Why

Oral stimulation aims to prepare for, and improve, eating function, maintain/normalize the sensitivity in the mouth and facilitate a normal swallowing frequency. It also helps the child to associate oral activity with food and feeling satiated from a meal.

When

Do the oral stimulation routine before every tube feeding or meal. If needed, the oral stimulation routine can also be used to dampen the child’s mouth, or to clean the mouth with damp gauze. In this case, the stimulation/cleaning is to be performed as often as needed and not only in relation to feeding/meals. 
Stop the stimulation if the child shows signs of discomfort or if the gagging reflex is provoked.  Try again at the next feeding.

Preparation

Position the child in side lying, sitting or half sitting position – depending on the occupational therapist’s instructions. Make sure the head is centered and held straight, and that the chin is leaned slightly down towards the chest. Support the child’s head if needed.
If necessary, clean the mouth with damp gauze before doing the oral stimulation. Cleaning is performed like the oral stimulation routine for gums and cheeks, but the gauze should only be brushed against the gums one time (not three), before being removed from the mouth. Swap to a new piece of damp gauze for each section of the mouth and/or for repeated cleaning of a specific section.
Dampen your finger with sterilized water before every stimulation. Make sure to apply firm pressure in all steps of the stimulation. Remember to give the child a brief pause between every stimulation, as this allows the child to process the stimuli and swallow.

Stimulation routine

Body and face

Start by touching the child’s hands and arms. 
Gently touch the cheeks and lips with the child’s own hands.

Gums and cheeks

Start by stimulating the upper gums on one side (1). Repeat on the lower gums (2), on the same side. Then repeat on the upper gums on the opposite side (3). And finally repeat on the lower gums on the second side (4).
With a dry finger, mark the spot for stimulation on the outside of the mouth. Then, using a damp finger, stimulate the outside of the gums with the soft side of the fingertip, starting at the middle and moving towards the back of the mouth. Stimulate the gum by moving the finger back and forth three times, then turn the finger around and stimulate/slightly stretch the cheek, while retracting the finger from the mouth. 

Tongue

Press firmly down on the tip of the tongue three times, moving the finger a little bit further in each time. Be careful not to go too far back, as this may trigger the gagging reflex.

Palate

Press firmly on the hard palate (right behind the front teeth) for a second. Be careful not to go too far back, as this may trigger the gagging reflex.