19 months old limited sounds

Q:

I recently watched your Orofacial Myology Introductory Course, and it was and will be extremely helpful for me! I wanted to ask your expert opinion on a new client. I tested a 19-month-old boy with a receptive score of 90 and expressive of 66. He is only saying mama and eye eye eye as his happy noise. He had difficulty breastfeeding due to tongue tie which was clipped. He seems to have a high thick palate and possible lip tie (I couldn’t see in his mouth well). I wanted to see what you would suggest as far as therapy. He needs a functional communication system (signs, pictures, words) but is there anything I can work on at his age to begin achieving lingual basics? One thing I will need to convince Mom to do is to get rid of his paci!!! Thank you for any input or goal suggestions.

A:

I don’t have a solid “feel” for who this young boy is or a vision of his potential.   I’ll give some input from what I think may help based on the info you sent to me:

Myo cannot be used in its usual manner since it draws “from” the client; however, certain motor skills can be advanced by doing “to” the client.  For example, with a gloved hand, one could stroke the sides of the tongue, stroke down the center of the tongue, etc. Then have Mom do it.  Then have the child attempt to do it, regardless of how accurate it is…it will still be helpful to his motor control.  Difficulty breastfeeding would not be caused by the release of a tongue tie unless there was something unmentioned with the success of the release.  It should have helped him, not hindered him with breastfeeding.  With a child this young and possibly other challenges, I would rely on as much oral motor training as possible.

With regard to his saying only mama and eye eye eye, I would start to build from those sounds.

Example:  As he says mama, have him repeat it after you.  Then you drag out one of the syllables and have him repeat that, possibly with a musical tone.  ma maaaaaaaaaaaaaaaa   ma maaaaaaaaaaaaaaaa

Then do something similar with another bilabial, probably /b/   baaaaaaaaaaaaaaaa ba  or ba baaaaaaaaaaaaaaaaaaa

Work on eye eye  by touching his lips together as he says it and you are creating   Bye Bye

These are the types of activities that make sense to me and are basic and rely on your trusting your instinct with this particular child; try many things slowly and continually to see what you can come up with…then add one small change and so on.

In his case, I’m not sure whether to eliminate the pacifier at this time.  How often is it used?  I’m just not sure without more information about the entire situation.

Remember to consider his age and ability to understand as you give exercises and other forms of treatment to this child.