Down Syndrome feeding and pre-feeding exercises

I thought I would post some information regarding oral motor feeding skills with regard to children with Down Syndrome.  I am definitely not an expert….however….have been doing a significant amount of research and have taken (and continue to take) courses offered by Lori Overland…so I feel as if I do have information to share.  If anything…..I hope to help parents and lead them in the right direction. 

First I want my readers to click on the link below.  This article was written by Sara Rosenfeld-Johnson…she is basically the guru when it comes to feeding and Down Syndrome.  The link below discusses the 7 Myths about Down Syndrome:

The+Oral-Motor+Myths+of+Down+syndrome[1]

 
This blog provides information related to the oral motor myths listed above….and then information about bottle and breast-feeding your baby with Down Syndrome: http://downsyndromenewmama.blogspot.com

 

This blog offers information about feeding and I really liked the pictures provided in reference to spoon-feeding your baby with Down Syndrome: http://gotdownsyndrome.blogspot.com

 

The article below was taken from the got down syndrome blog.  Please go to the above link for more information.  Be sure to go to her blog http://gotdownsyndrome.blogspot.com  I found very useful information….and especially love the tips about spoon feeding.  Remember when spoon feeding your child with Down Syndrome be sure to present the spoon sideways to decrease tongue protrusion and to improve tongue retraction.

 

 

SPOON FEEDING:

A very important aspect for oral motor therapy with babies/young children with Down syndrome is discouraging tongue thrust and encouraging lip closure.  A very simple way to get this “oral motor therapy” in is in the way of spoon feeding. There’s a certain technique which can be done when spoon feeding to facilitate this.

This can be used on children who are very young – from the very first time they start eating solids!

Hold the spoon sideways, so that the side of the spoon is touching each side of the mouth, let the child get the food off it that way.

 

Immediately turn the spoon the other way (still sideways, but facing a different direction) and feed the child.

Then turn the spoon again the opposite direction and let them get the last bit of the food off.

 

It is best for this to be done 3 times in a row, like the above picture shows, because then it helps keep that tongue in. If you just do the sideways spoon feeding once, then the child can put his tongue out to help swallow the food or lick the food off of his lips. After you do it 3 times the child will hardly stick his tongue out at all after that last bite, since he has already been swallowing the food.

Try it on yourself – Feed yourself with the spoon like you normally would – your tongue protrudes forward this way. Feed yourself with the spoon sideways, your tongue is pushed back. It works so well.

 

**** please visit: www.talktools.com for oral motor feeding tools needed for children that have Down Syndrome, low muscle tone, oral motor weaknesses and sensory feeding concerns.

 

 

 

 

 

I have been taking another class offered by Lori Overland…and wanted to post pre-feeding exercises that should be used prior to your feeding sessions.  These exercises are not only for children that have Down Syndrome…but also for those who present with low muscle tone.  The goal of the exercises is to improve strength and mobility of the muscles needed for feeding and also for speaking.

 

PRE-FEEDING EXERCISES: 

 

1. Palatal massage:  the goal of the palatal massage is to maintain the shape of the palate.  Find the palatal raphe:

The palatal raphe is a rather narrow, low elevation in the center of the hard palate.  You can run your tongue along the palatal raphe…starting from the bump behind your teeth…follow the palatal raphe until you get to midline.  It is like you are running your tongue along a line…you should be able to feel it.  The reason you are running your tongue along the raphe is because you need to find the midline point.  You will know that you are midline on the palatal raphe when you have found the bump.  So that will be your starting point for this exercise.

I think it is pretty easy to find the bump at the top of the palate.  Remember to start your tongue behind your front teeth…and run your tongue along your palate…straight back….when you find the bump you will know that this is the starting point….the point where you will start this pre-feeding exercise with your little one.

Now…inside your little one’s mouth you will find the bump…the bump lies between the two halves of your palate.  Once you find the bump on her palate….use your index finger and run the pad of your index finger down to the lateral ridge (the spot where her teeth will insert)….then roll back up to mid line to the palatal raphe…and then back down to the other side of the mouth.  So to be clear…you are running your finger sideways…from the bump on the top of the palate to the lateral ridge…(the spot where her teeth will insert)

Each side should be massaged four to five times prior to the feeding.  The goal of this exercise is to maintain the shape of the palate.  Remember the palate fuses around one year of age. 

2. Maintaining Lateral movement of the tongue:

For this exercise you should use:

A Toothette  ….be sure to cut the wings of the Toothette when working with an infant or toddler…the Toothette is too large for an infant or toddler with the wings. 

 

An infa-dent

 

A Nuk brush

 

All three of these tools can be purchased at www.talktools.com

 

The goal of this exercise is to stimulate the sides of the tongue to improve tongue lateralization.  This means the child’s ability to move the tongue to the side.  Remember this is a skill she will need for feeding and for speaking.  When working on this exercise start at the back of the tongue and move towards the front of the tongue.  Be sure to use four to five strokes on the left side of the tongue and then four to five strokes on the right side of the tongue.  When  you are doing this exercise….you should see the tongue moving to the side.

 

3. Maintaining Phasic Bite/Munch Pattern:

What is a phasic bite?:  A neurologic reflex present in infancy where pressure on the gums causes rhythmic opening and closing of the jaw.

Use your index finger and stimulate the lower gums from back to front.  You are looking to see if this caused a rhythmic opening and closing of the jaw……a munch pattern.  This exercise will teach chewing skills.  ( I will post over the next week or so…the chewing hierarchy….specific to exercises that should be done to improve chewing skills in little ones with Down Syndrome or with low muscle tone).

