Sensory Processing and Oral Motor Skills in Children

The Influence of Sensory Processing on Oral Motor Skills in Children: Understanding the Sensory Foundations

As occupational therapists and speech-language pathologists, we increasingly recognise that oral motor development doesn't occur in isolation. Recent research reveals that the sensory systems, particularly the vestibular, proprioceptive, and tactile systems, form the critical foundation upon which oral motor skills are built. This understanding has implications for how we assess and treat children with feeding difficulties, speech challenges, and oral motor dysfunction, whether they have identified disabilities or are typically developing.

The Sensory Foundations of Oral Motor Development

The foundation of oral motor development lies in the integration of multiple sensory systems. At the base of the pyramid are the tactile, vestibular, and proprioceptive sensory systems. Children need this foundational input for sensory integration and brain organisation. This pyramid model (The SenseUp Model) helps us understand why addressing sensory processing is crucial before expecting complex oral motor skills to emerge.

Multi-sensory integration is foundational to function, and when challenges derail sensory integration, it leads to difficulties in development, learning, and emotional regulation. This principle applies directly to oral motor development, where children must integrate sensory information from multiple systems to coordinate the complex movements required for feeding and speech.

The Prevalence of Sensory-Related Oral Motor Issues

The research reveals that sensory-related oral motor difficulties are more common than previously understood:

• Five to 10 percent of typically developing children have a serious feeding disorder at some point, and that could include oral-motor or oral-sensory problems
• Feeding disorders occur in 25-35% of developmentally normal children and 40-70% of children with developmental disabilities and/or chronic medical conditions
• As identified by research, five to ten percent of typically developing children may experience serious feeding disorders, which can include oral-motor or oral-sensory issues

These statistics underscore that sensory processing difficulties affecting oral motor skills are not limited to children with diagnosed disabilities, they represent a significant concern across the developmental spectrum.

Development

The development of the foundations for eating skills begins intrauterine and progresses during infancy and the first years of childhood. Oral sensorimotor skills improve as part of general neurodevelopment, which includes the acquisition of muscle control (including posture and tone), cognition and language, as well as psychosocial skills.

Understanding this timeline helps therapists recognise that for an adequate development of eating skills, certain neuromotor developmental steps are required.

The Vestibular System's Influence on Oral Motor Skills

The vestibular system serves as a critical organiser for oral motor function.

Postural Foundations for Oral Motor Control

One of the most significant ways the vestibular system influences oral motor skills is through its impact on postural control. Research demonstrates that having a stable pelvis and trunk allows for proper head position for mealtime.

This connection extends beyond feeding safety to functional oral motor performance. When children lack adequate vestibular processing, they may struggle to maintain the postural stability necessary for coordinated oral movements, leading to inefficient feeding patterns and increased energy expenditure during meals.

Developmental Readiness and Timing

The vestibular system also determines when children are developmentally ready for oral motor challenges. As babies develop their gross motor skills, they become developmentally ready to try solid foods. This is usually around 6 months of age when the baby is able to: sit with support in an upright position (either on the lap or in a suitable highchair), roll over, rotate trunk and head voluntarily and bring hands and toys to mouth for exploration.

Vestibular Processing and Motor Planning

Recent research reveals fascinating connections between vestibular input and motor planning. For example, when a baby learns to crawl, there is an uptick of activity in parts of the brain that are related to motor planning. This same motor planning process applies to oral motor development, where the sensory and motor systems work together to create a "body map" of different movements of the mouth, tongue and jaw.

The Proprioceptive System's Role in Oral Motor Function

The proprioceptive system provides the foundational awareness that allows children to control and coordinate oral motor movements effectively. The proprioceptive system is located in our muscles and joints. It provides us with a sense of body awareness and detects/controls force and pressure. The proprioceptive system also has an important regulatory role in sensory processing as proprioceptive input can assist in controlling responses to sensory stimuli.

Body Awareness and Oral Motor Control

The proprioceptive sense provides us with information from our muscles and joints, and it helps us to understand where our body parts are in relation to one another. In the oral motor system, this translates to awareness of tongue position, jaw stability, and the ability to grade force during chewing and swallowing.

