Q: How do you teach young children to keep their mouths closed? I am working with a 28-month-old with an open mouth resting posture. He also sucks his thumb and uses a sippy cup.

This question is a huge one that requires a lot of background. I will be writing a full chapter on this in my next book, called 21^st Century Articulation Therapy to be published in 2012. Let me write a few main ideas here:

Medical

We always have to make sure that there is not a medical condition that is perpetuating the open-mouth rest posture. Upper respiratory problems are particularly problematic here. We want medical problems that are causing or perpetuating an open-mouth posture to be eliminated in ideal situations.

Thumbsucking

The thumbsucking is perpetuating the problem. A thumbsucking habit causes the child to habituate an oral posture with the jaw low and the lips parted. It has to be eliminated.

Feeding

With a child this young, I would make sure that he is moving through the food texture groups. If the child is still on purees and very soft food, he is not building the co-contraction of the muscles of his jaw, and therefore the jaw still sits low. I know that we have split speech and feeding apart in SLP, but this is a mistake in my opinion. Feeding is gross motor control. Speech is fine motor control. The second evolves out of the first. Gross motor control issues should be addressed before, or simultaneously, with fine motor ones.

Sippy Cups

The sippy cup has to go. Children lower the jaw and part the lips too far when they drink with a sippy cup. A regular cup forces the child to pull the jaw upward as he drinks. Even straw drinking is not good enough. The average child goes through a period where he bites down on the rim of the cup as he drinks. This helps develop the upward jaw position.

Chew Toys

Teach him to bite and chew on flexible firm objects – baby chew toys, chewy tubes, cloth, etc. This exercises the jaw muscles to pull the jaw upward. Babies naturally do this during the mouthing phase, which begins just before babbling occurs. Chewing on objects teaches the child to pull his jaw up and activate his lips.

Jaw Stability

Teach the client to bite down with the molars onto a firm objects that have a little give – straws, Toothette handles, toothbrush handles, swizzle sticks, bite blocks, bite sticks, etc. Place the object between his molars on one side, and give it a tiny tug to make sure he is gripping it with his teeth. Teach him to hold the object with his molars for increasing periods of time. Now a very young client might not have any molars yet, so this may have to wait until he does. If he does have molars, teach him to “hold it” while he engages in other quiet non-speech activity. WARNING: Do NOT do this during gross motor activity! Too dangerous!

Resistance to Jaw Elevation

Use resistance to build co-contraction of the jaw muscles. Press down slightly on the jaw, and tell the client to “pull it up.” With a very little kids you need almost no pressure at all – simply placing your finger on the front of his chin is enough weight. This teaches him to pull the jaw up in to place. (Chew toys do basically the same thing.)

Lip Closure

The child also has to learn to keep his lips closed for increasing lengths of time. This is what I do with kids who can handle a little more direction: Teach him to hold a thin, lightweight object between his lips. Use a coffee-stirrer straw at first, and progress to something with more weight, like the handle of a Toothette. Place the tool lengthwise between the lips, so the ends stick out to the left and right of his lips. Make sure he is not using his teeth and only his lips. Encourage the client to hold the object between his lips for increasing lengths of time while he is involved in other non-speech and non-feeding activities. Again, use caution and do NOT do this during gross motor activities.

Resistance to Lip Movement

Add a little weight to the lips to make them close more firmly. Press downward slightly against the lower lip and ask the client to pull it up. Press upward on the upper lip and ask the client to pull it down. This will activate lip closure.

Final Note

If the client has really low tone, closed mouth posture may take years to develop. Therefore we can weave these activities in and out of the client’s program on a regular basis. He can’t do this all the time, but he could do one or two of these activities every few days to encourage a closed-lips rest posture on a regular basis.

Resources on establishing a closed-lips rest posture:

• Marshalla, P. (2001) How to stop thumbsucking. Marshalla Speech and Language. Kirkland, WA.
• Morris, S. E., & Klein, M. D. (2000, 1983). Pre-feeding skills: A comprehensive resource for mealtime development, 2nd edition. Austin, TX: Therapy Skill Builders (Harcourt Health Sciences).
• Hanson, M. L., & Barrett, R. H. (1988) Fundamentals of orofacial myology. Springfield: Charles C. Thomas.
• Van Norman, R. (1999) Help for the thumb-sucking child. NY: Avery.