{"product_id":"oral-motor-evaluation-template","title":"Pediatric Oral Motor Evaluation Template","description":"\u003cp\u003e\u003cstrong\u003eA fillable oral motor evaluation for infants and young toddlers with tethered oral tissues, and for older children who cannot yet follow oral motor directions.\u003c\/strong\u003e\u003c\/p\u003e\n\u003cp\u003eBuilt by Meagan Dungan, M.S., CCC-SLP, this 18-page fillable PDF covers feeding, airway and pre-speech, and records the baby's response to every technique in the Tiny Tongues protocol. Technique numbers 1 to 15 match the protocol.\u003c\/p\u003e\n\u003ch3\u003eWhat's inside\u003c\/h3\u003e\n\u003col\u003e\n\u003cli\u003eIdentifying information, referral and concerns\u003c\/li\u003e\n\u003cli\u003eA screen to confirm oral motor versus myofunctional therapy\u003c\/li\u003e\n\u003cli\u003eBirth, medical and growth history\u003c\/li\u003e\n\u003cli\u003eFeeding history for baby and nursing parent, plus solids and cup transitions\u003c\/li\u003e\n\u003cli\u003eBreathing, sleep, tension and pre-speech history\u003c\/li\u003e\n\u003cli\u003eProvider team input, with sections for the IBCLC (latch, milk supply, transfer, supplementation) and the release provider\u003c\/li\u003e\n\u003cli\u003eInfant oral mechanism exam and reflexes\u003c\/li\u003e\n\u003cli\u003eNon-nutritive suck assessment, including the floor of the mouth during suck\u003c\/li\u003e\n\u003cli\u003eFunctional assessment of tethered oral tissues: lingual frenulum, full upper labial frenulum assessment, lower labial and buccal frenula, and infant tool scores\u003c\/li\u003e\n\u003cli\u003eAirway and breathing, including the tongue-to-palate sleep check\u003c\/li\u003e\n\u003cli\u003eFeeding and pre-speech: breast or bottle observation, spoon with the J-scoop, cup, chewing and early sounds\u003c\/li\u003e\n\u003cli\u003eBaseline response to all 15 Tiny Tongues techniques\u003c\/li\u003e\n\u003cli\u003eStrength, range of motion and coordination ratings\u003c\/li\u003e\n\u003cli\u003eEngagement and regulation\u003c\/li\u003e\n\u003cli\u003eRelease readiness checklist and phase placement\u003c\/li\u003e\n\u003cli\u003eClinical impressions, diagnosis and coding reminders\u003c\/li\u003e\n\u003cli\u003eGoals, with a direct link to the NTX Goal Bank\u003c\/li\u003e\n\u003cli\u003eTreatment plan with IBCLC and pediatrician coordination, home routine and discharge criteria\u003c\/li\u003e\n\u003cli\u003eMedical necessity, education, consent and signatures\u003c\/li\u003e\n\u003c\/ol\u003e\n\u003cp\u003eAlso included: referral decision guides for physician, GI and dietitian; ENT, airway and sleep; and tethered oral tissue release assessment.\u003c\/p\u003e\n\u003ch3\u003ePairs with\u003c\/h3\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003ca href=\"\/products\/tiny-tongues-infant-oral-motor-protocol\"\u003eTiny Tongues Infant Oral Motor Protocol\u003c\/a\u003e ($97): therapist-provided oral motor therapy from pre-release to discharge.\u003c\/li\u003e\n\u003cli\u003e\n\u003ca href=\"\/products\/pediatric-feeding-myofunctional-therapy-goal-bank\"\u003ePediatric Feeding \u0026amp; Myofunctional Goal Bank\u003c\/a\u003e ($35): measurable goals for latch, suck, oral motor skills and caregiver training.\u003c\/li\u003e\n\u003cli\u003eSave with the \u003ca href=\"\/products\/oral-motor-evaluation-protocol-bundle\"\u003eOral Motor Evaluation + Protocol Bundle\u003c\/a\u003e ($105) or the \u003ca href=\"\/products\/complete-oral-motor-set\"\u003eComplete Oral Motor Set\u003c\/a\u003e ($135).\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003ch3\u003eMore from NTX\u003c\/h3\u003e\n\u003cp\u003eEvery NTX resource is built to work with the others. Browse them all on the \u003ca href=\"\/collections\/therapist-education\"\u003eTherapist Resources\u003c\/a\u003e page.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eFeeding\u003c\/strong\u003e\u003c\/p\u003e\u003cul\u003e\n\u003cli\u003e\n\u003ca href=\"\/products\/pediatric-feeding-evaluation-template\"\u003eComprehensive Pediatric Feeding Evaluation Template\u003c\/a\u003e ($15): fillable feeding evaluation, birth to 18, with 5 referral decision guides.\u003c\/li\u003e\n\u003cli\u003e\n\u003ca href=\"\/products\/pediatric-feeding-evaluation-report-writing-guide\"\u003eGold Standard Pediatric Feeding Evaluation Report Guide\u003c\/a\u003e ($47): report writing, 3 annotated sample reports, coding, plan of care kit and appeal letters.\u003c\/li\u003e\n\u003cli\u003e\n\u003ca href=\"\/products\/feeding-evaluation-report-bundle\"\u003eFeeding Evaluation + Report Bundle\u003c\/a\u003e ($55): the feeding evaluation template and report guide.\u003c\/li\u003e\n\u003cli\u003e\n\u003ca href=\"\/products\/complete-feeding-documentation-set\"\u003eComplete Feeding Documentation Set\u003c\/a\u003e ($85): feeding evaluation template, report guide and goal bank.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003e\u003cstrong\u003eMyofunctional (ages 2 and up)\u003c\/strong\u003e\u003c\/p\u003e\u003cul\u003e\n\u003cli\u003e\n\u003ca href=\"\/products\/myofunctional-evaluation-template\"\u003ePediatric Myofunctional Evaluation Template\u003c\/a\u003e ($19): fillable tethered oral tissue evaluation for ages 2 and up: speech, feeding and airway.\u003c\/li\u003e\n\u003cli\u003e\n\u003ca href=\"\/products\/myofunctional-therapy-protocol\"\u003eMyofunctional Therapy Protocol for Tethered Oral Tissues (3 Editions)\u003c\/a\u003e ($97): pre-release to discharge, 14 exercises, in 3 kid-friendly editions.\u003c\/li\u003e\n\u003cli\u003e\n\u003ca href=\"\/products\/myofunctional-evaluation-protocol-bundle\"\u003eMyofunctional Evaluation + Protocol Bundle\u003c\/a\u003e ($105): the myofunctional evaluation template and the 3-edition protocol.\u003c\/li\u003e\n\u003cli\u003e\n\u003ca href=\"\/products\/complete-myofunctional-set\"\u003eComplete Myofunctional Set\u003c\/a\u003e ($135): myofunctional evaluation template, 3-edition protocol and goal bank.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp\u003eInstant download after checkout. Single-clinician license; please do not share or redistribute. Resources support, not replace, clinical judgment, your release provider's instructions and payer requirements.\u003c\/p\u003e","brand":"NTX Feeding \u0026 Myofunctional Therapy Institute","offers":[{"title":"Default Title","offer_id":44688227106894,"sku":null,"price":19.0,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0768\/0458\/7598\/files\/NTX-Oral-Motor-Eval-Cover_52bed18b-19e5-490d-905d-71321d3f86b9.jpg?v=1793132148","url":"https:\/\/ntxfeedingandmyo.com\/products\/oral-motor-evaluation-template","provider":"NTX Feeding \u0026 Myofunctional Therapy Institute","version":"1.0","type":"link"}