Ask a Therapist: Straw Drinking Progression


I recently purchased the straw therapy kit for my 17 1/2 month old daughter with Down syndrome. She was breastfed for the first year and we began transitioning to a straw cup around 9-10 months old. I also have kept the tip of the straw short each time. She does not have tongue protrusion and only occasionally an open mouth posture when tired or concentrating. We began using the first straw for two weeks without any issues. We are now on the second straw of the series. She seems to have no difficulty with it either, good lip closure and rounding, no leakage or spills. How long do I need to stay with the 2nd straw? She is actually capable of using the more difficult straws already also, but I realize there is a reason to progress through the straw hierarchy in order. When do you recommend advancing to the next straw if there are no issues? Do we continue the recommended order of the straws? Is there a minimum time for each straw despite no issues? Any advice is greatly appreciated. I am also working with our Speech therapist, but she does not have much experience in this area.

Thank you for your time.


Dear Robin,

Thank you for your question!  When beginning the straw drinking hierarchy, you can either begin at straw #1 or #4.  You are correct in making sure the child is only putting 1/4 of the straw in their mouth, this way the child is using good lip rounding and the tongue is retracted.  It sounds like you might want to try straw #4 with your daughter.  If she only puts 1/4 of the straw in her mouth, then you will not need to cut the straw (straw #1 and 4 are the only ones you can cut).  If she is putting more than 1/4 of the straw tip in her mouth then you will need to cut the straw to 1/4 inch above the first twist.  By straw #4 the tongue must be completely retracted in the mouth and the jaw is stable.  She will not be allowed to suckle on straw #5.  If you see a forward and backward movement of the jaw - then she is still suckling.

The criteria for success involves:

1.  No liquid leakage or air leakage between the lips.

2.  The jaw should be relatively still/stable, indicating jaw-tongue independent movement.

3.  Lips should be slightly protruded.

4.  The child is able to drink 4 ounces of liquid in 2 min or less.

If you give your daughter straw #4 - you will know if it is too hard - she will be struggling to suck liquid up - then you will return to #3 until she meets criteria.

I hope this helps and let me know if you have any further questions!

Monica Purdy


  • Diane Bahr

    Hi Kathy, I worked in a clinic where we saw up to 45 children with Down syndrome per week (many from birth). I personally would not go to bottle feeding as open cup feeding is more natural and sophisticated. It is actually more like breast feeding than bottle feeding. Plus, consider the child’s age. So, I recommend open cup drinking, straw bottle drinking with the Straw Bear, and appropriate spoon feeding. I wrote my parent professional book secondary to the work we did with children with DS. It has a lot of information to help you get children on track with feeding. The book by Robyn and Lori also has great information on this topic. Both books are available through TalkTools. If you want my help, please feel free to contact me. di (

  • Kathy Keel

    I will be testing a 12 month old girl with Downs Syndrome next week. At this time she is fed through a peg tube. She had great results of no aspiration at a recent MBSS so feeding therapy is good to go. We will be using the a Talk tools sensory and OM approach with her. At this time trial feelings with slp moving to pleasure feeds as she progresses is recommended by swallow study. My question is, mother has asked about bottle feeding. Should I by pass bottle feeding and try cup drinking and straw sucking? She will stay on tube feeding until she is able to get her nutrition orally Thank you

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