Q: Hi all! I am a SLP working with a 5 year old little boy with all the classic OM issues. Tongue-tie, cross bite, narrow palate, abnormal swallow pattern, poor lingual resting posture, etc. Parents followed through with lingual frenectomy via laser and he completed pre and post frenectomy exercises. I am currently working on appropriate resting posture and beginning swallowing exercises, although his attention is poor. Progress with /s/ is terrible. Due to the cross bite, he produces /s/ with a tiny hole between his right central and looks like canine. I have tried everything I can think of to reroute the air flow with NO LUCK. Is this a waste of time until they address the cross bite? They went for a consultation at their regular dentist and he won’t touch it until he is 8. I have suggested a second opinion and provided them with preferred provider, but they aren’t interested… Any advice?
A: Was the primary reason they came to you for the /s/ problem or something else? Without the full info I need, I can give you some things to consider, etc. Hope it helps. First and most important is the ORDER/SEQUENCE that you offer the treatment program. You eliminated the barrier, which is the number one thing to do…..good! He is no longer tongue tied. Here is the sequence usually needed: 1. Eliminate all barriers: oral habits, ankyloglossia, airway, habit devices (rakes, etc.) 2. Maximize him in lingual capacities: A. Shaping tongue within oral cavity – skinny, relaxed horizontal, lingual and vertical movements/excursions WITHOUT mandibular involvement so that the tongue is doing the targeted movement independently. We use the 2 and 3 Way Mouth Props to stabilize the jaw so that the tongue can move independently. You can use other tools but we use the Mouth Props. B. Suction flat to the palate. You said he has a vaulted narrow palate. If he cannot even come close to fitting the tongue within the palate, then you have hit a stop point. If he is just overflowing a bit, then your lingual exercises might allow it to fit in the palate in a short period of time. C. Bowl: he should be able to make and sustain a bowl. D. There are a few more things but I am not sure if you have the Myo Manual so I don’t want to confuse you. If you have the Myo Manual, let me know and I will try to guide you through the basic lingual training portion. Once he has maximized or passed all of these sections, then it might be fair to consider starting the /s/ at that point, unless it is a lateral /s/. In the case of lateral sounds, you have to take him beyond and through all of the suctioning exercises to be fair to him. All this considered, if he has a narrow palate and any airway issues, it probably isn’t even fair to ask him to produce /s/ and eventually habituate it. Without writing a book since I could add so much more, Carmen, I’m hoping this will help give you some guidance as to the sequential manner of approaching this young man’s difficulties. Hope all is well with you.