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Having a child with Down syndrome you tend not to take any small milestone for granted. Every eating and drinking skill is an accomplishment. Drinking from an open cup has been our longest fought for skill. It eludes us. We tried a myriad of approaches and still it is a struggle. I would get frustrated and push too hard, he would give up and not try, and we just couldn’t find anything to bridge the gap between drinking from a straw and drinking from an open cup.
At birth Big-C had difficulty drinking from a bottle so we had to use a nasogastric tube (tube goes into your nostril and down to your stomach). This was used to supplement the amount he got from the bottle. Once we left the hospital he was a bottle drinker, but he was not able to breast feed. He could latch on, but was unable to actually drink. I pumped for 6 months until after his open heart surgery and then he was able to become a breast feeder! That was an accomplishment for me and him.
As he grew and began to wean from the breast, with guidance of our speech pathologist we worked through a variety of sippy cups. The first one, Nuk sippy cup, the spout was similar to the texture and flexibility of a bottle which made the transition easier. Then we used a Gerber sippy cup with a firmer spout with a valve we could remove so he could figure out how to drink without the valve helping to control the flow.
As we were moving through sippy cups we began introducing bottles with straws starting with the Honey Bear cup. Which is a piece of tubing into a honey bear container. We could squeeze the bear and see the liquid rise to help with the speed and sucking until Big-C got the hang of it and was able to drink from the honey bear himself. We then graduated from that to a variety of strawed cups and water bottles. Now primarily we use the Take & Toss cups for home and the CamelBak water bottles when we are out and about. They say the Take & Toss are spill proof, not for my kiddo, especially since we wash and reuse even after the straw has been bitten nearly flat.
Open Cup Drinking Challenge
Big-C drinks from a straw with his tongue cupping under the straw, so when he tries to take a drink from an open cup, there his tongue was under the lip of the cup. This is not helpful, give it a try and see how you do drinking with your tongue under the lip of the cup.
We tried the Nosey cup. There is a notch cut out to avoid his nose hitting the edge of the cup. It always tended to get bumped and spill half the liquid out of the low side. Also, Big-C likes to do things by himself, even if he needs a little help. I love this independence in him, but it can be frustrating when teaching him something new. With the Nosey cup, he would turn it around the wrong way to drink from it, or not let me hold it up for him to help with the speed of the liquid. So after a few failed attempts, whenever the cup was brought out to drink with it was met with indignation.
We tried drinking from regular cups
When using a thin liquid like water, he would just get a full face of water, SPLASH! He had trouble controlling the speed or it would spill out on his lap prior to making it to his face. We tended to work on drinking during the warmer months. When it’s 80° outside, who cares if you get a face or shirt full of water. We also tried this in the tub. Neither technique did the trick, and he would just turn it into a game.
We would thicken the liquid using Gogurt or watered down applesauce, but the amount would travel down the cup at a fast pace and spill. When I controlled the speed of the fluid he would tend to either open his mouth really wide without resting his bottom lip on the lip of the cup then just sort of eat the thick fluid. He also would keep his mouth puckered but closed and pretend to drink even adding a “ahh” when he put his cup down. He would never actually drink.
The Cup and Technique that Finally Helped!
A week ago we needed to get a feeding eval from a clinic based speech pathologist. She was to help us determine if we need a swallow study prior to a tonsil/adenoid surgery. Turns out he has no issues with feeding or swallowing so that’s good. The therapist had a suggestion and we tried it out at the appointment for helping learn to drink from an open cup. Using a clear Solo cups. Seriously that’s it.
Here’s why it works. The cup is small on the bottom and wide at the top. This increased angle decreases the speed at which the fluid travels and Big-C can see it coming at him. The wide opening at the top presses the corners of his mouth so that he doesn’t purse his lips and it gets his tongue back into his mouth.
The cup is clear so I can see the fluid. I don’t have to crowd into his personal space to try and look into the cup when he’s drinking.
The cup is flexible and won’t crack. This is not true of generic cups similar to this, just the Solo cups. We can bend it or he can bite the edge of the lip without fear of it cracking. I can tip it up and hold it at his lips to wait for him to actually swallow. The lip of the cup is comfortable and rounded so he doesn’t pull away.
He’s not getting frustrated with it and continuing to try to drink. We started with semi-thinned yogurt and are thinning that more to a drinkable yogurt texture. Tonight the whole family had cups of applesauce so we were all drinking from the same type of cup. Big-C loved that! We’re hoping this progress continues and we are able to drink thin liquids from an open cup very soon.
Don’t give up!
If you are struggling with finding a way for your child to drink from an open cup, don’t give up. Keep trying different ideas until one seems to fit well for your child and your family. Although we didn’t succeed with the earlier suggestions, it doesn’t mean they don’t work for others. Just keep trying. With persistence our children can accomplish more!
Please check out my other Therapy Thursday posts about how we work therapy homework into our daily hectic lives! Leave a comment about what’s working or not for your child when drinking.