In April of 2015, I received an e-mail about a little boy with Down syndrome named Colter. His mother was desperately seeking help…he couldn’t chew his food and she was at her wits end trying to figure out how to teach him.

Even though this is “speech therapy,” his actual speech was not an issue at this point…yes there were delays but if a child can’t eat that is priority #1. Plus, in the back of my mind I knew that if we targeted his feeding goals his verbal speech would start to develop as well.

I love feeding therapy! When we meet goals, it means we are getting nutrition and hydration to little ones and it positively impacts the whole family. Many people take for granted the ease that there is in getting a baby or toddler to eat meals and snacks throughout the day. However there are many families out there that experience a battle EVERY TIME, EVERY DAY they try to feed a child. There has got to be few things more stressful to a parent than a child not being able to eat or being an aspiration risk. Colter was a mix of both of those.

Colter was 18 months old and swallowed almost every solid he put in his mouth but without chewing. He yearned to eat but couldn’t get the motor plan down to do so. He couldn’t move his tongue side to side (also known as lateralizing) so if food was placed in the front of his mouth he would suckled it and then swallow. What is frightening about a child doing this is that if it happens frequently they actually lose their choking reflex. We had our work cut out for us.

I educated his mother on how to place meltable solids on the side of his lateral molars so he had a better chance at chewing it and keeping it there. For practice, we used the TalkTools Pre-Feeding Hierarchy, as described in Lori Overland & Robyn Merkel-Walsh’s book A Sensory Motor Approach to Feeding. This eliminated the risk associated with choking on food and focused solely on practicing chewing and tongue lateralization. This paired with a pre-feeding program began to work wonders on Colter. We used a Z-Vibe with pre-feeding exercises from Lori Overland’s TalkTools course Feeding Therapy: A Sensory-Motor Approach before we started any feeding therapy.

Colter’s mom was diligent about keeping up with this program, which was a major factor in how far he came! Within 6 months Colter was eating much more solid food and the best part was he was being safe while doing it!

A few months later, his verbal speech exploded. He always had a higher receptive ability than expressive and thanks to getting his feeding on track, his verbal expression blossomed. When I explained to his mother that his talking was most likely a direct result of oral motor therapy, she said “I know you said that him talking more could be a possibility when we first started therapy but I didn’t think it could happen!”

Currently Colter is 2 years, 9 months old and is eating everything. One of his first words was “eat”! He loves beef jerky, hummus with veggies, fruit snacks, watermelon, and grapes. He is beginning to speak in 2 word utterances and has great intelligibility when doing so.

The next frontier we are on is drinking from a straw. Colter still uses a bottle and isn’t thrilled with learning to drink from anything other than that! Now our focus has shifted to drinking from the Honey Bear. We had to put the beloved Honey Bear “away” for a month or so as he was so opposed to it. Then during therapy one day, I started to do some lip rounding pre-feeding exercises with Colter and he was successful, so we brought it out on a whim. All of the sudden, it clicked for him! While we are still working on him getting used to it, his family and I are thrilled with how far he has come!

What I love about Colter’s story is that he is a textbook case about what TalkTools can do for kids. In Lori Overland and Robyn Merkel-Walsh’s book A Sensory Motor Approach to Feeding, it is discussed that you cannot separate speech and feeding. While it may not be a 1:1 ratio, speech and feeding have a very close connection. Colter is proof of that!

~ Vanessa Anderson-Smith

Vanessa Anderson-Smith is a Speech-Language Pathologist born and raised in South Dakota. She received her Bachelor’s Degree at Augustana University and Master’s Degree from The University of South Dakota. In 2013 she began Anderson-Smith Speech Therapy, LLC. Her practice focuses on assessment and treatment of motor-based speech and feeding disorders among children and adults. Vanessa lives in Canton, South Dakota with her extremely supportive husband, Ryan.

"When our son Dashiell was born in early 2004 with Down syndrome, we immediately began researching possible intervention and therapy options. We realized that in our talkative family, speech would be our priority. When we found an article by Sara Rosenfeld-Johnson, MS, CCC-SLP about her oral-motor therapy, the connections between feeding and speech really made sense to us, especially since we could start working on speech skills before Dashiell was talking. When Dashiell was five months old, I attended Lori Overland, MS, CCC-SLP, C/NDT's class on feeding children with Down syndrome and started doing the feeding and oral-motor therapy exercises at home. When he was a year old, we started working with Sara and other TalkTools therapists whenever the visiting clinics came to our area. Dashiell has been using the exercises at home for almost 10 years. He has worked his way through the feeding exercises, the straw hierarchy, and the bite blocks and is currently working on using the jaw exerciser, button pull, and tongue depressor push ups among other exercises.

The TalkTools program has helped Dashiell immensely. Because of his good muscle tone and habits, his speech is understood by unfamiliar listeners almost all of the time. His strong speech skills have opened many doors for him. He loves telling stories and jokes, and his friends in a typical classroom can understand him. He has made presentations to many classes and groups about what it is like to have Down syndrome and even emceed an event for over 600 people. We are so grateful that Dashiell can express his feelings and ideas. He has a lot of great stuff to say!"

-Dashiell's parents

"When our daughter was born with a tongue and lip tie, we were presented with a problem that we didn't know how to address. Breastfeeding is important to us and we really wanted to give it our best effort. Feeling overwhelmed after having an unsuccessful tongue tie revision, we turned to Lori Overland, MS, CCC-SLP, C/NDT and the TalkTools team in the hopes that some oral motor therapy would help strengthen her tongue and jaw. We started doing oral motor exercises several times a day before breastfeeding and started seeing some improvement pretty quickly. Lori noticed that her tongue still seemed restricted (all long distance via video by the way, which I thought was especially impressive!). We ended up having a more thorough revision of her tongue, and also had her lip tie revised. Within a couple of weeks, we had a baby with a very strong suck and whose symptoms of gagging, choking, and being unable to hold a strong suck while feeding had disappeared. I truly believe that all the oral exercises we did beforehand contributed to the success we saw. Our daughter was five months old at the time and we are so grateful that at almost a year, she’s still breastfeeding."

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