4. Pacifier Rock:

I could not find a good picture of the pacifier that you should use…just be sure it is not one that has a flat-bed on the bottom of the pacifier (the part that goes in the baby’s mouth)….it should be an elongated shaped pacifier.

With your middle finger under the jaw….and your pointer finger on one side of the mouth…in the corner…and your thumb on the other side of the mouth…in the other corner….you will be ready to help your little one.

Use your middle finger to help the jaw to come forward…and your thumb and index finger to move the lips into a pucker/kiss.  You will be using your middle finger to rock the jaw back and forth….and your index finger and thumb to improve lip rounding.

 

5. Tongue Bowling:

Children with low muscle tone may have a flat tongue that may protrude forward. 

Stroke the tongue…start at the tip and work towards mid-line…this should create tongue bowling.  This exercise should be done four to five times.

6. Massage:

Using your hands or the textured sensory bean bags offered by www.talktools.com

The following exercises should be done four to five times:

1. Start at the TMJ  and move down towards the corners of the lips.

2. Start on the sides of the nostrils and work down towards the lips.

3. Start under the nostrils and work down towards the lips.

Massage wakes up the muscles…very good for children with Down Syndrome and children with low muscle tone.

 

 

***if your licenses speech and language pathologist wants you to use a vibrating tool.. www.talktools.com has 3 cute ones…

 

 

Jigglers add calming and organizing sensory input, and can be used for oral exploration, reducing “fixing” in the jaw, and increasing awareness. Instructions included. Requires one AA battery which is included with the Jiggler.

However….be sure to know that too much vibration on low tone children may break down muscle tone.  Be sure to consult with your licensed speech and language pathologist before using a vibrating tool.

 

7. Tap and tone:

Just like if you were going to the salon and getting a facial….you will be “tapping” the child’s face with the palms of your hands….the goal is to tone and strengthen the muscles of the face and cheeks.  To strengthen the lips….tap on the lips and make the “O” sound….just like in the song Old MacDonald had a farm…remember….E-I-E-I-”O”.  Tapping on the lips will improve the tone and strength of the muscles of the lips and improve lip rounding.

 

8. Upper lip mobility:

You will be using the Toothette indicated above…found on www.talktools.com to improve upper lip mobility.  Remember for infants and toddlers you may have to cut off the wings so that it is the right size for your little one.   You can wet the sponge if the child does not like the texture of the Toothette.

The Toothette goes inside of the mouth….start on the corner of lips…and move the toothette under the lip to midline….repeat this four to five times…and then move to the other side of the mouth.   Midline…is the middle of the top lip. 

With older kids you may purchase:

Vibrator & Toothettes – TalkTools®

This will add more sensory information and more likely to get mobility.

With the older kids you may also use the Z-vibe….it comes with three different heads.

To promote upper lip mobility use the Z-vibe with the yellow head.  You will be doing the same exercise indicated above under upper lip mobility.  The Z-vibe adds more information.  It has a firmer rubber tip.  Remember to perform the exercise from corner to midline.

If the older child is resistant to using these tools…use the back of a toothbrush…use a vibrating toothbrush….some of the older children can be taught how to do this exercise on their own.

 

9. Ice Stick to improve lip rounding:

 

Ice Sticks can be used to develop oral placement/feeding and speech therapy programs and are excellent for achieving lip rounding and lip closure.  The ice stick can be purchased at www.talktools.com

In order to improve lip closure place across the lips (so the ice stick should be presented horizontally) and have the child make closure with their lips on the ice stick.  You can also ask the child to kiss the ice stick to improve lip rounding.  To further improve lip rounding: place the ice stick inside of the child’s mouth (vertically).

Lip rounding can also be addressed with the Jigglers indicated above….turn the Jiggler on and ask the little one to kiss the Jiggler.

What if your child can NOT pucker her lips for a kiss.  How can you help her with lip rounding……therapist should stabilize the jaw with her middle finger under the mandible….so you do not want the jaw to move….index finger and middle finger should be in either corner of the mouth.   Since the child is not able to pucker her lips for a kiss just yet….you will be using your index finger and thumb to help her to get her lips into the pucker…being sure to keep her jaw stabilized with your middle finger.  Now help her to kiss the Jiggler.

Remember…..too much vibration for children with low tone may break down muscle tone….so be sure to consult with your licensed speech and language pathologist for guidance.  The vibrating tools should not be used as a toy….it should only be used therapeutically.

 

I hope this post was helpful…please reply with any questions.

Kim

 

About Kim

My name is Kim Marino and I have been practicing as a licensed speech and language pathologist since 1993. I work on Long Island providing diagnostic evaluations and services to children from birth to age 21. My experience is vast and am proud to say that I work with children that may present with articulation and phonological concerns, oral motor feeding concerns, Down Syndrome feeding, cognitive rehabilitation, auditory processing delays, receptive language delays, cleft palate feeding and sound development and expressive language delays. Most importantly, I am the mother of four amazing children and am happily married to my childhood sweetheart. I feel blessed to have my four children and so lucky to share this journey in life with my husband. I always had it somewhere in my head that I wanted to develop a blog or a website of some sort so that I could provide families with an additional resource....so that parents could help their little ones become a better communicator. And as I was developing this blog....I realized that I also needed to share the stories about my life and my children....and the funny things along the way that help to keep me smiling. Whether you are a working mother or not...finding balance between home, children and life can be a challenge....I hope that my blog helps to bring a smile to your face..and also some tools to help you help your little or big one. I hope you enjoy! Kim
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