The research confirms that the jaws can provide a ton of deep pressure input. Chewing and sucking gives lots of input to this sensory system. Cheeks can also respond to proprioceptive input while chewing, as they expand depending on bite size, and respond to food moving from side to side in the mouth.

Muscle Tone and Proprioceptive Processing

Low muscle tone significantly impacts proprioceptive processing and oral motor function. Low muscle tone in the facial muscle can result in an open mouth posture. Because stability of the jaw allows the tongue to dissociate movement patterns within the mouth, this open lax jaw precludes dissociation resulting in an immature anterior/posterior pattern in which the tongue and jaw move together rather than independently.

Force Regulation and Coordination

Children need proprioceptive feedback to develop appropriate bite force and pressure control during feeding tasks. This is particularly important for managing different food textures safely.

The Tactile System's Complex Influence

The tactile system's role in oral motor development is perhaps the most complex, as dysfunction can significantly impact feeding behaviours and speech development.

Oral Exploration and Learning

The mouth serves as a primary tool for sensory exploration in early development. Mouthing objects is part of typical development, preceding object exploration with hands alone or in combination with visual regard. Through this process, infants can perceive hardness, texture, and shape, and this object knowledge can be transferred across sensory modalities.

Tactile Processing Variations

The research reveals significant individual differences in tactile processing that impact oral motor function:

• Over-responsive children: Some children may be hypersensitive to oral stimuli, causing them to gag, grimace or have other strong reactions to certain types of food.
• Under-responsive children: Others may be hyposensitive and may not feel food in their mouths or may let it drop out of their mouths without realizing it.

The Oral-Tactile Connection

Orally, the tactile sense receives input when anything touches the lips, tongue, gums, and cheek. The tongue in particular has a lot of tactile receptors to give feedback on the way something feels or it's temperature. Remember the Homonculus man with the big head, lips and hands?

The Interconnected Nature of Sensory Systems

It's crucial to understand that these sensory systems don't work in isolation. Since oral sensory processing is affected by three senses, your child could be over, under, or not processing any one or all of these sensory systems.

Evidence-Based Intervention Recommendations

Based on the comprehensive research evidence, intervention approaches should address the sensory foundations while considering the specific population and goals.

Sensory-Based Approaches:

The evidence supports interventions that address sensory processing foundations:

1. Address Postural Foundations First:
• Altering the child's position significantly improves oral motor and swallowing function. Optimal positioning during feeding can optimise the child's oral motor coordination, making chewing and swallowing easier
2. Use Functional, Context-Specific Interventions:
• Motor learning is experience dependent, meaning that children establish motor patterns through opportunities that are frequent and are as closely related to the desired task as possible
• For example, if a child wants to chew a banana, they should be provided with frequent opportunities and modifications that encourage them to engage in the motor task of chewing a banana
3. Incorporate Sensory Processing Approaches:
• Provide appropriate proprioceptive input for children with low postural tone
• Address vestibular foundations through postural training
• Support tactile development, not through trauma-inducing ‘exposure’ but child led exploration

Current best practice emphasises:

1. Limited Evidence for Isolated Techniques: There is limited high-quality evidence supporting the use of oral motor exercises or sensory techniques in the treatment of paediatric feeding disorder–related sensory deficits and swallowing dysfunction in isolation
2. Comprehensive Assessment: Speech-Language Pathologists evaluate signs of weakness and abnormalities in oral structures, including muscle tone, mouth coordination, and strength, as part of the assessment process
3. Family-Centred Care: Include caregivers as active participants in intervention, particularly given the success shown in premature infant programmes

Clinical Implications and Future Directions

Understanding the sensory foundations of oral motor development has several important implications:

Assessment Considerations

• Evaluate all three foundational sensory systems (vestibular, proprioceptive, tactile) before focusing solely on oral motor skills
• Consider sensory processing patterns when children present with feeding difficulties or speech challenges
• Assess postural foundations as part of comprehensive oral motor evaluation

Intervention Planning

• Address sensory foundations before expecting complex oral motor skills
• Use comprehensive approaches that integrate postural control, sensory adaptation, and functional feeding experiences
• Consider the child's individual sensory processing patterns when designing interventions

Duration and Expectations

Treatment length depends on the problem and your child's age and skill level. Feeding therapy can take months or years. The more complex the condition, the longer it will take.

