Eating skills in children with low muscle tone or Down Syndrome

This is an old post….however…I just revised it…and added more information

 Children with Down Syndrome typically present with low muscle tone.  Children with low muscle tone may present with oral motor feeding concerns.  I have spent some time discussing Down Syndrome feeding…so please be sure to read under the Down Syndromepage for more information.  

 I want to start off by saying that the difficulty in feeding, based upon my experience and the courses that I have been taking, is attributed to the interaction between the sensory system and the motor system.  Your sensory system is the system that sends messages to your brain…..to tell you how you perceive something.  Your motor system is the system that sends messages to your muscles….telling them what to do.  In children with low muscle tone…difficulty in oral motor feeding is impacted by the interaction between the two systems. 

With regard to the sensory system….children with Down Syndrome are hyposensitive to taste and temperature and hypersensitive to texture.  This means that their sensory systems need more information in reference to taste and temperature (hyposensitive)…and their sensory systems are hypersensitive to texture (too much of a certain type of texture may be difficult to handle).  So when a mixed texture like a Stage three baby food is in their mouth….the mixed texture gives their sensory systems negative information…and they may not be able to tolerate.  With regard to their motor system and this same texture (stage 3 baby food)….their motor system is not getting enough input (as the input they would be getting with a hard crunchy cookie)….and therefore they may not know what to do with it.   Remember too…their motor systems are weaker….and may fatigue easier.

So what can we do to help little ones with Down Syndrome tolerate these in-between textures….changing one of the variables may help…..for example…..fruit may be a texture that a little one with Down Syndrome can not tolerate…..so you can try freezing a blueberry…and see if this colder temperature gives them enough sensory information…enough information that they will be able to chew.  Increasing the sensory information will help with regard to chewing.  Why??? because the added sensory information will help the motor system to chew.  Remember the motor system is weaker and may not have the skills to chew…or the endurance to chew.  Working on the pre-feeding exercises (I have talked about many of them…however still need to review the chewing hierarchy)….helps to develop the muscle memory that they need for chewing.

This post is specifically related to two factors with regard to Down Syndrome feeding: hyper-sensitivity and hypo-sensitivity.   Children with Down Syndrome typically are hypersensitive to texture…..this means that they may have difficulty in tolerating various textures.   As I stated above…their sensory systems may not be able to tolerate certain textures (such as the Stage 3 baby foods, meats, cheeses, fruits, vegetables).  And children with Down Syndrome are hypo-sensitive to taste and temperature…as I talked about above.

My experience has been children with low muscle tone prefer crunchier textures…and also foods that are easy to swallow.  The crunchier foods do have to be chewed….however, their hypersensitivity is related to the textures indicated below.  The harder-crunchier foods are easier in the sense that it does not send negative information to their sensory system and the hard crunchy texture gives their motor systems enough information to know that they have to chew.  However, also remember they may fatigue during chewing due to the lower muscle tone.

 So remember…they have hypersensitivity to texture and hypo-sensitive to taste and temperature.  And their motor system may be weaker and not have the skills to chew.  It is important to remember that their motor systems may have difficulty in chewing (that is why the chewing hierarchy is important).  Down Syndrome children will prefer the harder crunchier foods….and may have difficulty with various textures as indicated above.

 In my experience, I have found that one of the hyper-sensitivities may be to certain “mixed textures“, for example, a Stage 3 baby food is a mixed texture.  You have the pureed food…and then bits and pieces of a more solid texture.  Children with hypersensitivity may have difficulty with this mixed texture.  So, I have learned that children with a hypersensitivity when it comes to eating…this hypersensitivity is specifically related to texture.  Not only is the texture issue related to mixed textures…these children also typically have difficulty with the “in between textures“….that is what I call them.  These are the textures that do require some chewing….however are NOT solids.   Examples of the in-between textures include: soft cheeses, eggs, soft pasta (not Al Dente), deli meats, steak, chicken, vegetables and many fruits.  These in-between textures are difficult for the children that present with a hyper-sensitivity feeding issue. 

