Question
What are some of the recommendations for teaching mastication?
Answer
I think that teaching mastication can be one of the more difficult skills to teach. I have found the best success with children after their orosensory skills have been normalized and the children have advanced to the point of volitional control of individual oral motor movements. Mastication is a complex motor pattern involving precise movement of the tongue, lips, jaw, and cheeks. Depending on the child, I have used two different approaches to teaching mastication. One approach is teaching within the context of the entire motor plan. For example, if I know the child has the basic skills to chew (normalized orosensory skills, up/down jaw movement, ability to lateralize the tongue in both directions to the molar surface, ability to volitionally close lips, and suck in the cheeks) then I will attempt to use dissolvable foods (such as puffs) to teach chewing using the entire motor plan. As the child progresses, I advance the foods. To begin to teach the lateralization component, one technique that I will use involves real food (i.e. celery) to "roll" the jaw slightly while the child is biting down with their molars. The idea is to begin to unilaterally activate the medial pteryegoid and temporalis muscles during the chew to facilitate a more advanced pattern. For other children, particularly those who are older, I have found that this "gestalt" approach is not as effective. For this group of children, I will individually teach the tongue, lip, cheek, and jaw movements as individual skills and then put them all together. One of the challenges of this approach is that it can take several months to a year or more to observe efficient mastication.
This Ask the Expert is taken from the course entitled: Pediatric Dysphagia: The Basics; by Donna Scarborough.
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Donna Scarborough, Ph.D., CCC-SLP, specializes in developmental/medical speech language pathology, developmental neurosensory physiology and pediatric dysphagia at Miami University in Oxford, OH. She teaches the graduate level course in Dysphagia, Trach & Vent and head and neck anatomy & physiology to undergraduates. She currently serves as the chair of the Division 13 Research Committee and is a member of the ASHA's Division 13 pediatric advisory board.
