Tagged "suckle pattern"

Ask A Therapist: 7 year old with Down Syndrome who can't drink

Posted by Deborah Grauzam on

My son who has Down Syndrome will be seven next month and still can't drink.


Ben had a high palate and was breastfed. He really latched with his tongue. He only drinks from a hard spout sippy cup. He grinds his teeth really bad too. But he still uses his tongue, even as he drinks from the sippy cup. You can see his tongue out on the bottom of the sippy cup, it's like his sucking reflex is so strong his brain won't let him not use his tongue to suck! He doesn't stick his tongue out and it's not a thick tongue either. We have tried the honey bear and tubing as well, he just wants to use his tongue! Any suggestions on how to help my little guy?


Thank you!



Hi Robin,

It sounds like your son is still demonstrating what we call a "suckle pattern" when drinking. If he is not able to drink from the honey bear straw cup at all, I would recommend that you consult a TalkTools Trained Therapist to have an evaluation and get more information on how to work on straw drinking with your child. There is a strategy of using a syringe to place small amounts of liquid in his cheeks by his back molars but I feel this technique would be best implemented by someone with experience, who can guide you through the process. If that is not an option, I would watch Sara Rosenfeld-Johnson's video-on-demand "A Three-Part Treatment Plan for Oral Placement Therapy" and try to teach yourself before implementing the techniques with your son. Please let me know if we can help you with anything else.




Elizabeth Smithson, MSP, CCC-SLP is a Speech-Language Pathologist who has over 10 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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Ask a Therapist: Straws and Tongue Placement

Posted by Deborah Grauzam on

Hi Sara,

I have taken your Oral Placement course and you currently have devised a plan regarding this program for my son Cole. I have a question however it is regarding something I am seeing in treatment (I am an OT) when using the straw program. I have a patient who has down syndrome, 6 months ago could not form a seal around a straw much less retrieve fluid. She had/has frequent tongue protrusion which limited this skill. Using your techniques she has gained the ability to form a good lip seal (with cheek cueing provided) and can retrieve liquid. What is happening however is that after she sucks 1-2 times (I believe when she is going to swallow) she protrudes her tongue which then breaks the seal and continues to use a pattern we are trying to correct. Any suggestions or insight on this situation? This child has also learned to blow horn #1 and can do with cheek cueing for 8 blows before compensation. At times she has some nasal airflow which I believe her tongue (midblade) elevates and impacts based on the sound she makes when this happens. She can do bubbles as well with same cueing. Last bit of information on whistles and bubbles I included in case it helped with answering my original question. Thank you for your time!

I have seen the behaviors you describe concerning the suckle pattern with straw drinking.  Here is what I would try.  Have her draw the liquid 1 time, remove the straw, once she swallows, put the straw in again.  See if the single-sip technique helps with the tongue retraction.  Also, make sure the tip of the straw is on the surface of her lower lips and that she is drawing the liquid back using lip protrusion with tongue retraction.  If the straw is on her tongue blade that might also explain why you are seeing the protrusion.  I hope this helps. 

Sara Rosenfeld-Johnson, MS, CCC-SLP


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