Ask a Therapist: Sensory Processing assistance with a client that has Down syndrome

Hi Lori,
I am a speech pathologist working with Toddlers. A few years ago I attended your conference on feeding therapy. I haven’t had to use a lot of the techniques up until now, so I am a little rusty.  I currently have a little guy with Down syndrome who is not chewing a great deal. His mom told me that at home she is noticing a great deal of gagging and sometimes vomiting because of this. We have been trying different textures; however, nothing seems to be working. He is also pretty resistant to chewy tubes and allows them in his mouth for only a short time. He either lets go or will bite down and not let go. I have been looking at the chewing hierarchy, but tools are listed (e.g., z-vibe, etc.) that I can’t remember exactly what I am supposed to do with. Do you have any suggestions on how to target this or where to start? Thank you so much for your help. I appreciate it!

Hello and thank you for the questions.

As often occurs, I have a bunch of questions to start.

Does this little one have other sensory issues?  Is there an OT who specializes in sensory processing involved?  Have you made observations about what this little one is doing with his lips, cheeks and tongue (for purees, and for solids).

I would assume (based on the diagnosis) that you should probably be working on cheek mobility and bilabial closure for spoon, cup etc.  If a protrusion/retraction is the primary tongue movement, work on tongue lateralization.  Does the child tolerate vibration?  If so, use the vibe fine tip for the lateral tongue massage.  Try the vibe bite and chew XL head (looks like a yellow chewy tube) if he will not tolerate chewy tubes.  You may want to go outside the box and roll the tool from the lateral incisor to the first molar if this child does not like the tool on the molar ridge. By the way, I have just written a book which should be out in June if you need a review of the class (and updated exercises!!!!).


Lori Overland


  • admin

    Hello, Thank you for your email. Has your child had a comprehensive feeding evaluation? Can you tell me a little about HOW your child is eating his purees. Does he have good lip closure on a spoon? Does he use his cheeks? Does he have tongue retraction? Does he protrude his tongue when he swallows? Next, can he do an up/down jaw movement with support on a chewy tube? Does he have oral sensory issues (can you brush his teeth?, How does he feel about having the chewy tube in his mouth?) ? Does he bite on any non food items?

    Your son really needs an evaluation with a therapist who can task analyze his oral sensory motor skills before planning a program. You need to work on much more than biting on chewy tubes to develop the oral sensory motor skills to support chewing food. It sounds like his refusal to eat solid foods is secondary to reduced ability to break down the food (which may be why he vomited for so long…)You may want to read an article I wrote for the ASHA Journal Perspectives on Swallowing and Swallowing Disorders. The title is A Sensory Motor Approach to Feeding and it is on the Talk Tools website. If you tell me where you are located I can let you know if there is a Talk Tools therapist in your area. Best, Lori

  • Tan

    Hi! I have the same problem with my son. The speech therapist had been trying to get him to chew/bite for many years, since he was 4. He is 13 years old now. I have been to so many speech therapist and also asked his teachers to assist but no progress. We had also tried chewy tubes/ etc . None of this tools help. He is only eating porridge and for noodles, I have to cut them, he just swallows. The only improvement is he doesn’t vomit now, he knows how to spit.
    Any suggestions? The speech therapist told us that because he can’t chew, it’s also a reason why he has no speech.
    Please advice. Thanks!

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