Oral Fixation

Oral Fixations

“Believe you can and you’re halfway there.”- Theodore Roosevelt

What are oral fixations?

Oral fixations refer to a strong or obsessive craving to put things around or in the mouth. During early childhood, infants go through a phase in which it is developmentally appropriate to put things in and around the mouth. This oral phase of exploration allows children to explore different things within their environment (biting, chewing, sucking on toys, clothing, paper).  Eventually, children outgrow this behavior by the end of their toddler years. However there are some children that engage in these behaviors long after infancy, which may be indicative of an oral fixation. It is important to eliminate any oral fixations, as it causes the individual to sit with an open mouth posture with the tongue forward in the oral cavity, contributing to lingual weakness.

Why does my child constantly put things in his/her mouth?

An infant places items in and around the mouth to learn and explore their environment. Sucking on items involves pleasure and can calm a hungry or teething baby. Mouthing and chewing is another way to explore and manipulate their environment. However, those children that continue to engage in these oral habits after infancy may be experiencing oral fixation. Oral sensitivity, timing of “oral phase” activities, and cravings may be some reasons your child is experiencing oral fixations

Oral sensitivity– Hypersensitivity! Children may be hypersensitive to objects in their mouths, and therefore may require/crave more oral stimulation.  These children will often bite, chew, and/or suck on any object they can get their hands on to fulfill this sensation!

Weaning off the ‘Oral Phase’– Timing is important in regards to weaning a child off of oral phase activities. These activities include weaning a child off a pacifier, bottle, breastfeeding, and/or sippy cup too early or too late. Children typically should be transitioned off the bottle and sippy cup, and to an open cup, around the age of one.  The American Academy of Pediatrics recommends that infants be solely breastfed until six months of age and then breastfed in tandem with solid foods.  Although breastfeeding is recommended for a least the first year and then for as long as mutually desired by the baby and the mother, the continued act of sucking perpetuates the anterior motion of the tongue within the oral cavity and can influence oral facial muscle imbalance, adversely affecting feeding and swallowing skills as well as expressive speech skills. Karen Sokal-Gutierrez, M.D., M.P.H. states that children who use a bottle and sippy cup for prolonged periods of time flatten the tongue to draw fluid from the cup and push it to the back of the mouth for swallowing. This action is different from the muscles used to drink from a regular cup. Prolonged bottle use prevents the development of muscles that are needed for speaking and articulation because a child has not had practice using these muscles.

Cravings– Your child may be craving different tastes- salty, sweet, bitter, sour!

Symptoms of Oral-Fixations

  • Constantly biting finger nails
  • Constantly putting fingers in or near mouth
  • Excessive biting, chewing, sucking on items around him/her
  • Thumb sucking
  • Teeth grinding
  • Lip licking
  • Nail biting
  • Tongue sucking

Negative effects of continued oral fixations

As stated earlier, oral fixations cause the individual to sit with an open mouth posture with the tongue forward in the oral cavity, contributing to lingual weakness. In addition other effects include:

  • Separation anxiety
  • Immature activities (crying and tantrums)
  • Poor eating habits
  • Poor oral hygiene including drooling resulting from lingual weakness
  • Oral motor issues that affect the tongue, lips, jaw, and placement of adult teeth

What can I do to help?

Contact us! Speech-language pathologists specialize in helping to address oral fixations. We help to find ways to reduce inappropriate oral behavior. Together we can find out what triggers oral fixations, and from there reduce the behavior. This will benefit the child’s overall well-being and improve performance.


(Hutton, Thaashida, 2009)


-Pamela Leibowitz







10 Productive and Fun Indoor Snow Day Activities

Well here it is… the 1st blizzard of 2015 .Let’s make this snow day a fun, yet productive one! Below are 10 indoor snow day activities to enhance your child’s speech, language, pragmatic, and critical thinking skills.

