Blog #73~ Feeding Issues and Down Syndrome
Last week I wrote about Down syndrome and low muscle tone. Not only does it affect gross motor areas of development but also oral motor and speech as well.
There are studies that have suggested these factors contribute to feeding problems in infants with Down syndrome:
“The problem lies in strength, mobility and range of motion of oral muscles. (Kumin, Goodman & Councill, 1991) This can result in weak sucking, swallowing, lip closure, and tongue protrusion (Pilcher, 1998; Kumin, 1994), and gastroesophageal reflux (McCurtin, 1997). The combination of reduced oral space and limited control also contribute to feeding problems in infants with Down syndrome. Due to a small oral cavity and midfacial hypoplasia, the infant’s lips appear thin, the palate is usually flatter with a high arch in the midline and the nasal passages are narrowed. The combination of reduced oral space and low muscle tone can result in tongue protrusion.” For more information: www.down-syndrome.org.
Development of oral motor skills improve the progression in feeding:
*Breast milk or formula
*Pureed foods
*Table Foods
*Skills for sucking a nipple
*Usage of utensils (straws, cups, spoons, forks)
Nick certainly had his own struggles in this area. At three years old, he was still eating concoctions of pureed and mashed up vegetables, fruits and still blended in baby cereal that resembled gruel. You didn’t dare introduce food with any lumps that he could gag or choke on. We enlisted a speech pathologist that specialized in oral motor feeding that included an intense treatment to address these problems.
The technique used by the specialist was, “Beckman Oral Motor Intervention” http://www.beckmanoralmotor.com. Make sure that you consult with a speech pathologist who specializes in oral motor therapy and has been trained in this area. The essence of the program is to get the muscles firing both around the lips and inside the mouth. First, the muscles around the upper and lower lips were stretched. This followed with gum massage to stimulate the mouth and stretches inside the cheeks. All of this would wake up the mouth and move to the next step of resistive chewing. Nick started with a Nuk Brush for this.
The specialist insisted on doing these techniques on me. I was amazed at how alive and tingly my mouth felt afterwards. She also taught me how to do them on Nick. Consistency is the key to building strength when embarking on this program.
As I mentioned last week, Nick was very delayed in his gross motor development. Because his trunk was so weak, he sat slumped. This affected his ability to chew and swallow. A co-treatment plan of therapy helped to escalate Nick’s progress. After Nick did the Beckman exercises, the occupational therapist would work alongside placing a nubby rubber cushion under Nick to help build up his abdominal and back strength.
She placed her hands on his trunk manipulating his shoulders to maintain integrity while biting exercises were performed. The feeding specialist pulled out all sorts of foods like Cheerios, goldfish, graham crackers, and sour gummy worms and wrapped them in gauze. Then she placed them one at a time in his mouth, and he would bite down. The gauze acted like a safety net to keep him from gagging or choking. In less than a year, Nick was able to chew and swallow textured foods safely and his trunk became strong enough for him to be able to walk at age 3 ½.
I never thought I’d see the day when Nick could eat crunchy foods 🙂
Nick has come a long way since those days of sitting slump, gagging on food. I am forever grateful to all of the therapists who have made him strong over the years and continue to help him grow. He is a force to contend with in the world. Last week he managed to pull yet another fire alarm at school.
Oh no, not again….. Tally now 30 alarm pulls…..
October and Down Syndrome Awareness Month is almost over. I hope you have gained some knowledge about Down syndrome in this month’s blogs. It’s been one heck of a journey raising Nick, but all four burners are going now. That’s what is in my noggin this week. 🙂
~Teresa
Big guy overcame low muscle tone! More Halloween costume pictures over the years are located in the October 2012 archives. 🙂
Down Syndrome with a Slice of Autism 