Often when I tell people I’m a Speech-Language Pathologist the person will say, “Oh, I had speech therapy as a kid. I couldn’t say my (insert speech sound here).” My husband jokingly calls me a pirate doctor, because I teach people how to say their arrrs. I usually follow up with a sarcastic eye roll. What most people don’t know is that there are many different areas of Speech-Language Pathology, including speech, language, cognitive-communication, swallowing, fluency and voice.
One of the areas I focus on is feeding and swallowing disorders in children. As part of my job I evaluate children who have mild to severe feeding disorders. Often these children have problems organizing their oral motor skills to effectively chew or coordinate bottle, cup or straw drinking. After an in-depth evaluation I work with the child to help develop the oral motor skills for them to become a successful eater. One of the goals we often target is straw drinking.
All typically developing children progress through certain oral motor skills as they grow during their first few years of life. There are critical periods of development that occur for certain feeding skills. Today I want to focus on the first year of life in relationship to the development of straw drinking. Now lets step back and talk a little bit about oral motor development.
Newborn to 4 months- Suckle reflex is present. A baby uses the buccal sucking pads to express milk from the breast or bottle and the tongue moves the milk to the back of the mouth for swallowing. The lips are not active in feeding. Sucking is a reflex.
4 months to 6 months- The suckle and suck reflex is lost and sucking becomes an intentional act. As the reflex diminishes, so does the forward tongue thrust motion. As the tongue thrust diminishes a baby is able to accept puree spoon feedings. The lips slowly become engaged in the feeding process.
6 to 7 months- A baby uses a primitive bite and release pattern when given a soft cookie; however, mostly sucks the cookie to break it down.
7 to 8 months- As a baby begins to accept thicker puree foods, the tongue movements are becoming more precise with up and down movements. By the end of eight months the tongue begins to move from side to side. Cup drinking may be introduced at this time, although larger mouthfuls of liquid may cause choking or coughing due to poor coordination of sucking, swallowing and breathing.
9 to 12 months- As a baby begins to finger feed the bite becomes more refined and chewing begins to transition to a circular (rotary) chew. The rotary chew is not fully established until 48 months. At 10 months the lips move to remove food from the spoon. Straw drinking may be introduced.
12 to 14 months- An infant can tolerate ground, mashed and coarsely chopped foods including small pieces of meat. The lips are active during chewing and are coordinated to drink from a straw. Some coughing may be present while drinking from a cup, if the liquid is flowing too fast.
So what does that all really mean when it comes to teaching your child to wean from the bottle?
1. A baby begins to develop the oral motor skills necessary to learn how to drink from a straw at nine months. In the next three to four months, he or she develops a coordinated sucking and swallowing pattern to drink from a straw without difficulty.
2. There is no reason to give your child a sippy cup other than for convenience. Sippy cups were first introduced into the market by Richard Balanger in 1990 as a “dripless liquid feeding container”. He later sold his design to Playtex. Today you will find an entire wall full of different brands of sippy cups at the big department stores. I remember how confused I was when I went to buy my first round of sippy cups. I too fell into the trap that many new parents make. The coveted search for the perfect sippy cup my developing little one year old would drink happily from. Guess what? I never found it! More on that later.
Do sippy cups cause speech sound errors?
The field of Speech-Language Pathology continues to move toward evidence based research to support our therapy techniques; however, I am not aware of any research that supports or refutes the idea that the prolonged use of a sippy cup, pacifier, or thumb-sucking causes speech sound (articulation) disorders. However, we do know that the use of a straw and open cup promotes the appropriate tongue position for certain speech sounds and swallowing patterns. I have treated many, many children with articulation errors such as lateral “s” (known as a lisp),who used a sippy cup and/or pacifier for prolonged periods. Often these children also have a reverse swallow tongue pattern that can impact dentition, as well. Children suck a sippy cup just as they would a bottle, so I like to call them glorified bottles. I will say that not all children who use a sippy cup (or a pacifier beyond a year) have articulation errors or a deviant swallow pattern. I have found that many of the children I see have very poor oral muscle tone. Using a straw over a sippy cup promotes appropriate oral muscle strength for the development of speech sounds.
Next week I’ll be discussing my two totally different experiences weaning the boys from the bottle to a straw cup. I’ll also cover strategies to use to teach your child to use the straw and review a few of my favorite straw cups. Please leave a comment or contact me through Twitter or Facebook if you have any questions regarding this or any other topic in speech, language or feedings/swallowing disorders. I love feedback!