How to reduce tongue protrusion in children with Down Syndrome

I am hoping that this post in conjunction with the information I have on my Down Syndrome page is helpful to those of you that are in need of information regarding Down Syndrome feeding.  This post is specifically in reference to tongue protrusion and how you can reduce tongue protrusion and improve tongue retraction in children with Down Syndrome. 

Using a Playtex Nurser Bottle…the kind with the drop-ins….is the bottle to use when feeding your baby with Down syndrome..  It is important to note that when feeding your little one….you also have to be sure to adhere to the following:

1. Baby should be fed in more of an upright position with chin down…..chin should be lower than the ears.  Most of us…..when feeding our little ones….feed her in more of a cradled position….with her head tilted back… this position her chin is higher up than her ears.  We do not want that position… sure that your little one’s head has her chin down….ears should be higher up than chin.

2. Slow to medium flow nipple….not the fast flow.  Now….if your little one has some cardiac concerns…the slow flow nipple may be too difficult for her…in the sense that she may take a longer period of time to drink the bottle…because the nipple is slow flow.  My experience has been that when a little one has cardiac concerns….and she is using a slow flow nipple….she really is working extra hard to drink the formula or breast milk….and if it is too difficult for her…and she is working too hard….she may be burning more calories than she is getting.  So be sure to consult with your speech and language pathologist and your little one’s pediatrician with regard to the type of nipple. 

The fast flow nipples….are just too fast….and the muscles in your little one’s mouth are not getting enough of a “work out”.  We want to strengthen the muscles of the cheeks, lips and the tongue….and encourage tongue retraction. 

3. Using the Playtex Nurser….in the chin down position:  The first step is to remove all of the air from the bottle and nipple…..and next present the bottle to your little one.  The correct presentation: the bottle should be in a downward position…by this I mean that the bottom of the bottle is down…and the bottom of the bottle is lower than the top of the bottle ( a downward angle).  Typically when we feed babies…the baby is in that cradled position…with head back…and the bottom of the bottle is higher up in the air…so the bottle is angled up.  I want the bottle angled down. 

4.You may initially need to push some of the formula or breast milk into your little one’s mouth…so she understands that she needs to really suck in order to obtain the liquid.

When feeding your little one with Down Syndrome…with this bottle and in the above position…you are forcing her to use tongue retraction in order to suck the liquid out of the bottle.  When drinking a bottle the typical way….the tongue protrudes during sucking.  If we feed your baby in the above position with the Playtex Nurser she will use tongue retraction….as well as strengthening the muscles of the lips, cheeks and tongue.  It may take her a little bit of practice…but she will get it!





When your little one is ready for a sippy cup…..DO NOT use the sippy cups that have the inserts…these promote tongue protrusion.  I love the Honey Bear Sippy cup….which you can find on the above web-site.  Your little one will have to retract her tongue just as she did with the Playtex Nurser.  The Honey Bear Sippy cup is great for all kids…not just kids with Down Syndrome… be sure to try this with your little one.  I have had little ones at four…five and six month of age (with Down Syndrome)…using the Honey Bear.


If you have any questions please be sure to post a question.


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 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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2 Responses to How to reduce tongue protrusion in children with Down Syndrome

  1. Heather says:

    Hello Kim,

    My daughter is 6 weeks old with down syndrome. I began using the playtex nurser bottle at 1 week old with slow flow nipple, upright position, mouth lower than ears and the bottle in the downward position. What I have experienced thus far is that i must push up the liner to fill the nipple repeatedly throughout a feeding session, her sucking does not replenish the milk in the nipple. The nipple appears too fast and pours out of her mouth on the sides and soaks her bibs. This leads me to believe that the tongue protrusion I am trying to prevent with this bottle is not actually working. Is that an accurate conclusion? I have looked for a preemie sized nipple that would fit the playtex nurser bottle, but have been unsuccessful. I just purchased a mini-haberman feeder which is the only bottle listed on the website promoting this type of feeding. After only one use with the haberman bottle so far, it appears less milk pours out of her mouth, but it does still come out, I made sure she was receiving the milk from the nipple from the horizontal, closed position. I can still feed her upright however the bottle is in a horizontal position not down. Does it make a difference using the haberman if it is not in the downward direction which is not possible with this particular bottle? Is the primary goal to reduce the flow of the milk (therefore preventing tongue protrusion) while in an upright position to keep it out of the ears? If so, is haberman the right bottle for us or should we stick with the playtex nurser even though she still cannot draw it up herself to fill the nipple and it comes out of her mouth soaking her bib? This is more than a little confusing to me and I want to be giving her the best. Please help!

  2. Amudha says:

    Helllo Kim, My son is 4 years old down syndrome. Can you please suggest way to reduce the tongue protrusion

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