Chewing Hierarchy Level 2 in children with Down Syndrome

Many thanks again to Lori Overland and to Sara Rosenfeld-Johnson for offering the invaluable DVD trainings regarding feeding skills in children with Down Syndrome.  I especially send my thanks to Lori for answering many of my questions via email..thank you for your expertise and for always taking the time to answer my questions.  And remember has all of the materials, literature and tools needed to help you help your little one.   Today’s post is in reference to Chewing Hierarchy level 2.  Remember if your little one demonstrates the munch pattern while eating…then during the pre-feeding exercises you are working on Hierarchy level #2


Chewing Hierarchy Level # 2 as a pre-feeding exercise:

If you are working on Chewing Hierarchy Level #2 as a pre-feeding exercise…this means during regular feeding your little one is chewing food at Chewing hierarchy level #1…while she is eating at level #1…during pre-feeding you work on level #2…with toothettes presented to the lateral incisor and then to the back molar… or you can use chewy tubes….go to for tools and supplies for this level.  When using the toothettes…be sure to cut the wings off to make it easier to put inside your little one’s mouth.

So you want your little one to take two bites:


One bite at the lateral incisor



One  bite at the back molar


What are we motor planning for?  Tongue tip pointing and tongue retraction.

Be sure to alternate sides…whatever you do on one side you do on the other side…unless you see asymmetry.

Once you see that your little one is capable of biting at the lateral incisor and then at the back molar ridge….you are ready to present this level during feeding.

And when you are working on chewing hierarchy level #2 during feeding…you are working on chewing hierarchy level #3 during pre-feeding.

Not only are you teaching your little one these chewing skills…you are also motor planning for the skills indicated above.

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
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