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Possible Oral Apraxia or Oral Motor Warning Signs

There are two types of oral motor problems.  

Oral Apraxia is a disorder where the child, who typically is a "late talker" is unable to coordinate and/or initiate movement of their jaw, lips and tongue (articulators) on command.  

Oral Motor disorders, which could be a different oral motor problem than apraxia (could be from weakness for example) is the second type, where the child is unable to coordinate and/or initiate movement of normal eating movements (vegetative activities.)

Here are some possible warning signs of the two types of oral motor apraxia written by a professional with help from Lisa Geng, the parent of two children who were diagnosed with 2 different types of oral apraxia by Dr. DeSouza, a neurologist.  This was updated after speaking with CHERAB's new advisor Sara R. Johnson CCC/SLP

Can your child do the following regularly, or on command..

bulletSmile?
bulletKiss, or make a kiss face?
bulletStick out their tongue?
bulletTry to touch their tongue to their nose?
bulletMake 'raspberries'?
bulletLick peanut butter off from their upper, side, or lower lip?
bulletImitate making a funny face?
bulletBlow out candles or blow bubbles? (a typically developing 10 month old can)
bulletBite their lower lip?
bulletShow various emotions in facial expressions?

If your child can not do all or some of the above -this may be a sign of Oral Apraxia which is worth looking into with medical and speech professionals.


Or does your child ..

bulletDrool excessively?
bulletBite straws when drinking, put the straw more than 1/4 inch into their mouth?
bulletOverstuff their mouths when eating?
bulletHave an open mouth posture?
bulletHave a protruding tongue?
bulletLook like they are smiling all the time?
bulletLike one brand of baby food carrots over another?
bulletHave a limited diet?
bulletSwallow without chewing?
bulletGrind his teeth during the day?
bulletHave a history of difficult nursing, or did you "not make enough milk for your child to nurse"?

If your child can not do all or some of the above -this may be a sign of Oral Motor problems which is worth exploring with medical and speech professionals.

If you are seeing any of the above signs, seek out the services of a Speech-Language Therapist for an evaluation of these skills. This can be done through your State's Early Intervention Programs, a free federally funded program for qualified children from birth to three years of age or through your school district's preschool disabled program, a free program for qualified children between the ages of three to 6 years.  You can also contact the American Speech Language-Hearing Association in Rockville, Maryland for a list of certified clinicians in your area."  It is very important to have an ACCURATE assessment completed by a skilled clinician.   You may also want an evaluation from a developmental pediatrician, or pediatric neurologist to look for signs of low tone (hypotonia) For more information please continue to explore our nonprofit.

A Reason to Know The Signs Of Oral Apraxia

by Lisa Geng, A Parent Of A Child With Apraxia

I just received an email from a parent who has a child that is about 18 months old, is nonverbal, and was recently diagnosed with oral apraxia.  She stated that she was a "blubbering idiot" because she cried, and I sent her this response, which may help some of you as well.

I remember that I went to a huge fair for "special needs children" that was a really wonderful and fun event for all the children-even the "normal" brothers and sisters that were there as well.  I remember having a great time, and then all of a sudden it hit me that my son was invited there, just like all these other children because he was "special needs."  All of a sudden it hit me-not that I didn't know before, but up till then those words never meant that much I guess.  

I stood there and was holding a hamburger for Dakota and a hotdog for Tanner and I looked at Tanner who was smiling and I started to tear.  My baby is "special needs."  I knew I could have lost it, so I focused on something else and acted like I had something in my eye.  

We didn't ask for this when we decided to be parents-this is an added surprise.  It doesn't mean that it's bad, it's just not what most people go through.

Believe me I know what it's like to go from "he's just a late talker-but man
 this kid is SO smart-just look at him!"
and believing he is completely normal: to finding out a day later that...

"he  is not talking because has a severe neurologically based speech disorder which is called all different names which can mean different things to different people since  the medical and speech professionals and the world can't agree on just one name so it's called apraxia or dyspraxia or oral or verbal apraxia or oral motor disorder or motor planning disorder or phonological motor planning disorder but no matter which name you call it most of the world is still ignorant to it but if I don't find out what he needs for appropriate therapy through insurance and school when it comes to speech and occupational and physical therapy as well as appropriate ways to educate him he may never learn to talk, and in addition he always had "soft" neurological signs like hypotonia and sensory integration that up until yesterday  I didn't even know existed and nobody not even his pediatrician ever knew he had and it took a neurologist and a developmental pediatrician to point these "soft" neurological signs out to us."

