Sensory & Oral Motor Skills: My Personal Evolution in Feeding Therapy, by Kelli Bavaro

The Way I See Feeding Has Changed: From a Sensory Lens to a Sensory-Motor Perspective

One of the things I have come to appreciate most about being a clinician for many years is that our understanding should change.

We learn. We observe. We ask better questions. We take new courses, work with new populations, collaborate with other professionals, and sometimes realize that something we once thought we understood was actually much more complex than we realized.

My understanding of feeding is one of those areas.

Earlier in my career, I approached pediatric feeding difficulties with a strong sensory lens. I was deeply influenced by approaches such as the SOS Approach to Feeding, Inside Out, sensory integration principles, and my training in understanding how the sensory system influences participation and behavior. Eventually, I worked with adults in a skilled nursing facility. This is when compensatory strategies and nutrition entered my clinical brain.

Those foundation remain incredibly important to me.

But over time, my clinical lens has expanded.

As I have continued to study oral function, feeding mechanics, and orofacial myofunctional therapy, and through absorbing additional training by clinicians such as Lori Overland , Mary Billings, and Robyn Merkel-Walsh, I have developed a much deeper appreciation for the motor side of feeding.

And this has changed the way I look at both children and adults who are struggling to eat, drink and even sleep and breathe.

Feeding Is Sensory. But It Is Also Motor.

When we talk about feeding difficulties, we often talk about sensory processing.

Is the child sensitive to texture?

Do they tolerate foods touching their face?

Do they gag when a new food is introduced?

Are they overwhelmed by smells, temperatures, or certain consistencies?

Does the child need foods to look or feel a particular way?

These questions matter.

An individual's sensory system and their ability to remain regulated are fundamental to feeding. If a person is overwhelmed, dysregulated, fearful, or unable to comfortably process the sensory information coming from a food, it is very difficult to learn a new feeding skill.

But there is another set of questions I find myself asking much more often now:

What does this person actually need to be able to do with their mouth?

Can they stabilize their jaw?

Can they clear a spoon with their lips?

Can they form and maintain lip closure?

Are they pushing their tongue forward in order to get food and liquid back?

Can they round their lips around a straw?

Can the tongue move independently and efficiently?

Can the tongue retract?

Does the tongue spread broadly across the palate?

Does the tongue lateralize to both sides?

Are they creating a bolus?

Can they coordinate the movements necessary to manage a bolus?

How does their dentition and jaw alignment factor into what I’m seeing?

These are very different questions from simply asking whether a child eats a particular food or texture.

And sometimes, they help us understand the answer.

Sometimes What Looks Sensory Has a Motor Component

This is where my thinking has changed the most.

A child who refuses a particular texture may certainly have a sensory aversion.

But what if the texture is difficult because the child doesn't yet have the oral motor skills needed to manage it?

A child who struggles with a spoon may not simply dislike the sensation of the spoon. Perhaps clearing the spoon with the lips is difficult.

An adult who avoids a straw may not be refusing the sensation of drinking through it. Perhaps lip rounding, suction, or oral stability is challenging. Perhaps, they don’t even know this is hard for them.

A child who pockets food may have sensory preferences or reduced awareness of food in the mouth. But we also need to consider whether the tongue has the range, strength, coordination, and lateral movement necessary to efficiently move that food.

An adult who takes a very long time to chew may need additional sensory support and regulation. But we should also ask what their chewing pattern looks like and whether their oral structures are working together efficiently.

Of course, sometimes the primary challenge really is sensory.

Sometimes it is primarily motor.

Very often, it is both.

And that distinction matters because the intervention may look very different depending on what is actually getting in the person's way.

My Clinical Lens Has Expanded; It Hasn't Replaced What I Learned Before

I don't look back at my earlier work and think: I was doing it wrong.

I think I was working from the information and clinical experiences I had at the time.

My sensory foundation taught me to pay attention to regulation, modulation, sensory preferences, environmental demands, and the child's relationship with food. It taught me that we cannot simply make a child participate in a feeding task because we have decided they should.

It taught me to slow down.

To observe.

To build trust.

To use chaining and carefully graded experiences.

