The importance of pre-feeding exercises in children with Down Syndrome-a must read!

I felt the need to edit this post following a comment from another blog site…I love to get connected with other SLPs…so great that we were able to meet up…that being said I felt it was important to add a little more information to this blog post below….in reference to what I read on let’s talk-Down Syndrome

The pre-feeding exercises listed below yes are NSOME (non-speech oral motor exercises) that are used in conjunction with a very specific model for feeding and speech production.  For the little ones I see for services these pre-feeding exercises are started right from birth.  And each exercise has a purpose.  The first one..the palatal massage helps to maintain the shape of the palate…reducing the possible high and vaulted palate that may develop given the tongue may not be resting on the palate to help maintain the shape.  And my kiddies…followed by the pediatric dentist have had great success with this exercise…also talking with Lori Overland..she also indicates success with this exercise.

The exercises that follow the palatal massage help to develop the muscle memory for feeding and for speech.  Please note…this is not to say that these exercises are for promoting speech…they are for promoting the muscle memory for feeding and develop the strength and mobility.  In conjunction with these exercises it is important to follow the chewing hierarchy..which I have posted about..the Honey Bear straw drinking technique..which I start at four months of age..and some of my little ones are drinking from a straw at six months…yes six months…great for lingual retraction…decreasing protrusion…and improving lip rounding.  Then to follow the straw hierarchy…with 8 straws in that kit.   Now the entire time I am working on these oral motor techniques…I of course am working on sound production…giving the tactile input as needed to help with placement of sounds…and in sound production.

The pre-feeding exercises are a MUST read…and a must along with straw drinking…the chewing hierarchy…use of the horn kit to help with sound production….and traditional speech and language therapy.  Bella…a little one I have been working with since birth…has followed this model…and she demonstrates great lip rounding…is able to make the W sound…is able to imitate non speech movements..and more importantly oral motor movements for speech purposes.  She is able to imitate sounds..and has great lip closure and wonderful tongue retraction in the needed 75% retracted 25% protruded position.  Amazing!!!  Great job with the Honey bear…with the straw kit…and with spoon feeding…all working towards a goal!

In reference to the upper lip mobility exercise below…for all of my DS children and kids with feeding issues related to muscle strength and mobility and yes coordination too…this exercise helps with spoon feeding (which I forgot to add to the edit part of this post…following the correct spoon feeding model…this also helps to increase tongue retraction…and help with lip closure on the spoon to clear the food off of the spoon…and then helps with bilabial sounds~great!!!!)….so the upper lip mobility exercise is great for getting ready for spoon feeding and getting those muscles ready for speech production.  If you read will see that each exercise has a purpose and a goal.  Please read below for more information in reference to each exercise and why I target that exercise.  And yes of course when doing these exercises be sure of the following:

As let’s talk-Down Syndrome states to stop these exercises when:

  • Averted gaze (looks away from you)
  • Increased rate of breathing
  • Color changes
  • Finger splaying
  • Warding off gesture (hands up in front of face)
  • Crying

For sure…the pre-feeding exercises are only “one part” of the treatment plan.  Understanding the reasons why a child may not be eating certain it an inability…is it a sensory concern…is it behavioral or a medical issue.  All of these factors need to be taken into account and considered as part of the entire plan.   And the entire plan consists for me of the pre-feeding exercises..the chewing hierarchy…spoon feeding…the Honey Bear straw cup…the straw hierarchy…the horn hierarchy…and of course traditional speech and language therapy in order to elicit sounds and words.  When all of this is part of the plan…I have seen the most success. Hope this cleared up any questions.


I have been taking another class offered by Lori Overland…and wanted to post pre-feeding exercises that should be used prior to your feeding sessions.  These exercises are not only for children that have Down Syndrome…but also for those who present with low muscle tone.  The goal of the exercises is to improve strength and mobility of the muscles needed for feeding and also for speaking…..AND HELPING TO DEVELOP THE MUSCLE MEMORY FOR FEEDING AND SPEECH.

