- What do you do for tongue thrust?
- What about drooling?
- How do you address low-tone and feeding? Exercises?
I want to take time and answer all of these, but today I will focus on low-tone, feeding, and children with DS. First, it is important to realize there is a misconception about low-tone. Low-tone or hypotonicity has to do with the muscle at rest. Our muscles have the potential to move or contract. The muscles of a child with low-tone are slow to contract, do not always contract fully, and have difficulty maintaining this contraction. Because the muscles’ response is delayed, children with low-tone often have trouble with postural control (for sitting and standing), balance for walking, and protective/righting reactions when falling. Physical or occupational therapists work with children to build core strength (muscles in the stomach and back), develop head control, and improve stability through the arms and shoulders.
How does low tone affect feeding in children with Down syndrome?
Low-tone doesn’t always affect feeding skills. Some infants with low-tone have difficulty latching on to breastfeed or maintaining a lip seal around the bottle nipple. Liquid loss, excessively long feeding (>30 minutes to nurse/bottle feed), or frequent pausing when drinking from the breast or bottle, are problems often attributed to low-tone*. Babies are born with fat pads in their cheeks that help with sucking. When babies have low-tone, the cheek muscles may not contract as tightly. This may contribute to a weaker suck preventing adequate suction on the nipple.
*Keep in mind that these same symptoms can also be signs of other conditions such as congenital heart problems. This is why it’s important for someone trained in feeding to listen carefully to your child’s story, watch her eat, and interact with her before and after feeding.
To improve bottle-feeding skills we work to establish the desired muscle movements and coordination. For instance, if the child is leaking milk from the sides of her mouth we want the lips to seal and the cheeks to activate while sucking. Techniques a feeding specialist might try include:
- A slower nipple
- A smaller nipple
- Cheek support from the caregiver
- Feeding the baby on her side
- Pacing (allowing the baby to drink, then tilting the milk out of the nipple to allow her to swallow)
- Providing postural support – using a light blanket to swaddle the baby with her hands in the center of her body (think baby burrito)
If a true weakness is identified, helping the child establish a non-nutritive suck (NNS) outside of feeding is sometimes suggested. The NNS is different from the suck used when feeding. As a baby drinks she gets into a rhythm called suck-swallow-breathe. The NNS is fast-paced, with a larger number of sucks before the baby breathes. A pacifier or clean pinky finger (with very short finger nail) is used to help improve the baby’s NNS.
As the baby grows, low-tone can affect the transition to table foods including puree. Many children with Down syndrome take their first bites of rice cereal just fine! It’s very common for the tongue to push out those first few feedings – we see this in typical children too. I will post about transitioning to table foods in the near future.
An experienced feeding therapist will be able to help identify if low-tone is contributing to your child’s feeding concerns and make appropriate suggestions to improve her feeding experience.