- For a toddler with Down syndrome who gags on solids, first assess what the lips, cheeks, and tongue are doing during feeding. In other words, do not assume the problem is purely sensory.
- Work on cheek mobility and bilabial closure for spoon and cup feeding. Additionally, address tongue lateralization when protrusion or retraction is the primary tongue pattern.
- If the child resists the bite tube, instead try the vibration bite-and-chew XL head (the yellow bite tube attachment) with the Sensi vibration tool.
- Notably, rolling the vibration tool from the lateral incisor to the first molar is an effective alternative when direct molar-ridge placement is not tolerated.
- Finally, involve an OT who specializes in sensory processing if broader sensory issues are present beyond oral feeding.
Reader Question
From the Community
“I am a speech pathologist working with toddlers. A few years ago I attended your conference on feeding therapy. Although I haven’t had to use a lot of the techniques up until now, I am a little rusty. Currently, my caseload includes a little guy with Down syndrome who is not chewing a great deal. His mom told me that at home she is noticing a great deal of gagging and sometimes vomiting because of this. We have been trying bite tubes. However, he is resisting them. Any suggestions you can give me are greatly appreciated.”
Therapist Answer
Answered by Lori L. Overland, MS, CCC-SLP, C/NDT, CLC, FOM
Hello, and thank you for the questions. As often occurs, I have a few questions to start before giving more specific guidance:
- Does this little one have other sensory issues?
- Is there an OT who specializes in sensory processing involved?
- Have you made observations about what this little one is doing with his lips, cheeks, and tongue during purees and solids?
Given the diagnosis, I would suggest working on cheek mobility and bilabial closure for spoon, cup, and similar utensil use. Furthermore, if a protrusion/retraction pattern is the primary tongue movement, work on tongue lateralization. Does the child tolerate vibration? If so, use the Sensi with the fine tip for lateral tongue massage.
To address bite tube resistance, try the vibration bite-and-chew XL head (it looks like a yellow bite tube) attached to the Sensi. You can also try rolling the vibration tool from the lateral incisor to the first molar as an alternative to direct molar-ridge placement. Either way, both strategies are especially useful when a toddler with Down syndrome resists standard bite tube placement.
By the way, I have just written a book that should be out in June if you need a review of the class, along with updated exercises. In addition, it will serve as a helpful reference for working with sensory processing and Down syndrome feeding cases like this one.
Clinical Considerations: Sensory Processing Chewing Down Syndrome
Typically, children with Down syndrome present with low oral-facial muscle tone, tongue protrusion, and sensory processing in Down syndrome differences that directly affect chewing skills. As a result, understanding the distinction between a motor-based challenge and a sensory-based challenge is essential before selecting an intervention strategy.
Notably, gagging during solids often indicates that the child's oral-motor skills have not yet developed to the level required for the textures being offered. Importantly, this pattern is not always a sensory aversion. In many cases, the child's cheek muscles, lip closure, and tongue lateralization patterns are the limiting factors. Therefore, a thorough feeding assessment using a sensory-motor framework helps clinicians identify the specific skills the child needs to build. Such evaluation is particularly important when addressing sensory processing chewing Down syndrome cases where low tone and motor development closely overlap.
For toddlers with Down syndrome, always assess lip-cheek-tongue movement patterns before deciding whether to pursue sensory-based or motor-based intervention goals. Although the two approaches are not mutually exclusive, identifying the primary driver of the feeding challenge ensures your goals are both targeted and measurable.
When sensory processing differences are also present, collaboration with an occupational therapist who specializes in sensory integration is strongly recommended. Moreover, OTs can assess the broader sensory system and develop a plan that supports the child's feeding work in therapy as well as at home. Indeed, this team-based approach reflects best practice for complex cases and leads to more consistent outcomes. An OT adds significant value when sensory processing chewing Down syndrome is a confirmed factor alongside oral-motor deficits.