“The goal of this hierarchy is to teach a graded, lateral chew with tongue-dissociation and movement across midline. Use a thin bolus such as a veggie stick, thin pretzel or crunchy Cheeto. Move to the next level in the hierarchy when the child can independently demonstrate the skill at the level you are working on with a stable jaw and dissociated tongue movement.”~Lori Overland, MS, CCC, SLP-Developing Oral-Motor and Feeding Skills in the Down Syndrome Population
CHEWING HIERARCHY LEVEL 1:
Chewing Hierarchy Level 1 can only be addressed in feeding when the child has mastered this level in the pre-feeding exercises. So…if your little one does not have a munch-chew….and you are only seeing a suckle (many children with Down Syndrome do not move past the suckle)…..you need to go back to pre-feeding Chewing Hierarchy Level 1. This means instead of food you will be using various tools in order to facilitate the chew. You can use the chewy tubes…offered at www.talktools.com. The yellow ones are smaller and better for babies. So it is important to remember….do NOT practice Chewing Hierarchy Level 1 during feeding if you do not see a munch-chew. The goal of the chewing hierarchy is to teach all of the levels of chewing. However, with little ones…babies that are learning to chew…the hierarchy MUST be presented as a pre-feeding exercise at first…and then foods are introduced.
So….one last time…if your little one is still suckling and is not demonstrating the munch-chew….this is a pre-feeding Chewing Hierarchy level 1 exercise.
Okay…so once you are seeing the munch-chew….present a stick shaped bolus…. like a pretzel stick or a veggie stick perpendicular to the lateral molar ridge…have the child take three bites…be sure to do this on both sides of the mouth. That is the excersie…three bites on both sides of the mouth. So: bite, bite, bite on the left….and bite, bite, bite on the right. Question: How much food should go in the child’s mouth?- As much as they can handle…small bites for the little ones of course.
Why is this so important….because hierarchy level 1 is not only teaching chewing…it is motor planning for the following: tongue retraction and the lateral chew. It is important to note right here…during your pre-feeding Chewing Hierarchy level 1…with the chewing tube…..once you see lingual retraction and the lateral chew on the chewy tube…and you see the munch-chew…NOT the suckle…you are ready to do Chewing Hierarchy level 1 with food.
Since you will be doing Chewing Hierarchy level 1 during feeding….what will you be doing during the pre-feeding exercises with your little one…YES!….Chewing Hierarchy level 2. My next post will be about chewing Hierarchy level 2…but wanted to end this post with the goals of level 2: teaches the motor planning for tongue tip pointing and tongue retraction.
A few extra tips….when you are doing the pre-feeding Chewing Hierarchy Level 1……you can also use the Z-vibe with the green head (found on www.talktools.com) and the Ark Probe also at talk tools.
Hope this was helpful….and have fun!
Post with any questions!