“I have a 12 day old infant with diagnosed Down Syndrome. She has moderate tongue protrusion. A friend suggested your products. I was wondering which ones you recommend and any suggestions you might have? Thank you for your help with this!”
Dear New Mom, although each child is different, there are several goals that I usually work on:
In my experience, children who have Down Syndrome often develop oral defensiveness and texture aversions, which can significantly impact their diet and ability to eat. So it’s important to work on normalizing these sensitivities if they’re already present. Or even better – to work preventatively before they start. There are several things you can do:
• As early as possible, get into the mouth to provide stimulation and introduce new textures. Use the Oral Motor Probe and proPreefer to stroke and apply gentle pressure to the gums, palate, cheeks, lips, and tongue. Stroke the sides of the tongue, run the tools across the tongue, inside the cheeks, over the lips, etc. For infants and toddlers, the proMini is a smaller version of the Probe designed to fit inside their little mouths. These therapy tools have different textures on them to provide a varied sensory experience. You can also dip them in food to introduce texture into mealtimes and for nutritive stimulation. Sticky foods work well, such as applesauce, yogurt, and stage 2 baby foods.
My 2.5 year old daughter has down syndrome. She has had feeding issues since birth and we are trying to work with her on chewing. She will bite and chew crackers and other hard foods, but will swallow soft things whole. We are working with a speech therapist as well as an occupational therapist, but they do not have a lot of experience with the grabbers, and other bite tools. Can you recommend a tool that will promote chewing?
You may need to teach her that soft foods (such as bananas, macaroni, etc.) need to be chewed just like hard foods, even though they feel closer to puréed foods, which can be swallowed without chewing. Whatever’s on the menu, take a bite yourself first. Concentrate on what your tongue is doing with the food. Are you just swallowing it immediately? Are you moving the food from side to side in your mouth? How many times do you need to chew the food? Count how many chews so you know how many is enough. As your daughter chews, actually count the number of chews out loud to help her keep track of her chewing. I count on and stick up my fingers as well. You can put on some music and chew to the music. It can also help to pretend to chew as she chews. Overemphasize and exaggerate your jaw and mouth movements, saying “yum, yum, yum.” Begin with foods requiring only a few chews, such as a banana. Then progress from there.
Another reason she’s not chewing soft foods could be related to oral sensitivities. In my experience, children who have Down syndrome can be hyposensitive with limited oral awareness. Soft foods do not have a lot of texture, and so they may not provide enough tactile information inside her mouth. If she can’t feel the food, she won’t know that she needs to chew it. Gum massage and textured oral motor tools can help increase oral awareness by providing proprioceptive feedback inside the mouth. Sensory chews are also an excellent way for the tongue, lips, jaw, and cheek to exercise and ‘practice’ movements. The textured ones simulate the feel of real food to help introduce new textures. You can also dip them in sticky foods (like mashed potatoes, yogurt, applesauce, etc.) to promote chewing.
Since she’s already biting and chewing crackers, you can also try Food Chaining, which is essentially gradually “connecting the dots” between foods to expand one’s diet. Dip her favorite crackers in soft foods (dips, jams, sour cream, creamy peanut butter, cheese whiz, etc.). This will give the soft foods some texture variety so she can slowly feel and experience with them.
I hope this helps! Let me know if you have any other questions.
Oral defensiveness falls into two main categories: HYPOsensitivity and HYPERsensitivity. Individuals with hyposensitivities have low oral tone and very little awareness of what’s going on inside their mouths. This “oral numbness” so to speak can cause anxiety and fear when it comes to toothbrushing. On the other hand, individuals with hypersensitivities are overly conscious of and sensitive to oral stimulation. Even the slightest touch can be overwhelming and even painful. In both cases, it is important to normalize sensation within the oral cavity in order to take care of those pearly whites!
There are many ideas/options to try with children who have aversions to textures. Please remember that each child is different and there is no “one way” to decrease these aversions. Helping a child to eat/touch/tolerate textures can be a long process and therefore “trial and error” is often the best way to “figure out” each individual child. Parents, hang in there!
Leila N. Bressler, M.Ed., CCC-SLP is a pediatric speech-language pathologist who has been working with the Birth to Three population for almost ten years. She has worked in the school setting and the clinical setting in both Georgia and South Carolina. Leila is also a mother to a toddler and feels that she has learned most of her knowledge from her daughter.
