11 answers

Mouth Is Always Open

I provide care for a wonderful little five month old girl. She is smart and sweet and on target for every developmental milestone. The problem is... she hardly ever shuts her month. Her lips are open and her tongue sticks out almost constantly. It doesn't matter if she is playing, smiling, or sleeping. I try to give all the babies in my care a pacifier when they sleep because doing so reduces the risk of SIDS, but this little one couldn't keep it in her mouth. It's not that she didn't want it. If I held her and gently put one finger on the pacifier she would suck away happily, but the moment I would let go it would fall out. She is difficult to feed because her tongue is always sticking out, but she is a good eater. She doesn't have any health problems and can breathe out of her nose just fine. I suggested to her mother that she ask the doctor about the problem and the mother looked at me like I called her daughter a leper! So I dropped it for a few months. Now we are starting on first foods and she is having a very difficult time. Has anyone experienced a similar problem?

What can I do next?

More Answers

First let me say, my 2nd child did this and outgrew it around 6 months of age. But read on about my 1st child who did not outgrow this tongue issue.

My son (now 8) has had the same tongue problem since birth. He does have some developmental delays and has always seen an Occupational Therapist & Speech Therapist. For 7 years, I voiced my concern to his therapists and pediatrician, but they basically thought it was just a bad habit. Finally, I was referred to an Orofacial Myologist (simply put, works on muscles in the mouth & tongue). It has been really hard for my son to do all of the "mouth" exercises, but we are seeing some tremendous progress. I don't know how young a child can start orofacial myology therapy, but I definitely recommend checking into it. If left untreated, the actual bone structure of the mouth/face can develop improperly and possibly make speech, eating, and swallowing more difficult. Also, it can affect how the teeth come in (crooked or straight).

My 2 1/2 yr old had this problem- delayed oral motor skills. He was born early, had torticollis and while pregnant I was on mag sulfate to stop early labor for 7 weeks, which is a nervous system depressant. Any or all of these could have caused his problem. He still has mild dysphagia-difficulty in swallowing correctly, but with constant therapy, we have nearly corrected the problem. The baby you describe sounds just like my little one was. Our pediatrician recommended therapy evaluation and oral motor skills therapy. The mom should not be offended, it is more common that most people think. It is easier to correct the younger you start. Hope this helps!

E.,
I would recommend checking out Kinesio Tex Tape. the website is www.kinesiotaping.com
there is an article about Oral Motor Control with Pediatrics
on the main page you can hold the cursor over the 'research/studies' button and scroll down to 'Oral Motor Control'

feel free to email me if you are interested in learning more about this. ____@____.com

here is the direct link to that article:
http://kinesiotaping.com/content.asp?CustComKey=13776&amp...

as far as dealing with the mother i'd reccomend first reassureing her that everything else is fine with her daughter. i'd bring up the fact of difficulty feeding because maybe if there's a tangible problem she'd be more apt to do something about it. a cousin of mine had a similar problem and it turned out that the little strip of tissue that connects the tongue to the bottom of the mouth extended further than normal. in her case all the way to the tip. a simple surgery was performed to cut it back and the problem eventually righted itself. based on what your saying it seems like a very minor problem that shouldn't be cause for alarm but should be checked out just to rule out any concerns. maybe if you present it to the mother with that attitude she'll be a bit more receptive.

I am not a dr but could she be tongue tied? just a thought...

S.

I am a med student and this is rather perplexing to me. This could very well be neurological as well as chromosomal...Down Syndrome. Keep in mind...I am not yet a doctor but these are just some ideas. It is important that all children in your care receive the best care. Try to be delicate when discussing this with the parents.

T.

No question that a doctor should take a look at her. The sooner the better because a lot of things can be put on the right path with therapy at this young an age.

Now, to bringing it up to her mother:
You do need to talk to her as an authority on young children. You have seen many children and can tell that this girl is different in this one aspect and needs to be evaluated so that it can be corrected, if needed.

Obviously, no mother wants to hear that something might be wrong with her child. Now that she had some time to think about it, she might be more approachable, or perhaps you could have an open door day where she would be able to observe her daughter with other kids and see that it's a bit out of the ordinary...

On the other hand, I don't know the mother's situation, but it doesn't sound like she is going to the regular baby check-ups because a doctor should pick-up on something like this... so perhaps, besides her fear of the unknown, it's her fear of not being able to afford the possible medical care costs... perhaps you might want to innocently ask about her doctor visits (where, who, how often, when is the next one scheduled, vacinations, etc.) to find out if that might be the stumbling block... there are lots of city, county, state and non-profit programs (many for free) available for kids...

Shooting in the dark here, but the girl definitely should get evaluated

Hi There-

I know this is a difficult subject to broach with parents, but you might want to bring it up to mom again. The open mouth posture you are describing could be due to low muscle tone of the lips, jaw, etc. It could be that this child will experience difficulty feeding. The fact that her tongue is out and she can't keep the pacifier in her mouth are also concerning. I don't specialize in pediatric feeding (I'm a speech pathologist), but I know a couple of SLPs that do. I can ask them if they have any tricks you can try while you have her.

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