Oral Motor Series
Oral Motor Skills and Breastfeeding
By Caroline L. Bias, M.S., CCC-SLP, Susan Chick, Beverly Morgan, IBCLC
Part 2 of a 3 Part Oral Motor Series Written for MOBI Motherhood International
Oral defensiveness, also called oral aversion, is when a baby can’t stand having something close to or in his mouth. In therapeutic jargon, this is called “intolerance and refusal.” Oral defensiveness, if undetected, can severely hurt or even put a stop to the breastfeeding relationship. In infants, this is played out in a variety of ways including the refusal to eat/nurse, gagging, vomiting, eating only while sleeping, breast refusal, bottle refusal, etc. Oral defensiveness is frequently seen in babies who had medical interventions such as Nasogastric tubes or Ventilators, and in babies with severe reflux, but it is sometimes also seen for no known reason. If your baby is showing signs that you think might be oral defensiveness here are some things to keep in mind when looking for help.
Developmentally-Based or Behavior-Based Approach?
There is much discussion in the “feeding community” about how to best treat children’s oral defensiveness. Some say that any method that achieves success most of the time should be tried. Others say that caution is required: therapies that are not carefully suited to a child’s individual needs can lead to more oral defensiveness and to greater problems later on.
If you are nursing your baby and she is becoming aversive or refusing the breast, a developmentally appropriate approach would encourage you to have skin to skin contact with your baby and to provide opportunities for your baby to latch on of her own free will. Usually, and with time, your baby will begin to associate your breast with a pleasant, nurturing experience. She will begin to want to latch on since you have set up an environment for her to feel safe and nurtured. Along the same lines, this therapeutic philosophy supports you in achieving a safe, comfortable and effective latch.
Occasionally a baby does not resume direct breastfeeding but you can still feel confident that you have set the stage for later success with oral feeding instead of increasing the aversion or teaching your baby to ignore their body’s signals.
The authors of this article wish to caution mothers about behavior-based desensitization for an orally defensive baby or young toddler. When using a behavior-based desensitization program, your baby is typically taught to ignore the signals their body is sending about avoiding something (breast, bottle, or table foods) and instead is rewarded for ignoring the signals. This approach can achieve success in terms of weight gain and growth, but your baby’s feeding experience may become more unpleasant, and you will not have addressed the root problem that is creating the aversion. In some cases, a behaviorally based approach can cause a more severe aversion.
This is not to say that therapy should not push your child or should not be challenging. Any treatment approach may present challenging moments, but the overall tone of the treatment should value the child’s feelings and physiological response first of all.
If you and your therapist take a developmentally based approach that values your child’s signals, this teaches your child to listen to his body and to trust his honest reactions to his experience. He can then develop the trust to follow you as you show him different responses as options.
For instance, if your baby is concerned about choking, his inner dialogue might be like this: “Milk is hitting the back of my throat and I hate it. I need to protect myself. I’m going to gag and scream every time I see the breast because that bad feeling is going to happen.” This is a true evaluation and response to his experience. A therapist can help your baby reassess the situation and learn new skills: "There is milk hitting the back of my throat and that means I should swallow. My therapist and mommy have taught me how to do that effectively. Now my tummy will feel full and I won’t feel like I’m choking. It is okay to take the breast.”
We suggest that you question your therapist as to her treatment philosophy. Find a developmentally-based therapist who can offer you and your family specific suggestions for reducing the aversion and encouraging your child to feed by mouth, who can help you discover the root problem, and who is sensitive to your baby’s emotional as well as physical well being.
The Long Term Value of Seeking Early Treatment
Oral defensiveness may be the first sign of a larger developmental problem. Many professionals and parents see a correlation between developmental delays and early oral defensiveness. Some children with oral defensiveness are later diagnosed as having language delays, articulation disorders or other types of developmental delays.
While it may seem as though there can be nothing positive about one’s baby having feeding issues, identifying these difficulties is a unique opportunity to get therapy to those children who need it, and at an age when they can benefit from it the most.
Most babies with feeding difficulties such as oral defensiveness will not go on to have future developmental problems. However, research continues to show that children who do receive early intervention have significant gains and are in a better position to achieve later developmental milestones. In any case, early detection and treatment are very important to the child with oral defensiveness, and in many cases, treatment can help save the breastfeeding relationship.
Parents are advised to see a lactation consultant to help resolve breastfeeding issues and to have a screening by a feeding specialist specializing in infants, if a baby has extended breastfeeding difficulties and/or oral defensiveness.