MYOFUNCTIONAL SYMPTOMS AGES 1-5+
Why Early Intervention Matters
Let’s discuss the Myofunctional symptoms which can be observed in children aged roughly 1 to 5+. There are a variety of physical and social problems which can be caused by myofunctional issues, so if your child shows some of the issues or behaviors below, they may benefit from Early Intervention Myofunctional Therapy.
Issues with food and eating
One of the clearest indicators of myofunctional issues in children two to four years of age is problems with food and eating. Common complaints of parents whose children have these issues are, “He is such a picky eater!” or “I can’t get him to eat many fruits or vegetables or meats, except chicken nuggets!” Problems can also include the child gagging or even vomiting when eating, or extreme messy eating.
If your child is sensitive or aversive to certain food textures, or seems to be a picky eater, then this can indicate a problem with their tongue muscles or swallowing. This occurs when the child cannot use their tongue adequately to form a proper bolus and move the food to the center of the tongue to initiate a swallow. In extreme cases, children may even choke on food if they cannot swallow correctly.
These issues may not be obvious when the child is first introduced to solid foods (around 6 months), because parents will start with very soft manageable pureed foods. However, once the child becomes a little older (around 1 year) and starts to eat harder solid foods, problems can become more apparent. Parents should be aware that these issues may become visible only when the child is a little older.
Speech symptoms
Another possible indicator of myofunctional issues is a delay in your child’s speech or exhibiting speech sound errors. These sound errors can greatly impact a child’s intelligibility to unfamiliar listeners. The child may say very little, or be hard to understand when they do speak, which can indicate problems with the positioning of the tongue. While some children do start speaking later than others, if you notice that your child seems frustrated by their lack of communication, or unable to produce certain sounds properly, this may indicate a physical oral motor problem rather than them just being a late developer.
If you are unsure about your child’s speech development, head to www.speechlanguagespot.com for information regarding speech, language and feeding milestones at various age ranges.
Speech errors can also be caused by a tongue-tie (where the tissue connecting the tongue to the bottom of the mouth is too short or too restricted) and performing a tongue-tie release. Some children will begin to speak more often and/or more clearly on the very day that the tongue-tie release is performed. Other children require myofunctional therapy to retrain the oral muscles. Tongue-ties are often related to myofunctional issues, as both involve problems with the tongue and swallowing. All speech sounds can be impacted by a restricted tongue, specifically speech sounds that require the tongue tip to reach the alveolar palate (such as t, d, n) and speech sounds that require full elevation and mobility of the tongue (such as l and r).
Tongue Thrust/Lisp/Reverse Swallow
A proper swallow requires the tongue to elevate and press against the palate. We swallow between 700-1000 times every day. If something is blocking the tongue's ability to make contact with the palate OR if there is a structural reason that is restricting the tongues mobility and ability to elevate (such as a tight or short frenulum "tongue tie"), then the tongue typically thrusts forward to close off all spaces and create the intra-oral pressure needed to swallow.
When the tongue is moving anteriorly and pressing against or even through the teeth during a swallow, this is called a "Tongue Thrust" or reverse swallow. Tongue thrust can affect dentition, cause malocculsions such as an Anterior Open Bite, and can affect speech sounds such as (s & z) or cause a "lisp". Tongue thrusting can also affect feeding, as the tongue also needs to elevate to the palate to swallow food.
Habits that contribute to myofunctional issues in this age group
Habits related to myofunctional issues include using a pacifier, prolonged bottle use, sippy cups, sucking on clothes or blankets, or sucking on digits (fingers/thumbs). A low resting tongue posture can be the result of any of the above-mentioned habits, which leads to an improper swallow. Children start to suck on pacifiers, fingers or other things in order to stimulate the release of endorphins, which should happen during proper tongue rest posture and proper swallowing. In the absence of correct tongue posture and swallowing, habits like digit-sucking meet a need. Such habits are hard to break unless you retrain the tongue, and if not corrected they can change the growth of the face and upper and lower mandible.
