Ask A Therapist: Reverse Swallow In Drinking

Hi TalkTools,

I have a question about the straw hierarchy. I have a 5 year old with severe phonological processing disorder and recently repaired posterior tongue tie. I have started the straw hierarchy with her. She is on straw #3 and able to take in a single sip and multiple, consecutive sips, but seems to take too big of a water bolus which causes her to pause before swallowing to make a suckling motion to manage it in her mouth before swallowing it. Any suggestions? Thank you.



Hi Jody,

I am thinking based on what you are saying that she is demonstrating a reverse swallow. I am gathering that you are saying that this is what you are seeing on multiple swallows and not single sips. If she is not doing it on single sips I would try to stay there for an extended period of time to get her used to swallowing in the correct way and then build up to multiple sips. Your client can demonstrate tongue protrusion with the first 4 straws but cannot move to #5 without tongue retraction. I hope this helps. Please let me know if you have other questions.




Elizabeth Smithson, MSP, CCC-SLP is a Speech-Language Pathologist who has over 11 years of professional experience working with infants, children, adolescents and adults. She earned her Master of Speech Pathology at the University of South Carolina. Liz is also a Level 5 TalkTools® Trained Therapist. She has received specialized training in Oral Placement Therapy, Speech, Feeding, Apraxia, Sensory Processing Disorders, and PROMPT©. Liz works with clients with a wide range of disabilities including Cerebral Palsy, Down Syndrome, and Spinal Muscular Atrophy.  She works through her own private practice Elizabeth Smithson Therapy, LLC in the home setting and in the TalkTools® office in Charleston, SC.

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