Clinical Practice Guideline: Report of the Recommendations. Down Syndrome, Assessment and Intervention for Young Children (Age 0-3 Years)
NYS Department of Health. (2006).
Albany (NY): NYS Department of Health, (Publication No. 495), 292.
This guideline provides recommendations pertaining to the assessment and intervention of young children with Down syndrome. The intended audiences for this guideline include families and professionals. Of particular importance to speech-language pathologists and audiologists are recommendations regarding assessment and management of communication, cognition, social relationships, oral-motor feeding, and hearing.
Early Intervention Program, New York State Department of Health; U.S. Department of Education
Interventions for oral-motor and feeding problems in children with Down syndrome may include behavioral interventions to improve tongue posture and encourage appropriate development of jaw, lip, and tongue movements used in eating, drinking, and speaking (Level C Evidence; p. 159).
Children with Down syndrome should be assessed for oral sensorimotor and feeding problems. Assessment should include: <br />
<ul>
<li><span style="color: #333333;">physical examination and thorough medical and feeding history (i.e., primary caregiver’s knowledge about the progression of introducing solid foods to the child's diet), </span></li>
<li><span style="color: #333333;">oral-motor examination to assess: </span>
<ul>
<li><span style="color: #333333;">presence/absence of oral reflexes,</span></li>
<li><span style="color: #333333;">structure and praxis of lips, tongue, palate,</span></li>
<li><span style="color: #333333;"> oral sensation,</span></li>
<li><span style="color: #333333;">laryngeal function (voice production),</span></li>
<li><span style="color: #333333;">control of oral secretions,</span></li>
<li><span style="color: #333333;">respiratory control,</span></li>
<li><span style="color: #333333;">swallowing function (including effect on nutrition intake and need for measures to prevent aspiration), and</span></li>
<li><span style="color: #333333;">oral postural control</span></li>
</ul>
</li>
<li>observation of body posture, positioning, risk for aspiration and interaction patterns between child and primary feeding during trial feeding, and</li>
<li>need for further instrumental assessment (Level D2 Evidence; pp. 92-93).</li>
</ul>
<p>The following assessment tests may aid in assessing oral-motor and feeding in children with Down syndrome:</p>
<ul>
<li>The Neonatal Oral-Motor Feeding Scale (Level D2 Evidence);</li>
<li>The Pre-Speech Assessment Scale (Level D2 Evidence); and</li>
<li>The Schedule for Oral-Motor Assessment (Level D2 Evidence).</li>
</ul>
During the assessment of language emergence in young children with Down syndrome, consider the need for augmentative communication systems (Level D1 Evidence). Consider the child's motor, cognitive, and receptive language abilities and the preferences of the family when determining appropriate communication system (Level D1 Evidence).
Developmental levels (instead of chronologic age) should be considered when determining the child’s readiness to progress in feeding. (Level D2 Evidence).
A team of pediatric professionals should be involved in the ongoing assessment of children with Down syndrome if there are concerns about oral-motor function or feeding (Level D2 Evidence; p. 93). Team members may include, but are not limited to, a speech-language pathologist, occupational therapist, registered dietitian, and primary health-care provider.
<div>When planning intervention strategies to facilitate feeding in young children with Down syndrome, it may be useful to consider parent-child groups or parent-parent training (Level D2 Evidence). It is important to consider ease of implementation by parents when considering oral-motor/feeding intervention options. (Level D2 Evidence).</div>
Interventions for oral-motor and feeding problems may include palatal plate therapy (Level B Evidence).
Professionals should have knowledge and experience in providing oral-motor interventions for children with Down syndrome (Level D2 Evidence; p. 159).