Conclusion

The research clearly demonstrates that sensory processing, particularly involving the vestibular, proprioceptive, and tactile systems, forms the foundation upon which oral motor skills develop. This understanding applies to children across the developmental spectrum, from premature infants to typically developing children with feeding challenges.

As practitioners, recognising these sensory foundations allows us to:

• Conduct more comprehensive assessments
• Design more effective interventions
• Better support families in understanding their child's needs
• Avoid ineffective approaches that don't address underlying sensory processing issues

The evidence points toward comprehensive, sensory-informed approaches that address the whole child rather than isolated oral motor skills. By understanding and addressing these sensory foundations, we can provide more effective support for children's oral motor development, leading to improved outcomes in feeding, communication, and overall quality of life.

References

American Speech-Language-Hearing Association. (2024). Pediatric feeding and swallowing. https://www.asha.org/practice-portal/clinical-topics/pediatric-feeding-and-swallowing/

Autism Research Institute. (2022, February 24). Sensory integration disorders in autism. https://autism.org/sensory-integration/

BabySparks. (2022, July 28). Crawling: A key step for sensory-motor integration, fine motor skills & oral motor development. https://babysparks.com/2017/04/24/crawling-a-key-step-for-sensory-motor-integration-fine-motor-skills-oral-motor-development/

Božanić Urbančič, N., Battelino, S., & Vozel, D. (2024). Appropriate vestibular stimulation in children and adolescents,A prerequisite for normal cognitive, motor development and bodily homeostasis,A review. Children, 11(1), 2. https://doi.org/10.3390/children11010002

Child Mind Institute. (2016, February 24). Sensory processing disorder in children. https://childmind.org/article/sensory-processing-issues-explained/

Children's Wisconsin. (n.d.). About oral motor and oral sensory problems. https://childrenswi.org/medical-care/gastroenterology-liver-and-nutrition-program/conditions/oral-motor-and-oral-sensory-problems

Developmental Therapy Associates. (2022, May 23). Parents guide to sensory integration & processing. https://www.developmentaltherapy.com/sensory-integration-and-processing-a-guide-for-parents/

Family Doctor. (2025, May 5). Sensory processing disorder (SPD). https://familydoctor.org/condition/sensory-processing-disorder-spd/

Guardado, K. E., & Sergent, S. R. (2023, July 31). Sensory integration. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559155/

Happy Chompers. (2024, August 9). What is oral motor therapy and does my child need it? https://happychompers.com/what-is-oral-motor-therapy-and-does-my-child-need-it/

Kid Sense Child Development. (2024, July 15). Sensory processing. https://childdevelopment.com.au/areas-of-concern/sensory-processing/sensory-processing-sensory-motor-integration/

Kids Sense Therapy Group. (2024, January 12). The power of active and passive proprioceptive input. https://www.kidsensetherapygroup.com/the-power-of-active-and-passive-proprioceptive-input/

Kim, K., Choi, M., & Park, E. (2022). Effect of oral motor facilitation technique on oral motor and feeding skills in children with cerebral palsy: A case study. BMC Pediatrics, 22, 674. https://doi.org/10.1186/s12887-022-03674-8

Kinspire Health Resources. (n.d.). Oral motor skills: Development, milestones, activities & more. https://www.kinspirehealth.com/blog/oral-motor-skills-development-milestones-activities-more

Kutest Kids. (n.d.). The impact of oral motor skills on communication. https://www.kutestkids.com/blog/oral-motor-skills