Sure there are warning signs of oral apraxia, which can be spotted long before verbal apraxia.  Problem is that most people don't know what they are.  Below are a few of the signs of oral apraxia that our son Tanner displayed.  Not every child with verbal apraxia has oral apraxia as well, but it is not uncommon.  Outside of the obvious, the reason we believe that we need to include this page in this website is because parents have read about oral apraxia at this website, and then based upon the "signs" of oral apraxia they learned about, they took their 2 year old child for an evaluation, where the child was diagnosed with oral apraxia by a professional.  

We have been told that besides this website, there is nothing else on the internet with "Parent Friendly "Signs Of Oral Apraxia".  

To give you an idea what is out there now, here are two  examples: This first one is a terribly complex example: a textbook definition of oral apraxia-scroll down to  number 3.  This second one goes to the opposite extreme of being an easy to understand definition of oral apraxia, but VERY limited information to say the least!  If you find anything new you believe is parent friendly, please let me know.

If there is not information out there that can be understood by people outside the field of speech, then there should be for important reasons:  Experts state that oral apraxia can be diagnosed as early as 18 months,  which is over a year younger than a positive diagnosis of verbal apraxia is usually received.  For the early intervention reason of "the sooner the better" for apraxia, awareness should be raised about oral apraxia while we continue to raise awareness about verbal apraxia.  Is oral apraxia a red flag to verbal apraxia?  Well according to Lori Roth, M.S.CCC-SLP, almost every child with oral apraxia has verbal apraxia.  So by catching these easy to spot warning signs early, we give our apraxic children the best possible chance.  Overcoming oral apraxia gives our children a smile, overcoming verbal apraxia gives our children a voice.  Below is a quote from "A letter to parents" which contains some of Tanner's early warning signs of oral apraxia. 

"...We decided that this diagnosis of apraxia finally explained why Tanner didn't move his face much, he typically would just stare at you without any smiles - we called him the “serious baby”.  Tanner couldn't even lick his own lips!  If Tanner had peanut butter or chocolate on his lip he couldn't even lift his tongue to try to lick it off.  Tanner would use his fingers to push the food on his lips into his mouth.  Also, Tanner couldn’t blow the candles out on his second birthday cake, in fact, he couldn't blow bubbles until almost 3 years old even though he tried and tried.  Nobody, including Tanner's Pediatrician, or his first Speech and Language Pathologist, knew these were all strong warning signs of Oral Apraxia-which can occur with Verbal Apraxia.  There are professionals who are knowledgeable, you just have to find them."

Dr. Marilyn Agin is the Medical Director for Early Intervention in New York, as well as having a private practice for pediatric and developmental medicine in New York City.  Dr. Agin is also the key medical authority behind the CHERAB Foundation.

A prominent Developmental Pediatrician in private practice in NY, Dr. Marilyn Agin, who attends many of our meetings, is also the Medical Director for Early Intervention in New York.  Dr. Agin, prior to medical school, received her master's degree in Communication Disorders, and was practicing speech pathology treating adults and children.  

Dr. Agin is extremely knowledgeable about apraxia, and autism, and frequently lectures to the medical community about what apraxia is, and isn't.   Dr. Agin gave permission for me to use her phone number on this website, (212) 274-9180.

When Dr. Agin saw Tanner for the first time at 3 years old she shook her head and said, "I could have told you a year ago this child had severe oral apraxia, he doesn't know where his tongue is in his mouth!"  She diagnosed Tanner with apraxia after a brief examination where it was never seen by Tanner's pediatrician, and it took months for even a speech therapist to diagnose Tanner with apraxia!   Tanner could have received appropriate therapy a year earlier if we only knew."

Dr. Marilyn Agin is in private practice as a Developmental Pediatrician, and the Medical Director for Early Intervention in New York City.  She is very knowledge about oral apraxia, and lectures to the medical communities about apraxia.  If you have medical questions regarding "Late Talker vs. Apraxia," why not "Ask Our Doctors"

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Send mail to support with technical questions or comments about this web site. 
Copyright © 1998 - 2003
Date of last update: February 17, 2003

To find your way around, click here for the index

"Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has." -- Margaret Mead, anthropologist

Send mail to Support with technical questions or comments about this web site. 
Copyright © 1998 
Last modified: Friday, June 03, 2005

To find your way around the CHERAB part of this site please click here for the index.

"Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has." -- Margaret Mead, anthropologist

Send mail to Support with technical questions or comments about this web site. 
Copyright © 1998 
Last modified: Friday, June 03, 2005

To find your way around the CHERAB part of this site please click here for the index.

"Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has." -- Margaret Mead, anthropologist