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1. Pajama Party Fashion Show– Pick out ridiculous outfits, accessories, and shoes from around your house and have a little fashion show down your hallway. You can be the first ‘model’ by strutting your ridiculous outfit down the hallway. Have your child narrate and describe the attire that you are wearing. For example, “Here comes mom, dressed in red and white plaid pajamas, with socks around her ears to keep her warm.” Take turns ‘modeling’ and judging the pajama fashion show! This is a great way to build vocabulary, form SVO sentences (subject, verb, object, sentences), and expand language!

2. Build a Fort– Gather up some old boxes, bed sheets, and a flashlight. Build a fort together and have fun! When the fort is made, shut off the lights to set the scene. Tell ghost stories or silly stories inside the fort together. This is a great way to be creative with language in a relaxed atmosphere.

3. Indoor Picnic- Grab a basket, a sheet, some plates, utensils, and finger foods and you’ve got yourself a picnic! Work on prepositions (ie., “I’m putting the muffin ON the plate, or the turkey is BETWEEN the bread). Prepositions take some time to learn; allowing this to be a hands on experience will be very beneficial for your child. Another activity is the ‘ABC Alphabet Picnic Challenge.’ What might this be you ask? Well it’s a challenging game that makes you think (and helps to build vocabulary and categorization skills). Take turns reciting each letter of the alphabet, as you say a letter state a food that starts with that letter! For example, A- apples, B- bananas, C- carrots, D- Doritos, E- Eggs, F- Frozen yogurt… (and so on). See how far you can go! Can you repeat the alphabet again with different foods??

4. Bake Cookies– Baking cookies is always fun! Pick out a fun recipe together. Target following directions (receptive language tasks), “Bring me a spoon.” If this is hard for your child, model it and do it together. If you notice your child is doing well, bring it up to 2-3 step directions. For example, “Bring me a spoon and then put it in the bowl.” In addition you can also target auditory processing skills. Read your child a small section of the recipe. Have your child recall information presented auditorily to them (How many tablespoons of sugar did the recipe call for). Lastly, you can also target sequencing. Read the first 3 steps to the recipe, and then have your child recall what those steps were in the appropriate order. If this is difficult for your child, give him/her choices!

5.Snow Castles Inside-Bring a small baby pool inside the house and make snow castles! This is great way to increase sensory awareness and build on language. You can use words like my castle is “Bigger, smaller, taller, wider, shorter, and/or smoother.” You can even create a Venn diagram comparing and contrasting your castles. Use words like “same” and “different.”

6. Play Board Games– Target turn taking skills and pragmatics!

7. Cook Dinner Together– As stated earlier under the ‘Bake Cookies’ section, have some fun targeting language skills, auditory processing, and sequencing in the kitchen.

8. Make Magazine Mosaics– Grab a bunch of old magazines, some scissors, and glue. Create a collage (a wintery collage, funny pictures, your initials, or anything you want). Take turns explaining your creations to each other or your family members.

9. Tell a ‘Story in a Bag’– Similar to charades, tell a ‘Story in a Bag’ is a fun way to think on your feet and have fun with language! All you will need is 2 large grocery bag (or any bags) and a few random items around the house. Pick out random objects for each other and put them in your bag, but don’t say what they are! When you both have your random objects in the bag- switch bags! 1 person at a time will tell a story using all the objects in the bag. This is a great way to target critical thinking and problem solving.

10. Exercise– Target receptive language and listening skills through “Simon Says.” This is a great way to be active and productive! For instance, “Simon says do a sit up, then a jumping jack.” This will keep the children engaged and listening attentively. Not only are they working on their language skills… but it also gives them a chance to partake in physical activity (which will benefit their overall physical and mental health). I recommend that you also go ahead and checkout GoNoodle!!! It’s a fantastic website that parents, speech-language pathologists, teachers, and children can use to target physical activity and following directions (https://www.gonoodle.com/)

Classrooms doing GoNoodle together:


& here’s a small segment of what GoNoodle looks like:


Have a wonderful, fun, and productive snow day!!

Pamela Leibowitz MA CF-SLP TSSLD



“There are no secrets to success. It is the result of preparation, hard work, and learning from failure.”- Colin Powell


Carryover is the generalization of a skill/ or skills learned in the clinic to outside settings.  While it is important to come to therapy sessions, it is also just as important to PRACTICE your skills at home. As the old saying goes, “Practice makes perfect.”  Increased practice and time on a skill will improve an individual’s success and rate of mastery.

