Ask a Therapist: Straws and Tongue Placement
An occupational therapist asks Sara Rosenfeld-Johnson about a patient with Down syndrome whose tongue protrusion breaks her straw seal after 1-2 sucks. Sara recommends a single-sip technique and correct straw placement to support tongue retraction.
- A single-sip technique, drawing the liquid once, removing the straw, letting her swallow, then reinserting the straw, may help interrupt the tongue-protrusion pattern that breaks the seal.
- Straw placement matters: the tip should rest on the surface of the lower lip rather than the tongue blade, since tongue blade contact can explain the protrusion.
- This suckle pattern, protruding the tongue after 1-2 sucks around the point of swallowing, is what breaks the lip seal during straw drinking.
- With cheek cueing, the patient has also achieved horn blowing and bubble blowing, though nasal airflow appears at times when her tongue midblade elevates.
Reader Question
“Hi Sara, I have taken your Oral Placement course and you currently have devised a plan regarding this program for my son Cole. I have a question however it is regarding something I am seeing in treatment (I am an OT) when using the straw program. I have a patient who has down syndrome, 6 months ago could not form a seal around a straw much less retrieve fluid. She had/has frequent tongue protrusion which limited this skill. Using your techniques she has gained the ability to form a good lip seal (with cheek cueing provided) and can retrieve liquid. What is happening however is that after she sucks 1-2 times (I believe when she is going to swallow) she protrudes her tongue which then breaks the seal and continues to use a pattern we are trying to correct. Any suggestions or insight on this situation? This child has also learned to blow horn #1 and can do with cheek cueing for 8 blows before compensation. At times she has some nasal airflow which I believe her tongue (midblade) elevates and impacts based on the sound she makes when this happens. She can do bubbles as well with same cueing. Last bit of information on whistles and bubbles I included in case it helped with answering my original question. Thank you for your time!”
Therapist Answer
I have seen the behaviors you describe concerning the suckle pattern with straw drinking. Here is what I would try. Have her draw the liquid 1 time, remove the straw, once she swallows, put the straw in again. See if the single-sip technique helps with the tongue retraction.
Also, make sure the tip of the straw is on the surface of her lower lips and that she is drawing the liquid back using lip protrusion with tongue retraction. If the straw is on her tongue blade that might also explain why you are seeing the protrusion.
I hope this helps.
— Sara Rosenfeld-Johnson, MS, CCC-SLP