self feeding toddler with Down syndrome

Kamdyn and feeding have been a bit tricky for me.  Because certain things have just always been, so I think I have almost accepted them as "normal", because it's how it's been.  But there are some issues that we are definitely working on, and I think we will be going back to the feeding clinic at Hershey Medical Center soon.

What are the issues?:

1. Minimal lip closure when using a fork or spoon
2. Taking bites has also improved, but as soon as the food is small enough to fit into her mouth, she crams it all in (CHOKING HAZARD!)
3. Tongue protrusion when using a spoon or fork (Not using her lips aka lip closure)
4. A little bit of aspiration (worse with a straw cup)
5. Fork and spoon skills also need improvement (It's so much faster to eat our apple sauce with our hands)

What improvements?

For a long time, Kamdyn would basically swallow her food whole.  She is much better about chewing.  Here she's eating some pretty crunchy cereal.

She can also eat potato chips (I know, so healthy, right?  They are a treat or a bribe to do PT. Don't judge. Desperate times call for desperate measures, or potato chips in this case.)

I put lip closure above, because she does still have a lot of tongue protrusion.

  But as you can see,

she CAN do it.  She can get those little lips around that spoon.

When we went to the feeding clinic before, it was a big struggle to get Kamdyn to drink.  We had to insist that she take a drink before she got another bite of food.  She also threw her cup all. the. time.  I'm happy to say that, she loves to drink now!  She still throws sometimes (she's still a toddler, ya know), but she also likes to put her cup in the cup holder of her tray when she is not drinking.

You may have noticed new bowl and fork and spoon. 

Scoop bowl:

At this point, she is dipping in her fork/spoon and not really scooping it, but when she starts scooping, the lip on this bowl will help push the food onto the fork/spoon.

It has a suction cup, but it's not toddler proof suction.  It's more for just keeping the bowl still so it's not pushing all over the tray, while she tries to eat.

Bendable fork and spoon:

It can be bent either way for a right or left hander.  Kamdyn is a "switch hitter" at this point.  The bending is a nice feature, and it has helped Kamdyn to be able to get it to her mouth head on.

Sometimes she gets frustrated and wants me to help, or she will ditch the fork and use her hands as soon as I turn my back.

But she also likes the independence of feeding herself.

Self feeding baby with Down syndrome

When Kamdyn was about 9 months old, I started to think about self feeding, because I remembered my other kids being able to do it at that age.  She started out with a straw cup that had handles on it, which made it easier to hold.  She required some help in the beginning, but it didn't take long for her to get it.

The whole straw cup thing was weird, because I just tried it with her one day, since I was thinking about self feeding, and she did it.  So we went from there.

The honey bear cup is a good cup for teaching how to drink from a straw, because you can squeeze the liquid up the straw while they drink. 

For food, we started out with large, easy to grasp foods like biter biscuits. I didn't like the biter biscuits, however, because she would bite off a big chunk, and I didn't feel comfortable with her having that much in her mouth.

A friend mentioned that she used Mum Mum rice crackers, so I tried those. They are great.
 

 
They melt in their mouth immediately like a puff, so I never worried about her choking or taking too big a bite.  And they are not messy like biter biscuits unless you put nutella on it:
 
 

Graham crackers also dissolve quickly.

As Kamdyn's first birthday approached, I worried that she would not be able to have that classic first birthday moment of eating cake, because I had not put food in front of her to feed herself.  Since she didn't have a pincer grasp, I didn't think she was ready for it.  Her birthday was her opportunity to show me.

She ate cake like a champ.

She was so proud.

Shortly after that, I was reading the Woodbine House fine motor skills book.  The book explained that low muscle tone also affects the muscles in the hands and fingers.  Well, that may be common sense to most, but I had never even thought of it.  Apparently, being able to coordinate the thumb and pointer to pinch a small object is a pretty intricate process that often takes our kids longer.  A toddler with Down syndrome will usually use a raking motion with the fingers to scoop the food up before they develop a pincer grasp.  This video demonstrates it perfectly:

As you can see, I only give her one piece at a time.  When she first started feeding this way, and I poured a pile of cheerios or puffs on her tray, she would scoop a whole handful and try to shove them all in her mouth.  In order to prevent choking and teach her to eat one at a time, I sit with her and offer one at a time.  Now, at almost 14 months, I can spread out a small pile of cheerios or puffs, and she will only eat a few at a time.  For larger foods, I am still only giving one at a time, though. 

Some products that I will be investing in as she grows are:

*Munchkin suction cup bowls

Kamdyn already likes to throw her cup, so we are working on it, but a little suction cup help can't hurt.

*Sassy spoons that have a shallow bowl and are curved to make feeding easier.

* Infa trainer cup before we go to an open cup, because it helps teach the motion of drinking from an open cup but helps provide more control.