There are no secrets to success. It is the result of preparation, hard work, and learning from failure.” Colin Powell

Ways to carryover at home:

  1. Homework (Carryover for children/adults)- Put effort into the homework that is sent home by the clinician (from practicing your oral motor exercises to targeting language goals or compensatory strategies). This is a great way to spend time on a skill and practice a skill at your own pace. If you have any questions or concerns about your homework, tell the clinician! Clinicians love feedback. Also, if you have a skill that you want to work on…voice your opinion! Tell your clinician what is important to you.
  2. READ (Carryover for children/adults)- Whether you are an adult coming for therapy or your child is coming for therapy, a great way to build knowledge is to read! If you are an adult coming for therapy such as… voice therapy, I recommend you do some research and read about ‘the voice’…familiarize yourself with the topic. Furthermore, let’s say your child is coming for language therapy. A great carryover technique to use at home is to read a book with your child… ask WH- questions (who, what, where, when, why?), have your child sequence events in a story, recall an event that happened, and/or make predictions.
  3. Crafty project (Carryover for children) – Do a craft with your child. Have fun! Have them follow 1 step directions. If you notice the child is doing well with directions try out 2-3 step directions. Talk about the craft, and increase vocabulary. Increasing vocabulary and following directions will benefit your child.
  4. Set a good example (Carryover for children)- Model good language and discipline. Show your child that it is important to practice, do it with them, and show them that you are there for support.
  5. Reinforcement (Carryover for children/adults)- Work hard play hard is a great motto to live by. Encourage yourself to practice. For adults reading this… TREAT YOURSELF! Say to yourself that if you practice, you will (not only be more successful at the skill) treat yourself to something you love! Maybe frozen yogurt? A manicure? A good movie? For children, come up with a sticker chart/ reward chart. Let’s say they practice 3 times a day for 7 days. Practicing will  then  allow them to pick out a new toy from the toy store, or get to go out for ice cream.

Pamela Leibowitz MA CF SLP TSSLD




“To keep the body in good health is a duty…otherwise we shall not be able to keep our mind strong and clear.”- Buddha

Here we are in mid January…the weather is cold (BRrrRRrrrr) and the germs are spreading like wild fire! We are constantly exposed to germs every day; from pressing the elevator button to touching a stairway’s banister. We have busy lives and important things to do, but what comes first is our health!! We must take care of ourselves. In order to be productive we need to FEEL good and be ready to conquer the world! Below are some tips for staying healthy.

  1. Wash your hands– Viruses are spread easily. Avoid touching your mouth, putting your fingers anywhere near your nose, and rubbing your eyes. Wash your hands thoroughly several times each day, especially before meals. Whenever you come back into your own house, make it habit to wash your hands! Carry a little hand sanitizer with you to kill some germs while you’re out on the go.
  2. Have a healthy diet– Consume foods rich in vitamins C and E. These vitamins are believed to be helpful in supporting the immune system. Vitamin C foods include: orange juice, bell peppers, dark leafy greens, kiwis, citrus fruit, tomatoes, and peas. Vitamin E foods include sunflower and corn oils, sunflower seeds, nuts, kale, and avocados.
  3. Sleep well!– Lack of sleep may inhibit your immune system. A good night sleep will keep your immune system at an optimal level.
  4. Stay hydrated– FLUIDS, FLUIDS, and FLUIDS! Drinking water will help you to stay healthy. Bring a water bottle with you and encourage yourself to sip on it throughout the day. When you are feeling a bit ‘under the weather’ drinking water prevents dehydration caused by a fever and loosens mucus. In addition, drinking tea when you feel sick or have a cold is very beneficial! There is also some evidence that inhaling steam early in the course of a cold or flu may reduce the spread of the virus.
  5. Work out– Exercise! Exercise is beneficial for both your physical and mental health. Exercise is known to lower stress levels, but research also indicates that exercise can enhance the immune system. In a recent study reported in Medicine and Science in Sports and Exercise, scientists found that modest exercise may prevent the elderly from getting colds and flu.
  6. Listen to your body– If you are feeling sick take it easy and slow! Don’t expose those around you to the virus that you may be coming down with. Wash your hands, get good sleep, and cover your mouth.
  7. Visit the doctor– If your symptoms worsen and your fever begins to rise, seek medical attention as soon as possible.

