As a feeding therapist, it is important to understand that the JAW is the foundation for ALL other orofacial movements during feeding. If there is a breakdown in typical movement and development at this stage, there will be delays and/or dysfunction across all feeding skills.
Why are we hitting on these milestones again? Because if a breakdown in skills of the jaw movement patterns is missed, it will be incredibly hard to make progress in feeding therapy! We want YOU to be prepared and armed with all the information you need to Screen The Peds.
What are we looking for when we Screen The Peds? (If you haven’t already, download our Pediatric Feeding Screening Packet for this! You can also refer back to this blog post for more feeding milestones)
To understand abnormal movement patterns, we need to really know what typical developing jaw movement patterns look like and how they present. Keep in mind, in typical development, the patterns do not develop on the exact same trajectory; we will not see every child meet all the milestones at the exact same age/time frame. But, this gives us a good reference point to pull from as we are completing feeding screeners & assessments
Jaw movement patterns begin developing from less to more controlled as they mature. It is important to look at jaw movement patterns across many spectrums when assessing. For instance, what skills are present when chewing on a non-nutritive item such as a chewy tube or teether, on soft solid foods such as a banana, and harder to chew foods such as grilled chicken or steak. We may see more developed chewing patterns (jaw movements) with softer foods but not with harder to chew foods. DOCUMENT WHAT YOU FIND! This will be important in making sense of assessment findings and writing up a treatment plan.
On average, between 3-9 months we see the emergence of munch chew, lateral jaw movements, and diagonal chew pattern. These jaw movements are critical for infants in the ability to safely eat thin and thick purees and soft foods such as avocados or bananas.
Rotary chewing develops between 6-36 months and can be broken down into stages which will help us as feeding therapists to identify if/where a breakdown has occurred. The first stage is diagonal chew pattern or diagonal rotary chewing. In this type of chewing pattern, the jaw moves across midline to form an X or diagonal pattern and comes back to midline.
Next, the circular rotary chewing pattern emerges. The jaw moves laterally, downward, across midline to the other side, and then upward to close. As this pattern matures, the child will transfer food across midline from right to left OR left to right. The child also has increased independence when biting pieces of food and less spillage from the sides of the mouth. During this phase, a child should transition from managing soft solids to hard solids with ease.
Abnormal Jaw Patterns To Be Aware Of
- Tonic Bite Reflex is tight closure of the jaw following stimulation in or around the mouth.
- Jaw Clonus is involuntary reflexive movements of the jaw that are repetitive and rhythmic contractions of the muscle.
- Jaw Retraction is when the lower jaw is brought up and back, displacing the alignment of the molars and there is often an abnormal increase in muscle tone. It may occur after food is presented or when position of the body is changed.
- Jaw Thrust – the jaw opens not only downward but outward, essentially “thrusting” forward
- Bruxism – “tooth grinding” or grinding the gums together if no teeth have emerged yet. Bruxism can be related to muscle weakness or increased muscle tone. Be sure to document what you see and palpate the masseter muscle to determine if it may feel “squishy” (potentially low tone) or “tight” (possibly increased muscle tone).
Knowing typical jaw movement patterns will help you identify when treatment is warranted and where to target goals during feeding therapy. We can not stress enough that as you screen or assess, DOCUMENT, DOCUMENT, DOCUMENT! You can not treat what you have not clearly identified!
With these tips on screening for pediatric feeding delays and jaw development, you’re well on your way to becoming a Feeding Therapist.
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