Question
What are some techniques to assist toddlers (around 20 months) who have an open mouth posture and drool? Are blowing bubbles and blowing horns effective?
Answer
Two readers sent in questions that were very similar about toddlers who have open mouth postures and drooling. In both cases the toddlers are reportedly within normal limits, although one appears to have low tone in the lips, is immature for his age, and has difficulty using a straw. I will assume that neither child has been diagnosed with a neurological, developmental, or swallowing condition.
An open mouth posture and forward tongue carriage is very common in toddlers and is a normal at-rest position. Children often sit at rest while watching television, listening to music or conversation, or when playing. It is likely that some children become engrossed in what is going on around them and do not notice that saliva is pooling in the mouth and spilling out on to clothes. Most children do respond easily to a gentle command to swallow, especially if they have heard it in the context of drinking or eating. A slight stoking of the skin under the mandible may also facilitate a swallow.
Controversy in the literature and in clinical practice exists in the efficacy of oral motor/neuromuscular exercises, even for those with known neuromotor disorders involving speech and swallowing. Clark (2003) provides an excellent review of the anatomy and physiology of neuromuscular impairments including weakness and disrupted muscle tone, as well as a thorough review of neuromuscular treatments, such as the use of active, stretching, and passive exercises, and the use of heat, cold, and electrical stimulation. Discussions in the literature also abound regarding using nonspeech activities to improve oral motor control for nonspeech and speech activities. In general, research does not support the use of nonspeech exercises for control of drooling or for improved articulation.
If the family and other care givers are concerned that oral structures and their functions may be compromised, the child should be immediately referred to a pediatrician or pediatric neurologist for evaluation. The speech-language pathologist should confer with the physician upon diagnosis of a neuromuscular condition to facilitate appropriate intervention planning for swallowing and speech development.
Clark, H.M. (2003). Neuromuscular treatments for speech and swallowing: A tutorial, AJSLP, 12, 400-415.
Dr. Kathleen Fahey has 27 years experience as a speech-language pathologist. She is a professor in the Audiology and Speech-Language Sciences program at the University of Northern Colorado. Her areas of expertise include normal and disordered speech-language and phonological disorders.