(Boiron, 2015).

Stay healthy!

Pamela Leibowitz MA CF-SLP TSSLD

Increasing Sentence Length

Increasing Sentence Length

“Communication is a skill that you can learn. It’s like riding a bicycle or typing. 
If you’re willing to work at it, you can rapidly improve the quality of very part 
of your life.”- Brian Tracy


What is morphology and MLU?

Morphology is the study and description of how words are formed in language. MLU (Mean Length of  Utterance)  refers to the average length of a sentence. MLU is typically measured in morphemes.  A morpheme is the smallest unit of language that holds meaning. For example the word ‘frog’ is one morpheme. You know this because if you break down the word to “fr-“ and “-og” each separate component does have any meaning in isolation. However, if you break up the word “frogs,” now you have two morphemes…. Frog (‘ribbit ribbit’)  and “s” (meaning more than one).

This is a crucial component when calculating a child’s MLU.  Overall the more complex the sentence is, the higher the MLU! A child’s MLU varies according to age. Below is an MLU age appropriate chart based on Roger Brown’s stages of language development:

Roger Brown’s Stages of Language Development:

Age (in months) MLU (Mean Length Utterance)
12-26 months ~1.0-2.0
27-30 months ~2.0-2.5
31-34 months ~2.5-3.0
35-40 months ~3.0-3.75
41-46 months ~3.75-4.5
47 months + 4.5+


How can I increase my child’s sentence length?

It’s important to remember that every child is unique.  When increasing /improving sentences, start by making note of what is missing from your child’s speech. The ultimate goal is for the child to form a sentence using subject, verb, and object. For example, “The boy is playing with his toys.”

  1. Increase vocabulary– Simple ways to increase a child’s vocabulary is to talk out loud. Tell your child what you are doing. You can incorporate this into your daily routine. Point out different places, animals, or things in your environment. Another way to increase vocabulary is through play! Play with your child and make learning fun. You can also buy flash cards/picture cards or use your iPad.
  2. Improve grammar – Grammatical markers play a major role when calculating MLU. A child that says “me hungry” is only getting credit for 2 morphemes, whereas a child that says “I want more food” will get credit for 4 morphemes. Therefore, model grammatically appropriate sentence for your child at home! Reading books together is another great way to facilitate and improve grammar.
  3. Expand! Expand your child’s sentences. For instance if the child says, “Purple flower” you can say “Wow, the purple flower is very pretty!” This technique can be facilitated in every day conversation and/or in play.

Pamela Leibowitz MA CF-SLP TSSLD 🙂

Go Ahead, Catch Some ZZZzzZZzzz’s!!

Go Ahead, Catch Some ZZZzzZZzzz’s!!

“Sleep is the golden chain that ties health and our bodies together.”- Thomas Dekker


Why is sleep so important?

Your body can be compared to a battery; it must be recharged on a regular basis to function properly. Good quality sleep is critical for one’s overall physical and mental health. A good night’s sleep enhances memory, stimulates creativity, improves overall performance, sharpens attention, improves physical health, and lowers stress levels.

How much sleep do you need?

Amount of sleep varies for each individual, but on average the body needs about 7-8 hours of quality sleep every night. It is best to go to bed at a regular time each night, and wake up at a regular time every morning.

What are some signs of a sleep disorder in adults?

Obstructive Sleep Apnea (OSA) is a cessation of airflow for greater than 10 seconds with continued chest and abdominal effort.  Symptoms of OSA in adults include:

  • Heavy snoring
  • Breathing stops while sleeping and results in a ‘snort’
  • Day time sleepiness
  • High blood pressure
  • Morning headaches
  • Restless sleeps
  • Depression
  • Anxiety
  • Short term memory loss
  • Intellectual deterioration
  • Temperamental behavior
  • Poor job performance
  • Overall weakness
  • Dry mouth
  • Mouth breathing

If you have any of these symptoms, and feel you may have a sleep disorder, consult your physician or ENT (Ear Nose Throat doctor) as soon as possible!