To recognize that a regulated nervous system is foundational to learning.

I still believe- nay- know hose things to be true all of those things to my very core.

What has changed is that I now look more closely at what the individual’s body is being asked to do.

From Looking at Feeding to Analyzing the Task

Earlier in my career, I certainly understood the pre-oral and oral phases of swallowing. I had worked with children and adults in a variety of settings, including pediatric and skilled nursing environments. But my understanding of the mechanics of feeding was, in retrospect, much more superficial than it is today. Now, I find myself breaking a feeding task down into much smaller components.

Instead of simply observing that a child "struggles with spoon feeding," I might ask:

What happens when the spoon enters the mouth?

Does the child open and stabilize the jaw?

Can the lips make contact with the spoon?

Can the upper lip clear the food?

Does the tongue remain organized?

Does the child immediately push the food forward?

Can the tongue move the bolus laterally?

What happens next?

Similarly, with a straw, I am not simply looking at whether a child or adult drinks.

I am looking at the entire sequence.

Can the lips round?

Can they maintain a seal?

Can the jaw remain relatively stable while the lips and tongue do their work?

Can the child generate and coordinate the movements necessary to draw liquid through the straw?

These details can tell us so much. These details can change the trajectory of a child’s life. Help an adult to understand so much about their experiences around food(cups, straws, bottles, you name it) throughout their whole life thus far.

This is what task analysis has given me: a much more focused way of seeing.

The Mouth Doesn't Stop Being Important When Feeding Ends

My growing understanding of oral function has also changed the way I think about the relationship between feeding and orofacial function more broadly.

The mouth is not simply a place where food goes.

Oral function matter from second 1 of an infant’s life. The tongue provides the first point of stability (long before crawling and walking). it then continues to matter long after a child has moved beyond purees, finger foods, and the high chair.

Tongue posture.

Lip posture.

Jaw stability.

Chewing.

Swallowing.

Nasal breathing.

Oral resting posture.

These functions can influence experiences throughout childhood and adulthood.

This is one reason I became so interested in orofacial myofunctional therapy.

The more I learned, the more I began to see connections between the skills I was observing at the feeding table and the broader functions of the orofacial system.

For some individuals, oral function may be part of a much larger clinical picture involving chewing, swallowing liquids or pills, oral resting posture, airway concerns, headaches, sleep-related concerns, or other symptoms that can warrant a broader interdisciplinary evaluation.

That does not mean every feeding difficulty is an orofacial myofunctional disorder. And it certainly does not mean that every oral symptom has a single explanation.

It means that oral function deserves to be looked at carefully.

Regulation Still Comes First

There is one thing I never want to lose as my clinical lens becomes more motor-focused:

The human in front of me comes first.

A beautifully designed oral motor activity is not going to be productive if a child is overwhelmed, frightened, dysregulated, or simply not ready to participate.

Regulation matters.

Connection matters.

Trust matters.

Sensory processing matters.

And the child's autonomy matters.

We can understand the mechanics of feeding incredibly well and still miss the child if we forget to look at the whole person.

This is why I don't see sensory and motor approaches as competing philosophies.

I see them as pieces of the same picture.

A More Complete Picture of Feeding

Today, when I evaluate a person with feeding difficulties, I am looking at more than what they eat.

I am looking at how they eat.

I want to understand their sensory system, their regulation, their relationship with food, and their environment.

And I also want to understand what their body is doing.

What happens before, during, and after the swallow?

What skills are present?

What skills are emerging?

And perhaps most importantly:

What is making this task difficult for this particular child?

That question has become increasingly important to me throughout my clinical evolution. Because feeding therapy isn't simply about getting a child to eat more foods. It is about understanding the complex interaction between sensory processing, regulation, oral motor function, motor learning, development, and the child's individual experience.

Sometimes the answer is sensory.

Sometimes the answer is motor.

Sometimes we need to address both.

And sometimes, the most important thing we can do is slow down enough to figure out which one we are actually seeing.

That is the lens I bring to feeding therapy today.

Not a replacement for what I learned before, but an expansion of it.

A deeper look.

A more curious eye.

And, ultimately, a more complete understanding of the human in front of me.