Q: I have a preschooler with an open mouth posture and forward tongue carriage. What homework for parents would you suggest? Should the Mom remind her to keep her mouth closed during play?

Treatment and homework activities depend completely upon the cause of the problem. She keeps her mouth open too much of the time. Why? The answer to that question guides your assignment of any activities, whether they are performed in the therapy room or at home.

There can be many different causes of an open mouth posture. For example, the child may have enlarged tonsils/adenoids and must keep the mouth open to breath. Or she might have low muscle tone and therefore allows the mouth to hang. Or she might have high tone that causes the lips to part. Or she might have malocclusion and therefore cannot close her mouth. Or this could be a simple habit.

The answer to the why-question guides treatment. This is the differential diagnosis. The homework will vary widely depending upon the differential diagnosis.

• Maybe the homework is to get the kid to a doctor to see if she has allergies.
• Maybe the homework is to get the child to the swimming pool every day to encourage better muscle tone.
• Maybe the homework is to chew gum every day in order to stimulate the masseter and internal pteragoids for a higher jaw position.
• Maybe the homework is to keep the lips closed for 30-minutes every day while watching a movie.
• Maybe the homework is to massage the face to loosen facial muscles that are too tight and holding the lips back away from one another.
• Maybe the homework is for the mom to give reminders.

Any one of these solutions can be effective depending upon the cause. Find the cause, and then begin to think about homework activities.