Why

Oral stimulation aims to prepare for, and improve, eating function, maintain/normalize the sensitivity in the mouth and maintain or (re)activate the oral reflexes, for instance the suckling and the swallowing reflex. 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 breast, bottle or tube feeding. 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.
Stop the stimulation if the child shows signs of gagging/discomfort. 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 and swapped for a new piece of gauze.

Stimulation routine

Body

□ Start by touching the child’s hands and arms with a firm grip/pressure.

Face

□ Use the child’s own hands to touch the cheeks and lips a few times, with firm pressure.

□ Stroke the child’s cheeks with your fingers using a smooth motion going from the earlobes towards the corners of the mouth, while applying a firm pressure. Then, if possible, stroke from under the eyes and down towards the mouth. Finish by stroking downwards from under the nose towards the mouth. Repeat 3 times on each side, either simultaneously or separately.

Upper lip

□ Stimulate the inside of the upper lip (with the soft part of the fingertip towards the lip) with a damp finger – starting at the side of the mouth and moving towards the middle. Stop at the middle, remove the finger from the mouth and repeat on the other side.

Gums and cheeks

□ Mark the spot for stimulation on the outside of the mouth. Then stimulate the upper gums on one side, starting at the middle (right above where the front teeth will be) and moving towards the back of the mouth (above where the molars will be). Stimulate three times, then turn the finger around and stimulate/slightly stretch the cheek, while retracting the finger from the mouth. Repeat on the lower gums on the same side. Then repeat on the upper gums on the opposite side. And finally repeat on the lower gums on the second side.

Palate

□ Pres firmly against the palate, to activate a sucking action.

□ Start with the fingertip placed at the center of the palate. Make a swiping motion towards one side, while pressing firmly against the palate. Release the pressure and start at the center again, swiping towards the other side. Repeat the stimulation three times (on each side). Give the child a brief pause, before repeating the stimulation again, three times on each side.

Tongue

□ Touch the tip of the tongue with firm pressure and move the finger back and forth (approximately 1 cm) at the center of the tongue.

□ Place the fingertip at the center of the tongue, apply firm pressure and pull the finger towards the tip of the tongue. Repeat this movement for 5-10 seconds. After a short pause, repeat this step of the stimulation.