Question: My 2.5 year old daughter has down syndrome. She has had feeding issues since birth and we are trying to work with her on chewing.  She will bite and chew crackers and other hard foods, but will swallow soft things whole. We are working with a speech therapist as well as an occupational therapist, but they do not have a lot of experience with the grabbers, and other bite tools. Can you recommend a tool that will promote chewing? 

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She may need to be taught that soft foods (such as bananas, macaroni, etc.) need to be chewed just like hard foods, even though they feel closer to puréed foods, which can be swallowed without chewing.  Whatever's on the menu, take a bite yourself first.  Concentrate on what your tongue is doing with the food.  Are you just swallowing it immediately?  Are you moving the food from side to side in your mouth?  How many times do you need to chew the food?  Count how many chews so you know how many is enough.  Then as your daughter chews, actually count the number of chews out loud to help her keep track of her chewing.  I count on and stick up my fingers as well.  You can put on some music and chew to the music.  It can also help to pretend to chew as she chews.  Overemphasize and exaggerate your jaw and mouth movements, saying "yum, yum, yum."  Begin with foods requiring only a few chews, such as a banana.  Then progress from there.

Another reason she's not chewing soft foods could be related to oral sensitivities.  In my experience, children who have Down syndrome can be hyposensitive with limited oral awareness.  Soft foods do not have a lot of texture, and so they may not provide enough tactile information inside her mouth.  If she can't feel the food, she won't know that she needs to chew it.  Gum massage and textured oral motor tools can help increase oral awareness by providing proprioceptive feedback inside the mouth.  Sensory chews are also an excellent way for the tongue, lips, jaw, and cheek to exercise and 'practice' movements.  The textured ones simulate the feel of real food to help introduce new textures.  You can also dip them in sticky foods (like mashed potatoes, yogurt, applesauce, etc.) to promote chewing.

Since she's already biting and chewing crackers, you can also try gradually "connecting the dots" between foods she already accepts and new foods to expand her diet.  Dip her favorite crackers in soft foods (dips, jams, sour cream, creamy peanut butter, cheese whiz, etc.).  This will give the soft foods some texture variety so she can slowly feel and experience with them.

As far as which products in particular to look at, I'd recommend the Textured Grabber and/or Y-Chew (both in the softest level).  The Z-Vibe can also be used to work on both biting and chewing skills and oral sensitivities.  Dip these tools into the puréed/soft foods that she likes for functional biting/chewing practice.

Last but not least, I'd recommend checking out this related article as well.

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All my best,

Debbie

Debra C. Lowsky, MS, CCC-SLP

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