Question: I work with a child who has Down Syndrome. She is 16 months old. She presents with open mouth posture and tongue thrusting not during feeding. Mom purchased a Z-vibe and I saw your article on using the Z-vibe to promote lip closure. Only problem is....anytime we go near her mouth she thinks the item is food and tries to open her mouth and touch her tongue with it. She does not yet understand commands such as close your lips. Any suggestions???

Usually when we put things to our mouths it’s to bite/chew/eat them, so it makes sense for some kids to think the Z-Vibe, a spoon, etc. might be food at first. 

You can try simplifying the command to just “don’t close” or “no close” or “no bite.” Even if kids can’t understand the words of certain commands yet, they can often sense your general tone. She'll eventually get the difference between what's edible and what's not.

That being said, my instinct is to suggest working WITH her interest instead of against it. If she's interested in the Z-Vibe - great!   Let her go for it. She may just need some time to explore it, learn about it, sense it, bite on the tip, etc. You can even dip the tip attachments in different purées / sticky foods (applesauce, yogurt, etc.).

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Once the newness wears off, you may be able to get in there and do more specific exercises/input.  You may have to wait until she’s older for certain exercises that require following directions.  But in the meantime, this oral stimulation/exploration will be good to help either normalize oral sensitivities that she may already have, OR help keep them at bay (children who have Down syndrome often develop oral sensitivities in my experience).

Letting her explore the Z-Vibe (under supervision) will also help increase oral awareness, which may be contributing to the tongue protrusion, among other things.

For lip closure specifically, try pairing it with the m sound. Say “mmmm” and see if she’ll imitate you. Touch the Z-Vibe to the lips for a tactile cue if needed, and turn it on to vibrate if more input via vibration is needed.

Last but not least, be sure to check out this article for more oral sensory strategies for children who have Down syndrome.

Debbie

Debra C. Lowsky, MS, CCC-SLP

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