Oral motor skills refer to the coordinated movements of the lips, tongue, jaw, and cheeks that are used for eating, drinking, speaking, and managing saliva. These movements are deceptively complex. Even something as automatic as swallowing involves over 30 pairs of muscles working in precise sequence. Oral motor development begins in the womb — babies practise sucking movements before birth — and continues to develop throughout early childhood.

Strong oral motor skills are the foundation of safe, efficient feeding and clear speech. When oral motor development is delayed or disrupted, children may struggle with a range of challenges that affect nutrition, communication, social participation, and quality of life.

Oral Motor Development Milestones

Understanding what is typical helps identify when a child may need support.

Birth to 6 Months

Newborns are equipped with rooting and sucking reflexes that enable breastfeeding and bottle feeding. Sucking requires coordinated lip seal, tongue movement, jaw pumping, and swallowing. By around 4 to 6 months, these reflexes begin to integrate and become voluntary movements.

6 to 12 Months

Babies begin to eat pureed and mashed foods. Tongue movement shifts from a simple forward-back motion to a more complex up-down and eventually side-to-side movement, which enables chewing. The gag reflex gradually moves further back in the mouth as the baby gains experience with textures.

12 to 18 Months

Toddlers begin eating a wider range of textures. They can manage soft lumps and small pieces. Cup drinking begins, initially with a lot of spillage. Lip control and jaw stability are developing rapidly.

18 Months to 3 Years

Children develop rotary chewing — the circular, grinding jaw movement used to process harder textures. Straw drinking begins. Drooling reduces significantly as saliva management improves. The variety of foods tolerated typically expands.

3 to 5 Years

By age three to four, most children manage a full range of food textures. Drooling should be minimal except during concentration on a physical task. Oral motor skills become increasingly refined in support of speech articulation.

Common Oral Motor Difficulties

Oral motor difficulties can arise from a range of causes including prematurity, low muscle tone, neurological differences, sensory processing difficulties, and structural differences. Here are some of the most common presentations.

Drooling

Some drooling is normal in babies and toddlers. However, persistent drooling beyond age four may indicate difficulty with lip seal, reduced tongue control, or poor awareness of saliva in the mouth (an interoceptive difficulty). Drooling affects social participation, damages clothing and books, and can be a source of embarrassment for older children. Occupational therapy and speech therapy can both contribute to managing this effectively.

Feeding Difficulties

Children may gag frequently, refuse certain textures, struggle to chew efficiently, store food in their cheeks, or fatigue quickly during meals. These difficulties can have both oral motor and sensory origins. A careful assessment is needed to distinguish between a child who cannot manage a texture (oral motor) and a child who will not tolerate a texture (sensory).

Difficulty with Straw Drinking

Straw drinking requires sustained lip seal, graded tongue and jaw movement, and coordinated sucking and swallowing. Some children find this very difficult. Straw drinking is worth working on — it is an oral motor exercise in itself and provides social access to the drinking norms of their peers.

Mouth Breathing

Persistent mouth breathing can affect the development of the jaw, teeth, and oral musculature. It may have dental, structural, or sensory origins. OT can address the oral motor and sensory components while coordinating with ENT or orthodontic input where needed.

OT Approaches to Oral Motor Difficulties

Occupational therapists who specialise in feeding and oral motor skills use a range of evidence-based approaches.

Oral Motor Exercises

Targeted exercises build strength, range of motion, and coordination in the lips, tongue, and jaw. These may include activities involving blowing, sucking, chewing, and tongue movements — always integrated into fun, motivating activities rather than clinical drills.

Sensory Preparation

Many children with feeding difficulties have sensory defensiveness in and around the mouth. Sensory preparation before meals — gentle tapping around the lips and cheeks, exploring different textures with hands before the mouth, oral vibration — can reduce defensiveness and improve readiness for eating.

Systematic Food Introduction

For children with significant food refusal or texture aversions, structured approaches such as the Sequential Oral Sensory (SOS) Approach or the ARFID treatment framework provide a graded, non-pressured pathway toward expanding food variety.

Equipment and Adaptations

Selecting the right cup, spoon, or straw can make a significant difference. A child who struggles with lip seal may do better with a narrow straw. A child with jaw instability may manage better with a deeper-bowled spoon. Small equipment changes can reduce frustration and build confidence at mealtimes.

Working Together in Malta

Oral motor difficulties often benefit from a multidisciplinary approach involving occupational therapy, speech and language therapy, and where relevant, paediatrics, dietetics, or dental care. In Malta, I work closely with other professionals to ensure children receive coordinated support that addresses all aspects of their feeding and communication needs.

If you’re concerned about your child’s development, contact us at +356 99872936 or visit wonderkids.mt to book an assessment.

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