Jill Rabin M.S. CCC-SLP/L IBCLC Pediatric Speech/Language Pathologist

1. Important Nutritional, Oral Motor, Feeding, and Language Ideas to Ensure Optimal Development of Your Child with Down Syndrome Jill Rabin M.S. CCC-SLP/L IBCLC Pediatric Speech/Language Pathologist International Board Certified Lactation Consultant

2. Medical Assessment/Intervention • Cardiology • Gastroenterology • Otolaryngologist • Endocrinology • Audiology • Ophthalmology/Vision Specialist • Brian Skotko-geneticist: www.brianskotko.com • Nutrition • Physical/Occupational Therapy • Speech Therapy/Lactation Consultant • Developmental Therapy

3. Oral Motor/Feeding/Language Characteristics of Children with Down Syndrome • Difficulty with motor planning • Decreased oral sensory awareness due to low tone • Overstuffing of food • Tongue protrusion • Issues with middle ear fluid/hearing loss • Motivated by music • Excellent gestural imitation • Telegraphic speech patterns

4. Ideal Nutrition for Infants/Babies with Down Syndrome • Breastfeeding/Breast milk • Organic foods/Clean diet • Impact of gluten • Impact of dairy • Biomedical treatment • Vitamins/Supplements • Appropriate feeding tools/aids

5. Bottle-Feeding/Breastfeeding Techniques and Aids • Sara Rosenfeld-Johnson’s bottle-feeding technique • Specialized bottles: Haberman Feeder, Dr. Browns, Innobaby, Calma, etc. • Paced bottle-feeding • Firm bottle nipples • Nipple shields • Supplemental nursing system

6. Bottle-feeding/Nursing Aids

7. Oral Motor Activities/Exercises • Breastfeeding • Straw drinking • Open cup drinking • Tongue elevation and lateralization exercises • Graded chewing • Lip strength/closure activities • Oral sensory awareness activities • Horn hierarchy • Lori Overland video

8. Specific Oral Motor Exercises for Tongue • Tongue pointing exercises • Lateralization of food bolus • Tongue retraction • Tongue tip definition/elevation • Tongue-ties

9. Posterior Tongue Tie

10. Specific Oral Motor Exercises for Lips/Jaw • Lip rounding • Prolonged lip closure • Lip isolation • Graded chewing • Bite and pull • Oral tug of war • Oral sensory awareness • Oral proprioceptive input

11. Jaw Grading/Tongue Lateralization

12. Chewy Tube

13. Lip Rounding

14. Exercises with Food • Combining crunchy with smooth • Food shape (strips) • Varying viscosity of liquids • Isolating lips to pick up food items • Lateralization of food items • Graded biting

15. Foods Used in Therapy

16. Oral Facial Tone Variability

17. Oral Motor/Feeding Resources • Debra Beckman: www.beckmanoralmotor.com • Lori Overland-videos on youtube of oral motor and feeding assessments with children with Down syndrome. • Sara Rosenfeld Johnson: www.talktools.com -has special bottle feeding technique, developed many oral motor and feeding tools. • Pam Marshalla: www.pammarshalla.com -gives presentations, has books, on stopping drooling, oral motor techniques, and apraxia.

18. Speech/Language Strategies • Audiological Assessment • Use of a Total Communication Approach • Expansion and differentiation of vocabulary • Modeling and expansion of sentence structures • Emphasis on articles in speech, e.g. the, a, etc. • Incorporation of siblings in therapy • Literacy Training • Non-therapy activities: Tae kwon do, dance, swimming,etc.

19. Speech/Language Resources • Libby Kumin-author of Early Communication Skills in Children with Down Syndrome (2003) focuses on speech and language skills in young children from birth to six years. • What Did You Say? (2006 DVD): focuses on how to help children develop intelligible speech. • Helping Children with DownSyndrome Improve Speech (2008): focuses on communication skills in older children from ages 6-14.

20. Importance of Use of Sign Language with Children with Down Syndrome • Issues with motor planning • Good at imitating gestures • Allows communication until verbal speech is present • Visual learners/hearing difficulties

21. American Sign Language • Known as ASL • Is the true language of the deaf • Has it’s own syntax and grammar • Best to use if child is truly deaf • Third most used language in the United States

22. Signing Exact English • Known as SEE • Using ASL signs, with English grammar and syntax • It’s expanded with prefixes, tenses, articles, prepositions and endings • Manual representation of English vocabulary and grammar • Takes longer to communicate • Used to teach deaf children English

23. Example of SEE

24. Types of Signs • Iconic Signs • Nouns versus Verbs • Have meaningful origins, e.g. boy, potato, onion, etc. • Sign approximations

25. Sign Language Strategies • Viewing of Signing Times videos • Incorporation of siblings in therapy • ASL.pro video dictionary • Pairing sign with verbal words

26. Resources to Learn Sign Language • www.signingtime.com • www.babysigns.com • www.asl.pro • www.loveandlearning.com • www.signingsavvy.com

27. Community Resources • Gigi’s Playhouse • National Association of Down Syndrome • Ups for Downs • North Shore Down Syndrome Awareness Group • Lutheran General’s Down Syndrome Clinic

28. Questions???