By Adriana Palacios, myofunctional speech therapist.

Speech therapy specializing in myofunctional therapy is responsible for evaluating, diagnosing, and addressing possible disorders in the stomatognathic system (SS). This system consists of the oral functions of sucking, breathing, chewing, swallowing, and speech. The proper functioning of the stomatognathic system is involved in craniofacial development and, therefore, will impact all stages of the individual’s life.

These oral functions are formed by different structures that encompass the muscles of the upper, middle, and lower third of the face:

Oral cavity / Source: Adriana Palacios

Structures of the SS / Source: Adriana Palacios

The stomatognathic system develops in the fourth week of pregnancy. In the ninth week of intrauterine life, mouth-opening movements and intraoral stimulation movements such as swallowing begin. In the 12th week, sucking and swallowing becomes more regular.

From birth, sucking-swallowing-breathing coordination allows the newborn to feed. At this point, difficulties can arise, and speech therapy specialized in myofunctional therapy and swallowing will be necessary.

The difficulties that can occur are:

• The presence or not of reflexes of the mouth area, such as: sucking, rooting, tongue crossing, tongue protrusion, biting, swallowing, gagging, and coughing. As well as tongue elevation movements.
• During sucking: not being able to initiate sucking, weak sucking, dysfunctional or disorganized sucking pattern, difficulties in latching on the nipple or teat, difficulties with lip sealing, loss of milk from the lip corners, excessive tongue protrusion, lack of sensorimotor control that generates an oversensitive or undersensitive pattern in the oral cavity.
• During swallowing: occurrence of choking, nausea, coughing, nasal spit-up of milk (nasal reflux), oral defensiveness, or general irritability.
• Other respiratory problems including pneumonia or recurrent respiratory infections, periods of apnea, and cyanosis.

Other difficulties that could be observed when the newborn is at rest are dribbling/drooling and/or an increase when sleeping, tongue positioning, the maintenance of the lip seal, and the type of breathing that the baby has and maintains. This combination of difficulties can impact the tone and muscle strength of the structures involved and as a consequence the proper functioning of the SS.

In lactation, several warning signs point to difficulties in the stomatognathic system, such as when the mother feels pain during feeds, when there is a clicking noise during the feed, relatively long feeding sessions or lethargy during feeding, severe irritability or behavioral problems during feeding, presence of tongue-tie.

This is why myofunctional speech therapy can perform a complete evaluation to determine the possible causes and the approach following a methodology such as myotherapy to improve the functioning of the stomatognathic functions, this is called myofunctional therapy.

References

Zambrana, N. y Puyuelo, M. (coords.). (s.f.). Terapia miofuncional orofacial: actualización y nuevos campos de actuación. Editorial EOS. 
García, R., Paniagua, J., Gimenéz, P., Murciego, P. y Simao, M. (2022). Abordaje de la disfagia pediátrica-neonatal. Elsevier.

Adriana Palacios is a myofunctinal speech therapist, she works in person at the LactApp Barcelona Clinic