Feeding and Swallowing in Children with Down Syndrome



Feeding and Swallowing in Children with Down Syndrome

Allen C. Crocker Family Lecture Series on Down Syndrome

May 24, 2010

Jennifer Perez, MS, CCC-SLP

Gwenyth Gorlin, MS, CCC-SLP

Topics for Discussion:

Complexity of Feeding

Typical Feeding Development:

-Review of feeding milestones and appropriate diet selection

Feeding Complications in Infants and Children with Down Syndrome:

Breast-feeding and Bottle-feeding

Gastroesophageal (acid) reflux

Spoon-feeding

How to reduce tongue thrust

Chewing

How to work on tongue lateralization (side to side tongue movements)

Cup Drinking

How to use a sippy cup, straw, open cup, etc.

Picky Eating:

Sensory Hierarchy

Food Chaining

Feeding Therapy

Early Intervention

Aspiration

Modified Barium Swallow Study: 617-355-7727

Websites we like: , , new-

Children’s Hospital Boston, Feeding and Swallowing Program: 617-355-7727

Typical Progression of Textures

0-4 months Breastmilk or Formula

4-6 months Smooth Stage 1 or 2 baby pureed foods

6-7 months Homemade Purees (smooth, not lumpy – NO stage 3)

(Or when holding head up)

7-8 months Hard Teething Foods (to develop munching skills)

(Or when bringing hands to mouth)

8-9 months Crunchy but dissolvable solids

9-12 months Soft mashable foods

12-16 months Soft table foods (can be mixed texture if chewing skills are adequate)

16-18 months + Tough and chewy foods

Hard Teething Foods

These foods are to practice biting and munching; not for swallowing - stick shape works best

Teething biscuits, dried fruits (papaya, mango), frozen foods (bagel strips, melons), raw vegetables if no teeth yet (carrots sticks, celery sticks), crisp tender vegetables (asparagus, green beans), very chewy foods that don’t break apart (pizza crust, Slim Jims, beef jerky)

Crunchy Dissolvable Foods

These foods should dissolve easily in the mouth with little chewing

Freeze dried fruits, snack foods (Gerber puffs and wagon wheels, baby Mum-Mums, graham crackers, veggie straws, fruit loops, cheese curls, Pringles, Snikiddy puffed corn balls, Kix cereal, Pirate’s booty, NOT cheerios)

Soft Mashable Foods

These foods need only “mushing”; no need for mature chewing yet – avoid mixed textures

Cooked vegetables (stewed carrots, potatoes, squash, beets), canned fruit, soft fresh fruit (banana, papaya, kiwi), cheese, eggs, pound cake, banana bread, muffins, donuts, pancakes, taco meat

Soft Table Foods

Good chewing skills are needed to eat these foods or kids may gag easily

Pasta, bread, soft sandwiches, chicken nuggets, fish sticks, roast chicken, deli meat, mac n cheese, soup and contents, lasagna, meatballs, hot dogs, French fries

Tough or Chewy Foods

Chewing should be mastered at this stage

Steak, pizza crust, raisins, hard crust on bread, fresh fruits and vegetables, sandwiches with both soft and hard ingredients, fruit leather, licorice, gummy candy, pretzel rods, tortilla chips, bagels, hard granola bars

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