Question
How do you remediate an open mouth posture in an infant with Down syndrome? What may be the cause of the open mouth posture? My son is 6 months old and he has never had swallowing or feeding problems. He has eaten solid food since he was 4 1/2 months old
Answer
Your son's tongue protrusion may be occurring for a number of reasons. First, tongue protrusion with concentration is normal for all children regardless of the diagnosis of Down syndrome. Second, I would rule out a medical cause. Children whose airway is compromised by large adenoids or tonsils may have difficulty keeping their tongues in their mouths. Upper respiratory tract infections which block the child's nose may lead to mouth breathing. During mouth breathing the jaw lowers and the tongue may not be contained within the mouth. Chronic ear infections (common in children with Down syndrome) can also lead to upper respiratory tract infections. Tongue protrusion associated with periods of teething or throat infections is usually transient and will resolve with appropriate treatment by a physician. I would consult with your pediatrician regarding a referral to a pediatric ear, nose and throat specialist to rule out an underlying medical cause.
Children with Down syndrome may have a smaller, higher arched hard palate which means that the tongue must rest in a smaller than average space. Some children with Down syndrome also have delayed oral-motor development and low muscle tone in the tongue. If this is the case your physical and occupational therapists as well as your speech-language pathologist should be able to build an intervention program that is tailored to your son's individual needs. The program should center on helping your son achieve stability in his trunk, pelvis, neck, shoulders and head, increasing oral/facial muscle tone, increasing oral sensitivity and improving lip, jaw and tongue movements.
I would consult with your son's doctors and team of intervention specialists to address the tongue protrusion. In the meantime, observe your son and take note of what he is doing at the time, how long the tongue protrusion lasts and if he is able to correct it himself. As he grows and develops he may just need a verbal reminder from time to time to close his lips and retract his tongue.
Melinda Chalfonte-Evans, PhD, CCC-SLP, is a Speech Pathologist at Cincinnati Children's Hospital Medical Center in the Division of Speech Pathology. She specializes in early language development and has worked extensively with individuals with Down syndrome. She is actively involved in both clinical activities and research related to Down syndrome and her work has been published and presented at local, regional, national and international conferences. In 2004, she was awarded the Professional of the Year by the Down Syndrome Association of Greater Cincinnati. Prior to joining the Division of Speech Pathology, Dr. Chalfonte-Evans served as the Director of Treatment for the Jane and Richard Thomas Center for Down Syndrome.