What are some signs of a sleep disorder in children?

Symptoms of OSA in children include:

  • Snoring
  • Hyperactivity
  • Developmental delay
  • Poor concentration
  • Bed wetting
  • Nightmares
  • Night terrors
  • Headaches
  • Restless sleeps
  • Obesity
  • Large tonsils
  • Noisy breathers
  • Chronic runny nose
  • Frequent upper air way infections/ earaches

If you feel that your child has any of these symptoms consult your child’s physician or ENT as soon as possible! A sleep disorder can impact your child’s overall well- being and ability to function with his/her maximal potential.

Attention Deficit/ Hyperactivity Disorder (ADHD) and Sleep?!

Attention Deficit Disorder – Inattentive Type is a disorder characterized by inattention, easy distractibility, disorganization, procrastination, and forgetfulness.  Children with this disorder typically shift from task to task without finishing, become easily distracted, get bored quickly, make careless mistakes, and have difficulty with organization.  Additionally, it has been estimated that as many as 45% of children with ADHD have some form of speech and language impairment (Tirosh & Cohen, 1998).

  • Snoring is associated with higher levels of inattention and hyperactivity
  • 81% of snoring children with ADHD could have their ADHD eliminated if their habitual snoring were effectively treated. Chervin, RD et al. Symptoms of Sleep Disorders, Inattention, and Hyperactivity in Children, 1997, Sleep, 20(12): 1185-1192.

(Brian Palmer, D.D.S., Kansas City, Missouri, USA, April, 2001)

It is important to get quality sleep! If you feel that you or someone you know has a sleep disorder, is a restless sleeper, or just isn’t getting quality sleep consult a physician or ENT. The ENT will assess the tonsils, adenoid pad, congestion, snoring, and velum competency.  A good night’s rest will improve overall function both physically and mentally.

Hope you enjoyed this blog post! ZZzZzzzZZz

Pamela Leibowitz MA CF-SLP TSSLD

Communicating with Individuals with Aphasia

Communicating with Individuals with Aphasia

Aphasia is a language disorder that affects the ability to communicate, but does not affect intellect! Be sure to check out these tips when communicating with someone with aphasia. Be simple, be patient, be creative!

“To effectively communicate, we must realize that we are all different in the way we perceive the world and use this understanding as a guide to our communication with others.”- Tony Robbins

1. Be Simple

Simplicity is crucial when communicating with an individual with aphasia. Make your sentences short and sweet. Say one thing at a time.  Do not overwhelm the individual with too much information at once.

2. Be Patient

Slow down, and be patient! Give the individual some time to process what you are saying. Also allow extra time for them to express themselves without interrupting. If you see the individual ‘struggling’ to communicate their thought, I recommend giving them a few seconds before jumping in to help. Although you want to help, just jumping in can increase frustration.

3. Eliminate Distractions

Try to eliminate any background noise (radio, tv, phones, people talking around you). Go to a quiet area where you and the individual can really focus on communicating without any distractions.

4.Communicate with Another Modality

Visuals, Visuals, Visuals!!! Visual are extremely beneficial when communicating with an individual with aphasia. Visuals come in many different forms, and benefit the individual by allowing them to have another modality to interpret/ express a message. Rather than just auditorily hearing a message, use writing (mini dry erase board), pictures, or even an Ipad to assist in your conversation. Use your environment to enhance your conversation by pointing to an item in the room that you are referring to.

5. Ask What Helps

Have the individual tell you what helps. Every individual with aphasia is unique. Therefore don’t hesitate to ask their opinion on what helps them the most.

6. Confirm

Recap! Clarify! Show the individual that you understand. If you are unsure of something, ASK! Don’t pretend you understand when really you don’t. Clarify when necessary.

(American Heart Association)

For more tips about aphasia check out: http://www.aphasia.org/

Pamela Leibowitz MA CF-SLP TSSLD