And a big thanks to Latricia and Lila for allowing me to share this video:


I learned the exercises listed below from a six hour seminar class I took through Talk Tools: Developing Oral Motor and Feeding Skills in the Down Syndrome Population.  Thanks so much to Lori Overland for allowing me to share.  Lori taught this seminar.



1. Palatal massage:  the goal of the palatal massage is to maintain the shape of the palate.  Find the palatal raphe:

The palatal raphe is a rather narrow, low elevation in the center of the hard palate.  You can run your tongue along the palatal raphe…starting from the bump behind your teeth…follow the palatal raphe until you get to midline.  It is like you are running your tongue along a line…you should be able to feel it.  The reason you are running your tongue along the raphe is because you need to find the midline point.  You will know that you are midline on the palatal raphe when you have found the bump.  So that will be your starting point for this exercise.

I think it is pretty easy to find the bump at the top of the palate.  Remember to start your tongue behind your front teeth…and run your tongue along your palate…straight back….when you find the bump you will know that this is the starting point….the point where you will start this pre-feeding exercise with your little one.

Now…inside your little one’s mouth you will find the bump…the bump lies between the two halves of your palate.  Once you find the bump on her palate….use your index finger and run the pad of your index finger down to the lateral ridge (the spot where her teeth will insert)….then roll back up to mid line to the palatal raphe…and then back down to theother side of the mouth.  So to be clear…you are running your finger sideways…from the bump on the top of the palate to the lateral ridge…(the spot where her teeth will insert)

Each side should be massaged four to five times prior to the feeding.  The goal of this exercise is to maintain the shape of the palate.  Remember the palate fuses around one year of age.

2. Maintaining Lateral movement of the tongue:

For this exercise you should use:

A Toothette  ….be sure to cut the wings of the Toothette when working with an infant or toddler…the Toothette is too large for an infant or toddler with the wings.


An infa-dent 


A Nuk brush 


All three of these tools can be purchased at


The goal of this exercise is to stimulate the sides of the tongue to improve tongue lateralization.  This means the child’s ability to move the tongue to the side.  Remember this is a skill she will need for feeding and for speaking.  When working on this exercise start at the back of the tongue and move towards the front of the tongue.  Be sure to use four to five strokes on the left side of the tongue and then four to five strokes on the right side of the tongue.  When  you are doing this exercise….you should see the tongue moving to the side.


3. Maintaining Phasic Bite/Munch Pattern:

What is a phasic bite?:  A neurologic reflex present in infancy where pressure on the gums causes rhythmic opening and closing of the jaw.

Use your index finger and stimulate the lower gums from back to front.  You are looking to see if this caused a rhythmic opening and closing of the jaw……a munch pattern.  This exercise will teach chewing skills.  ( I will post over the next week or so…the chewing hierarchy….specific to exercises that should be done to improve chewing skills in little ones with Down Syndrome or with low muscle tone).

4. Pacifier Rock:

I could not find a good picture of the pacifier that you should use…just be sure it is not one that has a flat-bed on the bottom of the pacifier (the part that goes in the baby’s mouth)….it should be an elongated shaped pacifier.

With your middle finger under the jaw….and your pointer finger on one side of the mouth…in the corner…and your thumb on the other side of the mouth…in the other corner….you will be ready to help your little one.

Use your middle finger to help the jaw to come forward…and your thumb and index finger to move the lips into a pucker/kiss.  You will be using your middle finger to rock the jaw back and forth….and your index finger and thumb to improve lip rounding.


5. Tongue Bowling:

Children with low muscle tone may have a flat tongue that may protrude forward.

Stroke the tongue…start at the tip and work towards mid-line…this should create tongue bowling.  This exercise should be done four to five times.

6. Massage:

Using your hands or the textured sensory bean bags offered by

The following exercises should be done four to five times:

1. Start at the TMJ and move down towards the corners of the lips.

2. Start on the sides of the nostrils and work down towards the lips.

3. Start under the nostrils and work down towards the lips.

Massage wakes up the muscles…very good for children with Down Syndrome and children with low muscle tone.



