All material Copyright © May 2009 The Down Syndrome Centre
Reprinted with the express permission of the The Down Syndrome Centre as originally published on their website.
By: Marinet vanVuren
Marinet vanVuren is a South African born Speech and Language Therapist. For the past seven years she has worked with a range of Irish disability organisations including Enable Ireland, St Michael’s House and the Children’s Sunshine Home. She recently set up her own private speech and language therapy practice where she sees children of all disabilities with various speech, language and feeding difficulties.
The tongue is composed entirely of muscle and is moved and shaped by two types of muscles: (i) The intrinsic muscles are contained within the tongue and are responsible for the refined movements of widening, flattening, elongating, shortening, narrowing, thickening and lateralising the tongue. These muscles lift the sides, raise and depress the tip as well as change the shape and contour of the tongue. (ii) The extrinsic muscles are responsible for changes in the tongue position in the mouth. These muscles elevate, depress, protrude and retract the tongue and are important in the processes of eating, drinking and talking.
Children with Down syndrome often exhibit low muscle tone in the tongue. Their tongues may appear thick, bunched and slightly larger in size. Children with low muscle tone in the tongue generally exhibit imprecise pronunciation of speech sounds secondary to concerns with intrinsic tongue muscle function. Without the support of the intrinsic musculature, the extrinsic tongue muscles are unable to stabilise the tongue, thus creating further difficulties with eating, drinking and talking.
When targeting oral-motor skills, it is very important to remember the developmental hierarchy of oral motor tasks. Starting at 18-24 months (in children with normal muscle tone), children will be able to imitate the following oral motor tasks:

1. Sticking out their tongue or tongue protrusion.
2. Pulling their tongue back or tongue retraction.

From 24-36 months, children will be able to move their tongue from side to side or imitate tongue lateralisation. Only from 36-48 months are children able to lift up their tongue tip or perform tongue tip elevation tasks.
What activities can I do to develop tongue strength and mobility?
Activities to develop controlled tongue protrusion (sticking your tongue out):

• Show your child how to push his/her tongue against objects, e.g. clean bubble wand, cheerios on a plate, tongue depressor.
• Show your child how to balance a cheerio on the tip of his tongue.
• Poke your tongue in and out like a lizard in a slow rhythm. Do for 5 seconds.
• Encourage your child to lick foods from a plate (not at dinner of course!), e.g. Nutella chocolate hazelnut spread, 100’s and 1000’s. Encourage your child to use their tongue and not their lips.
• Encourage your child to lick food substances from a spatula or spoon (small measuring spoons are a great idea!).
• Encourage your child to lick lollies and ice blocks.
• Place food tastes around your child’s lips and encourage them to lick their lips.

Tongue retraction (pulling your tongue back):

• Difficult or strong blowing, e.g. difficult-to-blow whistles, party horns.
• Sustained blowing, e.g. bubbles.
• Straw-drinking with long, thin straws and thickened liquids, e.g. smoothies, milkshakes.

Tongue lateralisation or moving your tongue from side-to-side:

• Licking sticky foods from the corners of your lips, e.g. peanut butter, honey, chocolate spread.
• Put small bits of melt-in-the-mouth foods into your child’s cheeks. These can include chocolate buttons, meringue, prawn crackers, skips, etc.
• Show your child how to use their molars to bite and chew crunchy and chewy foods, e.g. carrot sticks, liquorice sticks, pretzels, and breadsticks.

Tongue-tip elevation or lifting the tip of your tongue:

• Get your child to lick large lick-and-stick stickers.
• Dab a long line of peanut butter on a tongue depressor and get your child to lick it all the way up, using only his/her tongue and not his/her head.
• Tongue lifts – pretend you are a weight-lifter having to lift cheerios on your tongue up and down.

(These exercises are to help increase control of the tongue. Use a mirror when you first do the exercises, so that your child can see what s/he is doing.)

• Open your mouth. Move your tongue from side to side in a slow rhythm. Try not to move your head – only your tongue. Touch the corners of your mouth with the tip of your tongue. Do this for about 5 seconds.
• Open your mouth a little. Slowly lick around your lips in a circle. Then go the other way around your lips.
• Try to reach your nose with the tip of your tongue. Try to touch your chin with the tip of your tongue. Then put these two movements together and move your tongue up and down for 5 seconds.
• Poke your tongue into your left cheek, then the right cheek. Do this 3 times on each side.
• Clean around your teeth with your tongue.
• Pull faces in the mirror, ask your child to copy you, moving their tongue up and down and side to side.

Featured Organization: The Down Syndrome Centre
We thank the Down Syndrome Centre for allowing us to reprint their copyrighted article. For more information about this organization please visit The Down Syndrome Centre