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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