For example, I once worked with a child who was mouthing inappropriate objects in the classroom – her hands, pencils, rulers, etc. So during therapy, I massaged her gums every 10-15 minutes throughout the session. She completely melted as soon as I started – she enjoyed it so much! I showed her parents how to do this at home, and eventually her need to chew subsided.
There are many ways to massage the gums, so I’ll describe what is most comfortable for me (right-handed):
1. Place your pointer finger just above the upper middle teeth. Move it across the gums to the back right molars and back to where you began. Repeat about 3 times. Then repeat the same motion on the lower gums.
2. Use your thumb to repeat the same movement on the other side of the mouth. Start above the upper middle teeth and move your thumb along the gums to the back left molar area. Repeat about 3 times. Then repeat the same motion on the lower gums.
3. During each step, notice his response and adjust accordingly. Is he relaxing? Great! Is he tensing? Try decreasing the number of repetitions, slowly working up to more over time. Even just a slight touch is progress. Make a note of the progress and try to go further in the next session. Repeat this exercise several times throughout the day, as often as possible. It MUST be done on a routine basis to have effect.
Instead of your fingers, you could use ARK’s Z-Vibe with the soft Brush Tip, which has pliable bristles for a gentle massage. If turned on, the Z-Vibe’s smooth vibration provides additional sensory input.
ARK’s Grabbers and Y-Chews are another safe way to provide oral stimulation. These chewies have long extensions that can reach all the way to the back molars for tactile and proprioceptive input. The textured and scented versions provide additional sensory feedback, and XT (Xtra Tough) options are available for more aggressive chewers.
If you can’t get into the mouth for gum massage, read this post as well, which has additional strategies for normalizing sensation within the oral cavity.
1. Change the individual’s toothpaste. It can be a change in flavor or a change in brand. A different brand may have a different texture, one that is perhaps a little more gritty. Also, changing the toothbrush to one that is a little harder or softer will get a different texture inside the mouth.
2. Massage the gums with a clean finger. This adds sensory input into the mouth and works on acceptance of textures.
4. Make small alterations in the foods that the individual already accepts. For example, if he/she likes biscuits, you can put a little mayonnaise (or some other kind of spread) on them. It shouldn’t be more than 1/4 of a teaspoon, VERY little. This may be a good starting point to add different flavors and textures. Adding these to something he/she already eats is easier than introducing a whole new food. You can also vary the kind of biscuits. Maybe you could bake some together? Play with the food and make your own recipes. There is a lot of room to be creative here! For more information on texture progression and the introduction of new foods, Food Chaining is an excellent resource.
Oral defensiveness falls into two main categories: HYPOsensitivity and HYPERsensitivity:
• Individuals with hyposensitivities have low oral tone and very little awareness of what’s going on inside their mouths. This “oral numbness” so to speak can cause significant speech and feeding delays. For example, the ability to create a food bolus is a critical oral motor skill necessary for swallowing. But how can I teach this skill to an individual who cannot feel his tongue? Lack of awareness can also lead to mouth stuffing, leftover food particles in and around the mouth, drooling, etc. In these cases, it is important to increase oral awareness by providing varied oral input and sensation throughout the oral cavity. It is at this point, however, that hyposensitive individuals can become orally defensive. Because they are not used to new feelings and sensations inside theirs mouths, they may be afraid/unsure of the sensations and therefore refuse intervention.
• On the other hand, individuals with hypersensitivities are overly sensitive to oral stimulation. Even the slightest touch might be uncomfortable and even painful, which can lead to texture/food aversions, picky eating, and speech and feeding delays. Let’s say, for instance, that an individual needs to work on tongue lateralization. To do this, I usually use an oro-Navigator to guide the tongue to one side of the mouth and then to the other. Or, I’ll place the Probe Tip inside the cheek area and tell the individual to touch it with the tip of his tongue. But how can we do these exercises if the individual won’t allow anything near his mouth because it hurts?
Although these two forms of oral defensiveness are different, intervention is quite similar for both – you need to get into the mouth and provide input in order to normalize sensation. As you proceed with the strategies below, keep in mind that there is no one approach or one answer. Each individual has different needs that will in turn require a different approach.