Lass, N. J., & Pannbacker, M. (2008). The application of evidence-based practice to nonspeech oral motor treatments. Language, Speech, and Hearing Services in Schools, 39, 408-421. https://doi.org/10.1044/0161-1461(2008/038)

Lee, A. S. Y., & Gibbon, F. E. (2015). Non‐speech oral motor treatment for children with developmental speech sound disorders. Cochrane Database of Systematic Reviews, 3, CD009383. https://doi.org/10.1002/14651858.CD009383.pub2

Lof, G. L. (2018, December 19). What does the research say regarding oral motor exercises and the treatment of speech sound disorders. Apraxia Kids. https://www.apraxia-kids.org/apraxia_kids_library/what-does-the-research-say-regarding-oral-motor-exercises-and-the-treatment-of-speech-sound-disorders/

Lof, G. L., & Watson, M. M. (2008). A nationwide survey of nonspeech oral motor exercise use: Implications for evidence-based practice. Language, Speech, and Hearing Services in Schools, 39(3), 392-407. https://doi.org/10.1044/0161-1461(2008/037)

McCauley, R. J., Strand, E., Lof, G. L., Schooling, T., & Frymark, T. (2009). Evidence-based systematic review: Effects of nonspeech oral motor exercises on speech. American Journal of Speech-Language Pathology, 18(4), 343-360. https://doi.org/10.1044/1058-0360(2009/09-0006)

Nural Sığan, S., Aksu Uzunhan, T., Aydınlı, N., Eraslan, E., Ekici, B., & Çalışkan, M. (2013). Effects of oral motor therapy in children with cerebral palsy. Annals of Indian Academy of Neurology, 16(3), 342-346. https://doi.org/10.4103/0972-2327.116907

OccupationalTherapy.com. (n.d.). Feeding development: What is typical? https://www.occupationaltherapy.com/articles/feeding-development-what-is-typical-5590

Playstreet. (2021, October 27). Oral sensory and motor issues seen in feeding. https://www.playstreet.in/2021/10/27/oral-sensory-and-motor-issues-seen-in-feeding/

Physiopedia. (n.d.). Sensory integration. https://www.physio-pedia.com/Sensory_Integration

Royal Children's Hospital Melbourne. (n.d.). Feeding development and difficulties: Physical, sensory and oral motor development. https://www.rch.org.au/feedingdifficulties/difficulties/physical/

Speech-Language-Therapy.com. (n.d.). Controversial practices - oral motor therapies. https://www.speech-language-therapy.com/index.php?option=com_content&view=article&id=49:readings&catid=11:admin&Itemid=108

SpeechPathology.com. (n.d.). 20Q: Non-speech oral motor treatments: Any evidence? https://www.speechpathology.com/articles/20q-non-speech-oral-motor-20430

Suburban Speech Center. (2022, January 7). Pediatric feeding and oral motor approach. https://www.suburbanspeechcenter.com/feeding-and-oral-moral-approach/

The Active Learning Space. (2022, May 9). Oral motor skills. https://activelearningspace.org/oral-motor-skills/

The OT Toolbox. (2024, August 22). Development of oral motor skills. https://www.theottoolbox.com/development-of-oral-motor-skills/

The OT Toolbox. (2024, February 23). Feeding developmental milestones. https://www.theottoolbox.com/development-of-bilateral-coordination-feeding-skills/

The Warren Center. (2021, October 8). Developmentally appropriate feeding skills by age. https://thewarrencenter.org/help-information/feeding/developmentally-appropriate-feeding-skills-by-age/

Wiener-Vacher, S. R., Hamilton, D. A., & Wiener, S. I. (2013). Vestibular activity and cognitive development in children: Perspectives. Frontiers in Integrative Neuroscience, 7, 92. https://doi.org/10.3389/fnint.2013.00092

Your Kids Table. (2025, February 17). Everything oral sensory processing: Activities and input ideas. https://yourkidstable.com/oral-sensory-processing/

Your Therapy Source. (2016, October 26). Postural control, gross motor development and mealtime. https://www.yourtherapysource.com/blog1/2016/10/26/postural-control-mealtime/