Thursday, March 12, 2009

speech revisited - this one's for Megan

Megan, mom to the lovely Audrey and adorable Stella, asked for more info on this post. So, I'll try to answer her questions and provide some more detailed info.

Her questions:

What exact age did you start speech?
And how did you teach the straw/cup?

Starting speech:
We had an evaluation with our speech path when Kira was 2 months old. Kira and I had a rough start to breastfeeding. I wanted a speech path to make sure that Kira's latching on looked ok. (I didn't want Kira to have to "re-learn" how to hold her mouth, etc.) When I called ECI (Early Childhood Intervention) to set things up initially, I requested the eval. Luckily, Patricia (our speech pathologist) was able to make room for Kira pretty quickly. We started seeing her regularly less than two months later. I don't know how soon speech services would have begun if I hadn't made that initial request.

Using a straw:
We started our son using a straw really, crazy early - like around 2-3 months. Sucking a straw is very similar to breastfeeding. My mom is a l&d nurse and suggested starting it early - using expressed breast milk in a cup. He was able to do it immediately. I hadn't even thought of doing it with Kira (so many other things on my mind at that time), until Patricia suggested it. Kira was right at 5 months, I think.

To get Kira started, I first put the straw in a cup of breast milk and held my finger over the end of it to create a vacuum. Then I put the straw in Kira's mouth and let the milk dribble in. We did that a few times, so she'd get the idea. Then I put the straw in the milk and let her try. I honestly can't remember how long it took her to figure it out, but I'm thinking she caught on that first day.

ETA - just thought of this - when we started we cut the straws really short (like about 1/3 of the straw), so that Kira wouldn't have to work too hard to get the reward of the drink. She didn't use a full size straw until a few months later.

Using a cup:
Kira's first few speech therapy visits were all about drinking and eating. Initially, we supported Kira's jaw when she drank from the cup. I'm sorry, but I can't remember exactly how Patricia had us do that. I think I held my thumb and pointer finger in a "U" shape and supported Kira just under her jaw - you'd want to double check that with a pro, though. We helped with the jaw support until Kira regularly drank without letting liquid dribble back out.

We also made sure that the cup rested on Kira's lip, not on her tongue. If she stuck her tongue out in anticipation for the cup - I'd wait until she had retracted it before I let her drink.

Using a spoon:
I'm thankful that we had Patricia around when we started Kira on solids. I know 5 months is early to start, but Kira was practically yanking food out of our mouths at that point. When you start spoon-feeding a baby, you usually do that whole scoopy spoon movement - where you put the spoon in and then lift it up, sliding it against their lip as you pull it out. Patricia told us not to do that (and man was that hard to re-learn after feeding Jackson).

Patricia had us put the spoon straight into Kira's mouth - like perpendicular to her mouth. Then Kira would do the work to get the food off of the spoon. Patricia also recommended not using the spoon to wipe food off of Kira's face (you know when you scrape, scrape, scrape then feed that whole extra spoonful to your kid). She wanted to make sure that Kira knew exactly what her mouth was supposed to do when presented with a spoon.

Speech up to about 12 months:
So, until Kira was about 1, speech therapy was mainly about eating and mouth exercises. Patricia had us do a "palate swipe" - kind of a massage for Kira's palate. The purpose of it was to help Kira's palate come down a little in her mouth, so that her speech would sound more typical later on. If you have "regular" muscle tone, when your mouth is relaxed your tongue kind of sticks to your palate and slightly pulls on it. Babies with low tone, however, will typically have their tongues resting at the bottom of their mouths.

We also did an exercise where we would put our pinkie finger where Kira's jawbones meet and let her bite, bite, bite. This was to help with strength and mouth posture (I think).

There may have been a couple of others - I'll go back through Kira's paperwork (if I can find it) and check.

Speech after 12 months:
Once Kira started regularly babbling and saying a few words, we started the sound card system. I think it's something that the group our therapist works with started. More info here.

The sound card system uses pictures and signs to cue sounds. Each of the 21 initial consonant sounds has a name, picture, and a sign/visual cue. We used the cards for several months. Now, we just use the cues.

So, for example, the "h" sound (like in "hello") - the name of the sound is "tired dog", the picture is of a dog, and the cue is holding your hand in front of your mouth like you're feeling the air coming out as you make the sound.

If Kira is trying to say a word and I want to isolate the sound, I use the cue while saying the initial (or ending) sound. I usually repeat the sound, word, and cue a couple of times. Then, I'll use the actual sign for whatever word I'm saying.

For example, the word dog. I'd say "d" (use cue) - "d" (use cue) - "dog" (then pat my leg - the sign we use for dog).

For us, speech therapy was initially about prepping Kira's mouth for speech. Now, we've moved on to actually producing speech. I'll post more later about the sounds she's mastered, what we're working on, and so on.

I'm happy to answer any questions, so y'all feel free to ask!


  1. Thanks!

    We were able to get A on a straw pretty quick using that method. I haven't had luck with S thus far. Guess I just need to work harder at it as I don't want her on a bottle after 12 mos.

    We've been using that spoon method.

    We have an eval. tomorrow with a private SLP. I'll let you know what she does/says.

  2. Ahhh, I'm completely overwhelmed now :( I took your advice, Wendy, and contacted Finn's service coordinator today and requested a consult with a ST. I told her that I've started Finn on solids and would just like to get a professional to observe to make sure I'm using correct feeding techniques, etc., because I know it won't be the same as it was with my other kids. She said that feeding issues are generally handled by an OT here, and that typically, it's not even considered a feeding "issue" - and therefore worthy of a consult - unless the baby is not eating, not gaining weight, etc. Which is not Finn - he's gaining fine, but he generally is still only interested in nursing and he's 8 months old. She's going to look into it for me and see if she can get someone out here. I would just hate to miss the boat on his early speech development, you know? Is there a book on feeding and speech for babies with Ds? I know there are books on gross and fine motor skills.

    Ramble ramble. Sorry.

  3. are so lucky you got such great ST, and so early! Kaia didn't start ST until she was just over 2! Crazy! Feeding issues here are also handled by an OT, and she didn't start that until about 2 1/2! Basically, she had no EI services until she was 2. Thank God for the internet or I would have been completely lost.

  4. What great information...I wish I had this stuff 2 years ago. :(

    Lisa~we were told the same thing about Kailey and eating...that we could only have an OT and since she was eating well it probably wouldn't elicit any new insight. Our EI is crappy though.

  5. I haven't heard of the sound card system before. I'm going to check that out. Goldie has been talking more, so we want to take advantage of her interest in language now. The ST and I were just talking today about if there is a connection between eating and speaking. We've both seen kids with and without DS that are tube fed and have incredible speech.