Chewing Hierarchy Level Number 1 in children with Down Syndrome

Once again my thanks goes out to the amazing Lori Overland and Sara Rosenfeld-Johnson for sharing their invaluable information.  As I have posted before I’ve taken many of Sara and Lori’s classes offered through  Not only am I thankful for the tremendous amount of information I have obtained…I am blessed to be able to work with the little ones I see for therapy…being able to implement what I have learned in order to help the children I see presenting with Down Syndrome…..and helping the mamas too of course! Below you will find information regarding Chewing Hierarchy Level 1.



“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 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)… 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  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  and the Ark Probe also at talk tools.


Hope this was helpful….and have fun!

Post with any questions!



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
This entry was posted in Chewing Hierarchy, Down Syndrome. Bookmark the permalink.