ISSUES RELATED TO FOOD IN A CHILD WITH DS

FOOD TIME STRUGGLE

Moms are too much concerned about feeding their children & as this is an universal truth, struggle is an inevitable part regardless of the child being special or typical! But when we are talking about a child with Down Syndrome we need to know few basic reasons for this struggle.
Firstly, as I always say rule out any medical cause leading to altered taste, loss of appetite and/or refusal of feed.
Look at the reasons other than medical.
The child with Down Syndrome has;

• Smaller oral cavity compared to a typical child of the same age.
• Shorter & thicker tongue that has less flexibility & space to move.
• Low muscle tone
• Poor muscle coordination
• Poor coordination between the act of push by the tongue & the act of swallowing of the bolus.
• Delayed & poor dentition (overcrowding & misalignment of teeth)
• Slower neurotransmission system (The transfer of signal from oral cavity to brain & back from brain to oral cavity)

The above mentioned reasons are responsible for the struggle!

It is difficult for the child to chew the food properly in a small oral cavity with thick tongue & weak muscle tone. 
When we feed the child the signal regarding the texture & consistency gets transferred to brain & brain orders the chewing & swallowing muscles, tongue & jaw to act accordingly. Because the signaling is slow in our children, before the brain orders, the child either spit out the food or swallow it without chewing. 
Now as a mother our inference is, 'the child is unable to chew' & we start with mashed & semisolid food. This becomes very easy for the child & then the child is not ready to come out from the comfort zone. 
Even with the poor dentition & low muscle tone if the child manages to chew & form a bolus, there is a problem in deglutition. 
Deglutition (the action or process of swallowing) happens as a result of simultaneous act of tongue & upper food-pipe. The bolus is pushed by tongue & at the same time swallowed by upper food-pipe. The poor coordination  makes it difficult for the child to swallow. 

Don't worry!

There is nothing wrong in giving mashed or semisolid food but we cannot continue with it beyond certain age.

How to deal?

We cannot change the size of the oral cavity & the size of the tongue. 

We can work to a great extent & improvise the oral muscle tone.

We can set a meal-time discipline.

We can work following the reward charts.
We can help the child a bit to identify the signal & respond. 

We can take a good care of oral hygiene & better dentition.

Let's go into the detail of each point one after the other.
1. Oromotor exercises help in strengthening the oral muscles. All the oral exercises I mentioned in my blog on speech will help the child to chew & swallow better. Encourage the child to do all those exercises regularly.

• Chew sticks can be used even for older kids having problems with chewing, swallowing & trying different textured food.
  
  
  
  
• There are different chew sticks freely available online. They have different texture, smell & even taste.
• We can encourage the child to chew the natural chew sticks. At our place we freely get them in a vegetable market. Below is a link showing the method of using chew-sticks. If the child is too young just give him the stick & allow him to chew in whatever way he wants.
  
   

https://www.youtube.com/watch?v=vXQZ4wrJ-BQ
https://www.youtube.com/watch?v=RP06V9hZJdw

https://www.youtube.com/watch?v=TVektFDud_s

• Offer hand to mouth activities like brushing the teeth with finger brush. You can read the advantages of using finger brush from the link posted below.

http://www.dentaltipsforall.com/finger-toothbrush-for-kids-benefits-how-to-use/0213/

• Copying animal sounds is an excellent fun activity that helps the child to strengthen the oral muscles & to speak/chew/swallow better. We can do that in numerous ways like sound books, animal sound toy piano, reading from books, listening songs & copying the sounds etc. There are number of videos available on YouTube. I am posting one for example. You can find many more. 

       https://www.youtube.com/watch?v=Woc5c8mePR4

• Even copying vehicle sounds is a joyful activity & helps the child to strengthen the oral muscles.

2. Meal time discipline is another very important aspect.

• Sooner you motivate the child for self-feeding easier it would be to train.
• Encourage the child to hold bottle/sipper/glass.

  

• You can use long & thick handed spoon & help the child to eat on his own.

•  You can make small pieces of chapati & encourage the child to eat independently. 

• You can give puffed rice, popped corns, nuts etc.

 

• Don't worry about spilling & mess.

• A slice of fruit or a whole fruit can be given.

• Set a discipline about the timing of meal. Involve the child in setting the timings.

• Use meal-time visual charts.

• Help the child to understand hunger & thirst. If the child is non-verbal teach him to indicate by alternate mode of communication.

• The duration of meal time should be ideally 20 minutes & can be stretched to a maximum of 30 minutes.

3. Using Reward Charts is very effective way to inculcate positive food habits.

• Our children have a tendency to sit at a same place, use the same plate & eat the same food. It is difficult for them to adjust to any type of change. 
• Keeping this in mind offer different type of food (different in taste,look,texture & consistency) since early age. 
• Prepare a chart as shown below & keep on introducing new food. 
• Allow the child to express his likes/dislikes & make changes accordingly. 
• Use pictures/smileys/gestures to facilitate the communication. 
• Make the meal-time pleasant rather than a struggle.

4. We can train the child to respond faster with the help of the oromotor exercises described  previously & by introducing different textured food regularly.

• While trying different food, start with the regular food of child's choice & in-between give a single bite of new food. The next bite should be the familiar food before the child reacts. You need to explain the child about it beforehand & decide the reward points for the same. For example tell your child that 'Today you will be having 5 bites of a new food I am going to introduce & you will get a reward after finishing the meal successfully'. Once you are done, talk with the child about his experience of those five bites of newly introduced food. If child rejects the new food try to find out the reason (texture/taste/look/consistency).

You can find many songs that encourage a child to eat healthy. I am posting few links.

https://www.youtube.com/watch?v=_x7WD73ApWY

https://www.youtube.com/watch?v=mMTF8HLDWZY

5. Oral hygiene and dental care is equally important.

• Brushing the teeth twice should be the routine. Our children are visual learners so chart with pictorial demonstrations of brushing teeth helps.

Below are some videos. Use them and make brushing enjoyable. You can find many more online.

https://learnenglishkids.britishcouncil.org/en/songs/brush-bus 
https://www.youtube.com/watch?v=lnHIgRhJctc
Lastly, consult a pediatric dentist once the teething starts and continue at every stage of teething.

Happy fooding!