Sleep challenges and resultant behavioral symptoms
Children in the toddler and early school years with myofunctional issues are sometimes prone to sleep disturbances like sleep apnea, night terrors, frequent waking, snoring and/or bed wetting after potty training. Myofunctional issues are strongly related to these concerns as they can lead to breathing problems (mouth breathing), which result in poor sleep.
With poor sleep, behavioral changes can be observed. If children are displaying ADD/ADHD symptoms such as inattention, impulsivity, or low tolerance for frustration, this can be due to not getting deep restful sleep. Parents may think that such behaviors are due to the child’s personality, but in fact they can be caused by myofunctional issues leading to enlarged tonsils/adenoids (see below) and resultant insufficient oxygenation at night and disturbing their sleep.
Growth and development
There are certain developments of the face and underlying bone structure which occur in the 1 to 5+ years age range, during which myofunctional issues become noticeable. Breastfeeding allows the upper mandible to develop and grow outward and forward, expanding the palate because nursing promotes proper lingual and mandibular positioning during sucking and swallowing. Bottle feeding promotes improper lingual positioning during sucking and swallowing. This can cause the child to develop a low resting tongue posture causing insufficient development of the upper and lower mandible.
The lack of development of the mandible can lead to poor tooth position, loss of airway space, and swallowing problems. Any noticeable malocclusion of the upper or lower mandible, like an overbite or underbite, is indicative of myofunctional issues.
Ear and tonsil infections
A final common symptom of myofunctional issues in young children is that they frequently develop ear infections and present with enlarged tonsils and/or adenoids. When swallowing is performed correctly, it clears the Eustachian Tubes, reducing risk of fluid accumulation or subsequent ear infections. If the child is not using the tongue to seal against the palate creating the intraoral pressure required to swallow properly (whether due to habitual reasons such as bottle feeding, thumb sucking or pacifier use OR due to structural reasons such as a restricted tongue/tongue tie), then the Eustachian tubes are often not cleared efficiently, leading to the development of fluid and or ear infections in the middle ear. This often leads to the child requiring Pressure Equalizing Tubes (“PE Tubes”) to help drain the fluid, but it doesn’t correct the swallow dysfunction.
Similarly, mouth breathing can cause the tonsils or the adenoids to become hypertrophic or enlarged, encroaching on the child’s airway space. As we previously discussed, breathing through the nose is preferable from a health perspective as it humidifies and filters the air before it passes through the airway, lessening the likelihood of infection. Children who have myofunctional issues are more likely to breathe through their mouth and are at a greater risk for infection or frequent colds/illness.
In some cases, the tonsils can become so swollen due to infection that they become very large (hypertrophic) and can block off much of the upper airway, making nasal breathing impossible. In these cases, it is necessary for the child to have the tonsils removed before they can be trained to breathe nasally.
It should be noted that the relapse rate for sleep apnea and airway constriction after tonsils and/or adenoids are removed is greater than 50%. When a child has surgery to remove tonsils and adenoids because of frequent infections/sleep apnea/inability to breathe through nose, immune tissue often regrows and airway becomes a problem again. This is why it’s helpful to check for myofunctional issues as young as possible, so that therapy can begin before more serious problems develop. In many cases, myofunctional therapy can be used to reverse hypertrophic tonsils and adenoids, as well as correcting issues that lead to chronic ear infections.
Conclusion
If your child is displaying any of the symptoms described here, then it would be a good idea to get them checked for myofunctional issues. Early Intervention Myofunctional Therapy may be able to help improve issues related to sleep, feeding and breathing. The earlier therapy is started, the less time it takes to retrain the dysfunction and outcomes are improved.
Myofunctional treatment requires an Interdisciplinary approach. If your child exhibits any of the above behaviors, it is critical to seek out an airway centric dentist or ENT whose practices specialize in Oromyofunctional Dysfunction, as not all providers are familiar or experienced in this realm.
I work very closely with several of the best airway centric Pediatric Dentists & Tongue Tie Release Providers and would be happy to provide you with a referral. Contact me for more information.
Dena Freedman-Muchnick, M.S., CCC-SLP, CLC
Speech Language Pathologist
Certified Lactation Consultant
Orofacial Myofunctional Therapist
IG @lactationspot
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