So…to re-cap….children with Down Syndrome typically present with a hypersensitivity concern….and this concern is specifically related to their ability to tolerate the mixed textures and the in-between textures.   They typically prefer harder crunchier foods….be sure though to follow the chewing hierarchy (which I will speak about)….you are following the chewing hierarchy so that you can teach chewing…..and doing the chewing exercises to help your little one with chewing. 

Children with Down Syndrome and oral motor feeding sensitivities  typically do NOT have a sensitivity to the Stage 1 foods and foods that do not require ANY chewing….examples of other foods besides Stage 1 foods would be and not inclusive to: applesauce, yogurt, and pudding.  These textures do not require any chewing and are easily swallowed.  

The next texture that can be tolerated by children with food sensitivities (in my experience)…. are hard crunchy foods.  This texture needs to be first bitten with the front teeth (so children that have biting issues…a different concern…may have difficulty with this texture)….next lateralized to the side…. then chewed and swallowed.  Examples of a solid texture include: cookie, cracker, pretzel, Veggie Sticks….and are not limited to these foods. 

So to go back to children with Down Syndrome…they are hypersensitive to texture….so they may prefer hard crunchy foods (this food does require biting and chewing…however is comprised of one texture) and a texture like a Stage 1 that does NOT require chewing.  However, children with Down Syndrome have a difficult time…due to hypersensitivity to mixed textures like a Stage 3 baby food and the in-between textures.  Other foods…in my experience…that that may be difficult for these little ones include…and are not limited to the following: oatmeal (similar to a Stage 3 food), soft cheeses, bananas and soft fruits, deli meats, eggs, soft pasta (easier time with Al Dente), vegetables…..and other foods that are NOT hard and crunchy…however still require some biting with front teeth, lateralizing and chewing. 

My oldest son had feeding issues and he was hypersensitive to textures…up until almost first grade….he came up with a great word to describe food that he could not tolerate: SWERBALIE.  I have used that word with parents to help them understand what their little one may be thinking.  For my son….he could not even look at food like a cantelope….he would gag just by the sight of it…..it looked to mushy to him. 

My second son…Andrew…he is ten…he has hypersensitivity issues now…although he did not as a younger child.  With him I try to follow the SOS approach when he is eating.  When following this model….children are encouraged to try new foods….however they slowly work through the steps with new foods….the steps are (and have been modified a little for my son):  LOOK, SMELL, TOUCH, TASTE.  Remember children with sensitivity concerns may have difficulty with just looking at the new food….they may NOT be able to smell the new food….and for most…touching the new food is too much for their sensory neurons to handle.  I have found in my experience as a therapist and as a parent…PATIENCE is the most important word.

 Ok….let’s go back again to Down Syndrome feeding and the other word: hypo-sensitivity.  This means that their sensory neurons need more information with regard to TASTE AND TEMPERATURE.  They may like spicier, saltier or really sweet foods.  This is because their sensory neurons actually need more information.  I had a little one I was working with years ago and she was about two years of age…and loved sopressata…this is an Italian cured salami…and is definitely spicier.  She loved sopressata….and ate it without any reservation.   Some children with Down Syndrome and other feeding issues may have less of a reaction to foods that are colder or hotter..so we may want to increase the temperature and make foods colder than typical to really stimulate those sensory neurons.  And when doing feeding therapy we may alter the taste of the food (by increasing flavor) in order to give their sensory neurons more information.

So remember….when addressing oral motor feeding with children that have Down Syndrome and oral motor sensitivity issues….the three factors to consider: texture, temperature and taste.  Finally, please remember that their sensory systems are mixed….hypersensitive to texture and hyposensitive to taste and temperature….and the interaction between the sensory and motor system.

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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2 Responses to Eating skills in children with low muscle tone or Down Syndrome

  1. Evelyn cepeda says:

    Hi, kim this evelyn l tray to find the link for the bottler to feeling my dauther

  2. syeda says:

    Thanks Kim for this informative article. I am struggling with my son’s feeding issue too. I wish you were here in canada to help me out. Thanks again

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