e.g., narrow palate, restricted tongue, etc.) other providers will need likely need to be consulted early in the treatment plan. P.S. If you're an SLP, OT, PT, RDH, or DDS and you want to learn more about different OMDs and how to properly assess them, check out www.themyomethod.com or comment 'MYO' below and I will send more info your way! #speechlanguagepathology #speechlanguagepathologist #speechlanguagetherapist #registereddentalhygienist #dentist #dentists #pediatricdentistry #physicaltherapist #occupationaltherapist #occupationaltherapy #myofunctionaltherapist #continuingeducation #physicaltherapy #slpsofinstagram #myomembership #speechtherapy #speechtherapists #membershipprogram #themyomethod #myomethod

Sensory oral motor feeding difficulties aren’t just a temporary phase that children outgrow. 🍼🍎

These can be complex and often require professional evaluation and treatment to address effectively.
These challenges don’t simply resolve on their own and it takes a dedicated team of specialists to systematically assess and treat the underlying causes.

Unfortunately, most professionals treat sensory and motor as if they exist in silos. We cannot separate the sensory from the motor. Holistic feeding therapists understand this and approach feeding therapy through a sensory oral motor lens.

These professionals can develop a targeted plan to support and help children overcome their feeding difficulties, ensuring they receive the proper nutrition and care they need to thrive. 🤝

While we cover sensory and motor throughout the course, Ramya and Caitlin talk in depth about sensory-based feeding difficulties in Module 6 of the Feed The Peds® course. 📚✨

Tag an SLP or OT who might be interested in learning more about sensory-based feeding difficulties! ⬇️

#speechlanguagepathology #speechlanguagepathologist #slpsofinstagram
#pediatricoccupationaltherapy #pediatricoccupationaltherapist
#feedingtherapy #speechlanguagetherapist #pediatricot
#pediatricfeedingdisorders #pediatricfeedingdisorder #pediatricfeedingtherapy
#pediatricfeedingtherapist #pediatricfeeding #feedthepeds #onlinecourse #onlinelearning

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Sensory oral motor feeding difficulties aren’t just a temporary phase that children outgrow. 🍼🍎 These can be complex and often require professional evaluation and treatment to address effectively. These challenges don’t simply resolve on their own and it takes a dedicated team of specialists to systematically assess and treat the underlying causes. Unfortunately, most professionals treat sensory and motor as if they exist in silos. We cannot separate the sensory from the motor. Holistic feeding therapists understand this and approach feeding therapy through a sensory oral motor lens. These professionals can develop a targeted plan to support and help children overcome their feeding difficulties, ensuring they receive the proper nutrition and care they need to thrive. 🤝 While we cover sensory and motor throughout the course, Ramya and Caitlin talk in depth about sensory-based feeding difficulties in Module 6 of the Feed The Peds® course. 📚✨ Tag an SLP or OT who might be interested in learning more about sensory-based feeding difficulties! ⬇️ #speechlanguagepathology #speechlanguagepathologist #slpsofinstagram #pediatricoccupationaltherapy #pediatricoccupationaltherapist #feedingtherapy #speechlanguagetherapist #pediatricot #pediatricfeedingdisorders #pediatricfeedingdisorder #pediatricfeedingtherapy #pediatricfeedingtherapist #pediatricfeeding #feedthepeds #onlinecourse #onlinelearning
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