Feeding Problems and Orofacial Myofunctional Disorders (OMD)

Feeding Problems and  Orofacial Myofunctional Disorders (OMD)

Orofacial myofunctional disorders (OMD) or “oral myofunctional disorder” or “tongue thrust” are disorders of the muscles around involving the face, mouth, lips, or jaw. Recent studies on incidence and prevalence of tongue thrust behaviors are not available. However, according to the previous research, 38% of various populations have OMD. The incidence is as high as 81% in children exhibiting speech/articulation problems.  The incidence of OMD is as high in children picky eaters and feeding problems. With OMD, the tongue moves forward in an exaggerated way during speech and/or swallowing. The tongue may lie too far forward during rest or may protrude between the upper and lower teeth during speech and swallowing, and at rest. Signs or symptoms

  • Although a “tongue thrust” swallow is normal in infancy, it usually decreases and disappears as a child grows. If the tongue thrust continues, a child may look, speak, and swallow differently than other children of the same age. Older children may become self-conscious about their appearance.
  •  Some children produce sounds incorrectly as a result of OMD. OMD most often causes sounds like /s/,/z/, “sh”, “zh”, “ch” and “j” to sound differently. For example, the child may say “thumb” instead of “some” if they produce an /s/ like a “th”. Also, the sounds /t/, /d/, /n/, and /l/ may be produced incorrectly because of weak tongue tip muscles. Sometimes speech may not be affected at all.


  • Upper airway constrictions (e.g., deviated nasal septum) or obstructions (e.g., enlarged tonsils) or infections (e.g., rhinitis)
  • General hypotonia or low body tone
  • Low-lying resting posture of the tongue
  • Imbalance in dental growth
  • Inadequate development of facial and cranial bones
  • Inappropriate development of muscles in the head and neck areas
  • While identifying the causes of tongue thrust, it is important to remember that the resting posture of the tongue, jaw, and lips are crucial to normal development of mouth and its structures. If tongue rests against the upper front teeth, the teeth may protrude forward, and adverse tongue pressure can restrict the development of the oral cavity. The tongue lies low in the mouth or oral cavity and is typically forwarded between upper and lower teeth. If tongue thrust behavior is not corrected, it may affect the normal dental development. The teeth may be pushed around in different directions during the growth of permanent teeth.

Diagnosis OMD is often diagnosed by a team of professionals. Both dentists and orthodontists may be involved when constant, continued tongue pressure against the teeth interferes with normal tooth eruption and alignment of the teeth and jaws. Physicians rule out the presence of a blocked airway (e.g., from enlarged tonsils or adenoids or from allergies) that may cause forward tongue posture. SLPs assess and treat the effects of OMD on speech, rest postures, and swallowing. Treatment The basic treatment aims of orofacial myofunctional therapist is to reeducate the movement of muscles, restore correct swallowing patterns, and establish adequate labial-lingual postures. An interdisciplinary nature of treatment is always desirable to reach functional goals in terms of swallowing, speech, and other esthetic factors. A team approach has been shown to be effective in correcting orofacial myofunctional disorders. The teams include an orthodontist, dental hygienist, certified orofacial myologist, general dentist, otorhinolaryngologist, and a speech-language pathologist. A speech-language pathologist (SLP) with experience and training in the treatment of OMD will evaluate and treat the following:

  • open-mouth posture
  • speech sound errors 
  • swallowing disorders 

SLPs develop a treatment plan to help a child change his or her oral posture and articulation, when indicated. If tongue movement during swallowing is a problem, the SLP will address this as well. Treatment techniques to help both speech and swallowing problems caused by OMD may include the following:

  • increasing awareness of mouth and facial muscles
  • increasing awareness of mouth and tongue postures
  • improving muscle strength and coordination
  • improving speech sound productions
  • improving swallowing patterns 
  • Reinforce and establish a resting posture of the tongue away from the teeth, against the hard palate
  • Establish appropriate oral, lingual, and facial muscle patterns that promote correct gestures for chewing and eating
  • Retrain oral, lingual, and facial muscles to facilitate correct resting posture of tongue, lips, and jaw
  • Establish mature swallowing patterns
  • Prevent relapses after orthodontic treatment
  • Improve relationship between dental arches; reduce open bite and overjet
  • Improve nasal breathing patterns
  • Maintain overall facial muscle tone needed for chewing, swallowing, and speech
  • Create an oral environment that creates favorable conditions for development of dentition
  • Eliminate open-mouth posture
  • Eliminate dry mouth condition or xerostomia
  • Improve oral hygiene
  • Eliminate digit-sucking behaviors to facilitate normal growth of the palatal arch

If airways are blocked due to enlarged tonsils and adenoids or allergies, speech treatment may be postponed until medical treatment for these conditions is completed. If a child has unwanted oral habits (e.g., thumb/finger sucking, lip biting), speech treatment may first focus on eliminating these behaviors Complication

  • Lisping (for e.g., saying “thun” for sun)
  • Imprecise articulation of speech sounds
  • Open-mouth posture
  • Open bite
  • Abnormal eruption of teeth and dental arch
  • Abnormal tone of facial muscles
  • Prolonged meal times due to ineffective chewing and swallowing
  • Spillage of food/fluid from the anterior mouth
  • Negative cosmetic effects
  • Lower self-esteem
  • Problems with fitting of denture in future


  • American Speech-Language-Hearing Association (1993). Orofacial myofunctional disorders: Knowledge and skills. Asha, 35 (suppl.10), 21-23.
  • Garliner, D. (1974). Myofunctional Therapy in Dental Practice. Florida: Institute of Myofunctional Therapy.
  • American Speech-Language-Hearing Association. (1991) The role of the speech language pathologist in the management of oral myofunctional disorders. Asha, 33 (Suppl. 5), 7.
  • Benkert, K.K. (1997). The effectiveness of orofacial myofunctional therapy in improving dental occlusion. International Journal of Orofacial Myology, 23, 35-46

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Clinical – Editor in Chief : Dr WIDODO JUDARWANTO, pediatrician

Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider

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