I am looking for suggestions for our 2-year-old son with epilepsy. He currently functions at a 6 month level. He can eat by mouth (only stage 2 or 3 baby foods), but lacks a suck. He can swallow well, but we have to use a syringe to get liquid into his mouth first. I do have the Z-Vibe with the Cat and Mouse Tips, but since his mouth is so tiny, they haven't really helped. Can you suggest any others?

I've also tried a ton of cups and nothing has helped. If we don't see improvements soon, we will probably get the g-tube just for liquids. He has had one before, but we would prefer to get him to take everything by mouth. I have seen him suck on his finger and make a sound - so he is doing it at times. He will be getting Hyperbaric Oxygen Therapy in three weeks along with intensive speech therapy, and I want to make sure I have all the products that he may need. Any thoughts?  

To work on the suck, I'd recommend the Preefer Tip and/or the proPreefer.  The Preefer Tip is to be used with the Z-Vibe. The ProPreefer has the same tip, but is a non-vibratory alternative.   Both are used in the NICU.   I have personally never worked in the NICU, but other SLPs have told us that they are a great fit. 

Place the tip between the lips and pull it in and out to stimulate a suck. I use this technique with older babies and children. Your son is now 2, but you can still try this. Please be sure to ask his doctor for approval in using oral vibration with seizures AND with the Hyperbaric Oxygen Therapy treatment. I had a little guy in the same situation who was fine with it, and have never heard any contraindications, but it is always best to check to be on the safe side. You can also always use the Z-Vibe in the off position without vibration.

For cup drinking I'd recommend a Flexi Cup. These small flexible cups have a cut-out for the nose, so that you don't have to tilt the head back to drink.  I also find the cut-out helpful to watch what the upper lip is doing as a child drinks.  If you want to try it out first before buying, just find a small paper cup (like dixie cups) and tear an opening in it. 

Support should be given to the chin, stretch the upper lip down, and you may have to give some cheek support.  Make sure he doesn't tilt his head back, and a slight chin tuck may help, too.  You have to play around a bit, just like you have been doing!

After he has a tiny bit of liquid in the mouth, you can put your pinkie under the chin and push up while you have your thumb under the pink of the lower lip. This should keep the mouth closed.  Let me just mention that water and juice are considered "thin" liquids and CAN be difficult to manage. You may want to thicken it with puréed baby foods or just try let him drink a tiny bit of the puréed food.

It may also be a good idea to try straw drinking.  Our Bear Bottle can be used to teach straw drinking and/or make it easier for those with a weak suck.  It comes with a special valve that keeps liquid at the top of the straw, which means it takes just a tiny bit of effort to drink.  This should help with straw drinking, especially since you observed him sucking on his hand.  

You can also try putting puréed food on his hand to see if he'll suck it off.  Be sure to praise him for doing it.  Giving him a Baby Grabber to mouth/chew/suck on may also be a good idea.

I am sure you know this, but developmentally if he is functioning at a 6-month-old age level, then you go back to the skills that a child/infant should have at that age and build from there. 

I hope some of this is beneficial. Please keep me posted on his progress :)

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Debbie

Debra C. Lowsky, MS, CCC-SLP

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