A parent forwarded me a blogpost recently which set my Evidence Based Practice danger detector alarms ringing. The article seemed like a lovely case study with cute photos of a smiling boy and “discusses how the electric toothbrush and other methods can help with speech and language development.”
This is the sort of post that parents find, trust and act on. It seems to have social proof and was apparently written by a speech therapist. If you look past the pretty colours and photos (surrounded by advertising and sprinkled with affiliate links) the informed sceptic can see a hidden danger lurking beneath the surface. This danger is like a crocodile waiting quietly in a seemingly peaceful river. An unsuspecting parent doesn’t even know it’s there until it’s too late. So I’m here to call out a warning to parents and carers before more children are potentially harmed.
I’m loathe to do it but in the interests of accurate referencing here is the original post:
Warning: do NOT try this at home
By way of background I’m not a therapist who is risk-averse or against exploring new ways of doing things. I’m open-minded and if there is minimal evidence for or against a given approach and it makes sense in light of the evidence that is available and the needs of a specific child then I’m willing to give it a try but I monitor how each child responds and adjust the course of action constantly. In fact, I often push the limits and feel like a bit of a rebel in what can sometimes be a very cautious profession. The profession is like this because we tend to be lovely people who want to help everyone and so we tend to worry if we might accidentally hurt someone. Which brings me back to the article in point. The claims are quite frankly a load of bull and potentially harmful. The article started out quite sensibly but then I started to feel a little like Alice trying to converse with the Cheshire Cat and getting more and more confused in the process. Here’s a sample of the twisted logic in the absence of any supporting evidence other than a one off case study with limited information about what other interventions were used:
Claim: If your baby hit all of their developmental milestones except speech and if they tend to be quiet and don’t say much, you might think he or she is just a “good baby.” However, this could be a sign that their speech and language isn’t developing properly.
Response: I totally agree – this is generic claim is consistent with a wide array of speech pathology literature and common clinical presentation of otherwise normally developing children with speech and language delays.
Claim: “What may even be a greater sign of speech and language delays is when the sensory receptors in your child’s mouth aren’t working. What are sensory receptors? They are the senses in your mouth that tell you when food is hot or cold, salty or sweet, crunchy or slimy. If your child’s brain isn’t “computing” those sensory receptors, much like our computer virus, it will shut down and stop working.”
Response: The authors are suggesting that impairments in sensation such as temperature and taste “causes” speech and language delay. As far as I am aware there in NO literature to suggest an even tenuous link between these oral skills. In fact there is literature to suggest speech and non speech behaviours may even use different types of receptors and motor pathways. See here: Speech_Motor_Development.pdf
Additionally, this claim assumes that the majority of speech and language delays are due to motor/sensory deficits. Given the high prevalence of phonological vs motor speech disorders and that language delays potentially have NO motor components at all I feel quite confident stating that it is highly improbable this is the case. If there is any evidence to the contrary I would love to see it.
Claim: the author then lists a variety of potential indicators of low oral tone but specifically describes them as, “signs of weak muscle tone used for speech and language. Children with these types of challenges may also have what is called Apraxia, which is a neurological speech impairment and breakdown of messages being sent from the brain to the muscles in your child’s mouth.”
Response: Again, it is highly improbable that the majority of speech and language difficulties have a motor based aetiology. Apraxia, or Childhood Apraxia of Speech (CAS), also known as Developmental Verbal Dyspraxia (DVD) is very rare. ASHA reports an incidence rate of approximately 1-2 per 1000 children which accounts for only 3-4% of the children referred for speech disorders (see: ASHA report on incidence of CAS). Having parents “looking” for this disorder is like raising public awareness to prevent coconut related head injuries for residents of New York city; a possible but highly improbable risk. Yes, CAS is a serious speech disorder, and some children have it, but if your child has speech and language delays odds are it’s NOT due to CAS. A good speech therapist will carefully consider numerous factors and engage in a comprehensive differential diagnosis process before diagnosing CAS. To make it even more ludicrous CAS itself isn’t even directly associated with low tone and although it may be also be present, low tone is not one of the key criteria for the differential diagnosis of CAS.
Claim: “I noticed he had not yet discovered his tongue and couldn’t use some of the muscles in his mouth. That meant we needed to first “awaken” the sensory receptors in his mouth with muscle exercises and greater exposure to hot, cold, sweet, sour and other food textures.”
Response: Eating and speaking are DIFFERENT skills!!!!! Eating different foods does not result in better speech outcomes. Non Speech Oral Motor Exercises (NSOMEs) do not result in better speech outcomes. To quote Wilson et al (2009), “Although the efficacy of NSOMEs remains empirically untested at this time, studies of typical developmental speech physiology fail to support a theoretical framework promoting the use of NSOMEs.” Thus not only is there no supporting evidence for this claim there isn’t even a sound theoretical framework underpinning a likelihood of benefit. See here and here for more details.
Claim: The therapist goes on to say that they recommended the use of an electric toothbrush as, “the vibrations force children to manipulate the toothbrush with their tongue, lips and jaw, which is the first step to strengthening those muscles and awakening those sensory receptors.”
Response: According to any peer reviewed literature I have come across, vibration has not been shown to strengthen oral muscles or “wake up” sensory receptors. The only evidence provided is the narrative description of Tuck’s case. I doubt the electric toothbrush is all that was used to treat this child and the observed gains may well have been due to other interventions. So in line with this low level evidence and to counterbalance Tuck’s case, I have personally treated more than one child whose parents had been told to use a vibrating toy or implement such as a Z-Vibe to increase oral tone or sensation and as a result they had in fact LOST oral sensation and their feeding had DETERIORATED as a result. This would suggest that not only are there children for whom this approach doesn’t work but furthermore it is a potentially harmful approach.
Claim: This one is the real doozy of a claim that is completely incomprehensible to me, “You may think this idea is just for children with speech and language delays, but you’d be wrong. These types of activities are good for all children as they are developing their speech and language milestones as babies and toddlers.”
Response: Good for ALL CHILDREN!? What on earth!? What study suggests this? Why? How? When? In light of the cases I have seen where children have suffered real and lasting damage as a result of excessive use of oral vibration stimulation this claim is astoundingly risky. To be suggesting routine use of oral vibration using an electric toothbrush for all babies and toddlers is a wild leap from the already unfounded assumptions previously refuted and would be putting otherwise normally developing children’s oral development at risk.
I’m assuming the author is not a snake oil merchant but simply a well-meaning and poorly informed therapist. I hope that my little professional rant here can help parents to be more aware of the hidden dangers of these sorts of therapy approaches and to seek well-informed professional advice.
In closing, if you want to brush your toddler’s teeth with an electric toothbrush to take care of their dental hygiene needs by all means go ahead, but keep the toothbrush for cleaning teeth not treating speech