Early Intervention Feeding

As many of you know I travel a lot for business. I am now in NYC for my youngest daughter's graduation and to see a few clients. It amazes me how many of these kids still do not have therapists who know about early intervention feeding. I saw a child today with a significant tongue protrusion during swallowing and talking. The home-based therapist told this mother to press down on the child's tongue blade with the spoon to stimulate retraction. Mom was also told to press in on the tongue tip whenever the child's tongue blade was "hanging out of the mouth." Mom followed this professional's suggestions to a “T.” Guess what happened? Three weeks later this kid has a stronger tongue protrusion and does not want mom to put a spoon with "anything" in her mouth. When I teach my feeding class to the Special Educators at the University of Arizona I have them do these 2 tasks and feel what their students will be feeling. The response is generally a gag and a desire to stick the tongue tip out.

SLPs and OTs are being asked to do early intervention feeding with clients as part of our birth-t0-3 jobs. Before feeding anyone I would require them to watch Lori Overland's DVD: Feeding: A Sensory-Motor Approach.

We have to stop feeding kids like we "think" they should be fed and start feeding them to promote safe feeding and improve speech clarity.

The Sippy Cup Issue

What a great email I got today! An SLP forwarded me a link to an article on why “sippy cups” are not the best choice for transitioning kids off of bottles. In this article in Baby Talk they talk about the fact that to drink from a “sippy cup” the child has to use a suckle pattern. The best quote is from an SLP “There are only a few sounds we produce with the tongue out like ‘th.’ Most words are spoken with the tongue in, and the sippy cup does not encourage that.” Finally! I have been teaching this same information in my class, A Three-Part Treatment Plan for Oral-Motor Therapy, since 1992 but for some reason the message has not gotten out there. Even though Jonathan Eig wrote an article many years ago in the Wall Street Journal, in which I was quoted, this is the first resurface of the issue I’ve seen and I’m elated.

I have spoken with many dentists who also discourage the use of these cups as they foster an open bite. These cups are carried around and allow kids to have a sugared liquid in the mouth frequently throughout the day. For this reason the incidences of cavities is increased in kids who use them habitually. Many pediatricians don’t like them because a child can drink from them with the head tilted back allowing liquid to enter the Eustacian Tubes so these kids are at greater risk for ear infections.


There are so many reasons why they should not be used especially with our clients with tongue-thrusts which already impact negatively on their speech and feeding skill development. Using a recessed lid cup, Honey Bear with Straw or a Straw Drinking Hierarchy (admittedly biased source – other sources exist but I cannot vouch for quality) is a much better way to ensure adequate liquid nutrition, avoid spilling and actually improving oral placement and movements for speech.