***if your licenses speech and language pathologist wants you to use a vibrating has 3 cute ones…




Jigglers add calming and organizing sensory input, and can be used for oral exploration, reducing “fixing” in the jaw, and increasing awareness. Instructions included. Requires one AA battery which is included with the Jiggler.

However….be sure to know that too much vibration on low tone children may break down muscle tone.  Be sure to consult with your licensed speech and language pathologist before using a vibrating tool.


7. Tap and tone:

Just like if you were going to the salon and getting a facial….you will be “tapping” the child’s face with the palms of your hands….the goal is to tone and strengthen the muscles of the face and cheeks.  To strengthen the lips….tap on the lips and make the “O” sound….just like in the song Old MacDonald had a farm…remember….E-I-E-I-”O”.  Tapping on the lips will improve the tone and strength of the muscles of the lips and improve lip rounding.


8. Upper lip mobility:

You will be using the Toothette indicated above…found on to improve upper lip mobility.  Remember for infants and toddlers you may have to cut off the wings so that it is the right size for your little one.   You can wet the sponge if the child does not like the texture of the Toothette.

The Toothette goes inside of the mouth….start on the corner of lips…and move the toothette under the lip to midline….repeat this four to five times…and then move to the other side of the mouth.   Midline…is the middle of the top lip.

With older kids you may purchase:

Vibrator & Toothettes – TalkTools®


This will add more sensory information and more likely to get mobility.

With the older kids you may also use the Z-vibe….it comes with three different heads.

To promote upper lip mobility use the Z-vibe with the yellow head.  You will be doing the same exercise indicated above under upper lip mobility.  The Z-vibe adds more information.  It has a firmer rubber tip.  Remember to perform the exercise from corner to midline.

If the older child is resistant to using these tools…use the back of a toothbrush…use a vibrating toothbrush….some of the older children can be taught how to do this exercise on their own.


9. Ice Stick to improve lip rounding:


Ice Sticks can be used to develop oral placement/feeding and speech therapy programs and are excellent for achieving lip rounding and lip closure.  The ice stick can be purchased at

In order to improve lip closure place across the lips (so the ice stick should be presented horizontally) and have the child make closure with their lips on the ice stick.  You can also ask the child to kiss the ice stick to improve lip rounding.  To further improve lip rounding: place the ice stick inside of the child’s mouth (vertically).

Lip rounding can also be addressed with the Jigglers indicated above….turn the Jiggler on and ask the little one to kiss the Jiggler.

What if your child can NOT pucker her lips for a kiss.  How can you help her with lip rounding……therapist should stabilize the jaw with her middle finger under the mandible….so you do not want the jaw to move….index finger and middle finger should be in either corner of the mouth.   Since the child is not able to pucker her lips for a kiss just yet….you will be using your index finger and thumb to help her to get her lips into the pucker…being sure to keep her jaw stabilized with your middle finger.  Now help her to kiss the Jiggler.

Remember…..too much vibration for children with low tone may break down muscle tone….so be sure to consult with your licensed speech and language pathologist for guidance.  The vibrating tools should not be used as a toy….it should only be used therapeutically.



10Cheek Stretch:

What you will need:

Either the Zvibe/yellow preefer head (please note when you click on this link…you will see the yellow preefer will stil need to purchase the handle for it)….okay you can use either the Zvibe or an iced toothette.  Or with a baby you can use a gloved hand.

What you will do:

Present the tool in the cheek near the upper lateral molar ridge

Make a “c” inside the cheek by rolling the tool from top to bottom (starting by the upper gums and rolling down toward the lower gums).

Five times on the left side and five times on the right


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 The importance of pre-feeding exercises in children with Down Syndrome-a must read!

  1. kate slpjobs says:

    do you know any alternative to helping your child with lip rounding? besides the ice sticks.

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