Ask A Therapist: Persons with DS have larger tongues?

Posted by Deborah Grauzam on


I work for a not for profit helping connect families to community resources. I just attended an appointment with a mother and 3 month old infant with Down Syndrome at the child's Family Physician's office. When the mother made the statement that she feels like her child is choking on its tongue and asked if this would change, the doctor told the mother that persons with DS have larger tongues and hopefully as her child grows his mouth would grow. 

​***This is just not true. Low muscle tone may make the tongue appear to be enlarged but tongues of people with a diagnosis of DS are not larger than the typical population. If this child is choking it may be secondary to low muscle tone, the insertion of the tongue, or inability to coordinate suck, swallow and breath. Starting a muscle based program from birth will make a difference. Feel free to look at the resources on the TalkTools website, particularly the DS feeding class, at this point.***​

The mother also raised a question about her child's head shape and if it would change (there has been a referral for a helmet consult and a request for referral for PT that the PCP does not want to make until after the helmet consult). The PCP told the mother that it may or may not change and the PCP associated the child's head shape with the child's diagnosis of DS. How can I better educate this mother about this? I am beside myself. Is there not information that states otherwise?

​***I am not an expert in head shape...however some babies with DS do have some asymmetry or a flat back of the head. I have had a number of babies on my caseload that have successfully worn helmets.***​


Lori Overland, MS, CCC-SLP, C/NDT

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Ask A Therapist: Does Straw Therapy Help Accelerate Speech?

Posted by Deborah Grauzam on

My 2 year old (almost 3 year old) daughter with Down Syndrome is still having difficulty with speech. She has many signs, but her words are limited to ones such as "ball" and "book." I have asked her speech therapist about the Straw Kit. Her therapist does not seem to be in favor of anything other than traditional speech therapy. Does the straw kit help accelerate speech?

Also, her OT would like her to drink out of a cup. Which cup would be best, or is it best to continue with straws for now? Thank you!


Hi Ana,

Sorry to hear that your daughter is having difficulty with speech. I do believe that the straw kit is something worth pursuing.  I often work with children with another therapist in a situation like this.  One can work on traditional speech techniques and the other oral placement for speech production and feeding.  That might be something to think about.  The straws work on different levels of tongue retraction and lip rounding which are both movements used in speech production. I do find with my patients that speech comes faster with oral placement therapy.  As far as a cup I would recommend starting with the pink cut out cup.

Please let me know if you have any other questions.  We are always here to help.


Liz Smithson

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: Task Analyzing Oral Sensory Motor Skills

Posted by Deborah Grauzam on

Hi Lori,

I have a 7 months old client who is a breast feeder. When trying to give her new things like applesauce, yogurt, etc. She makes the bolus but she doesn't swallow. What can I do for her to swallow, besides achieving lip closure? Specifically for swallowing. I hope you can help me. Thank you.


Hi Rosy,

I wish it was as easy as just making recommendations for treatment ... but your treatment needs to be based upon assessment. You need to look at this child's medical issues (does this baby have respiratory issues, gut issues, allergies, etc? What is the primary diagnosis?), tone, posture and alignment issues (what you see in the body is what you get in the mouth), sensory system (is this a baby who has modulation, regulation or sensory discrimination issues?), oral structures (have you looked at the shape of the palate, the labial frenum, lingual frenulum, etc?) and then do a task analysis of oral sensory motor skills (you can task analyze any motor skill) to support safe nutritive feeding. Once you can target WHY this child is having difficulty managing purees, it will be appropriate to plan a program or to ask for suggestions for program planning. The two-day sensory motor class or the sensory motor feeding book may be helpful. Best,

Lori Overland, MS, CCC-SLP, C/NDT

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Ask a Therapist: Physical Therapist Question on Oral Motor

Posted by Deborah Grauzam on



I am a physical therapist working in Early Intervention in NJ. I have a 12 month child that I suspect has an undiagnosed syndrome. She has very low muscle throughout. Her cognitive level is about 6 months. She cannot sit unsupported. She can imitate a play action. She is making very few sounds. Frequently sticks out her tongue, open mouth posture. She can only eat pureed foods. I called for a speech assessment and was told by the Speech Therapist that there is no evidence that Oral Motor Therapy can help her speech at this age. Is that true?

Thank you for your help!




Dear Tal, 

Thank you for your question.  My name is Monica Purdy and I am a speech and language pathologist that also specializes in oral placement therapy and feeding. There is a lot of research on oral motor and the effectiveness and evidenced based information. If you visit this page on the TalkTools website you will find articles that you can print off and give to the speech therapist. Many speech therapists assume when someone mentions "oral motor" that they are referring to exercises such as "tongue wagging" (moving the tongue from side to side outside of the mouth), puffing the cheeks, and/or elevating the tongue to the nose or chin (again outside of the mouth). These activities do not have any support and are not related to speech or feeding and should not be used. However as you know being a physical therapist you can address muscle function by working on stability, dissociation, grading, precision and endurance in order to help a client with feeding and speech intelligibility. At TalkTools we do this by using kinesthetic feedback or tactile cues to help a client achieve these skills. Many times we work on feeding because it is a precursor to speech and we can prevent speech sound distortions from occurring if we address the muscles in feeding.   

I hope this helps, if you have any further questions please do not hesitate to contact me. 

Monica Purdy, M.A., CCC-SLP

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Ask a Therapist: The Child Refuses Tools

Posted by Deborah Grauzam on



My son was using TalkTools products since he was about 4 months old until he was 2 years old.


He is now 3 years and does not like them at all. Gets really mad when I try to use the chewy things, Z-Vibe or straws. He really does not want anything inside his mouth or to get his face massaged. 


Any recommendations?


Any other tools that are recommended for kids with Down Syndrome?



Hi Adriana,

These behavior can develop as children get older. In my class on Autism, I describe many factors that can contribute to behavioral challenges, sensory-motor challenges and moving forward in therapy.

First and foremost a predictable schedule with built in rewards is critical. Rewards need to be very frequent.

Secondly many kids need a sensory warm up. Consult with an OT/PT that specializes in sensory integration. Whole body movement, massage, music and sensory methods may be helpful prior to oral exercises.

Finally, without seeing your child myself I cannot recommend specifics; however at TalkTools not only do we support our work, but the work of Pam Marshalla, Debra Beckman and Diane Bahr, all have oral motor programs. I suspect the program may be too routine, so adding some massages, feeding programs and a more reinforcers may do the trick.

Robyn Merkel Walsh, MA, CCC SLP

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