Our friend and colleague, Lisa Aquilino Haley, Occupational Therapist, is at it again. Giving you the inside knowledge to help those trickiest kiddos.
Lisa Aquilino Haley has over 16 years of pediatric occupational therapy experience. In the most recent 7 years, she has been supporting infants, children and families experiencing feeding issues during in-patient stays at the Children’s Hospital of Eastern Ontario. She has recently transitioned to role of OT and facilitator of the out-patient feeding program, supporting picky eaters and challenging feeders in an interdisciplinary setting, with special interest in transitioning children from tube feeds to oral feeds.
She has a passion for online teaching and has recently started a website dedicated to sharing knowledge and practical information. You can find her at lisamarietheot.com or follow her on Instagram or Facebook at lisa_aquilino_haley_OT.
I get a lot of common questions around drinking: How can we reduce coughing on fluids? How can we move back a protruding tongue? What are the best spill-proof cup options? The answer to all of these is STRAWS! I love straws for so many reasons and I love teaching straw drinking skills. Here’s the why and the how of promoting straw drinking with our clients.
When you think about position when drinking, (as we OTs are always annoyingly thinking about), you realize that a head tilted way back, with a mouthful of fast-flowing fluid, and emerging oral motor skills is a recipe for coughing disaster. By providing a straw, we can create more of a chin-tucked in position and prevent laryngeal penetrations (Ko et al, 2021), (Ra et al., 2014).
Also, straw drinking is so great for increasing lip closure, muscle tone and of course tongue retraction. When clients have had prolonged bottle and/or sippy cup use, the tongue has been trained to cup around the base of the nipple and move forward and back to draw out fluid. This often leads to that open-mouthed, low tone, tongue sticking out posture even at rest. When using a straw, they have to learn a new pattern which involves moving the tip of the tongue to the roof of the mouth in order to create a “wave” of movement to push the fluid back. In order to promote this, a very short amount of the straw should extend past the child’s lips and onto the tip of their tongue.
Which leads to the next point – what are we looking for in a straw cup? I prefer those without the weighted valve at the bottom. This is because without that handy little valve, a child MUST keep the cup down, in a chin tuck position, in order to suck up fluid. Here are my favourites:
Now that we have an understanding of how great straw drinking is for so many reasons, as well as what to look for in a straw cup, how do we actually get kids to drink from a straw? Of course, you may have kids who just instinctively “get it”, so you could always offer first. The shorter straw should prevent them from simply chewing away at it, or trying to suckle it like a bottle nipple.
As always, use your clinical judgment here. If you feel that straw drinking isn’t appropriate for your client, due to lack of coordination or underlying medical diagnosis that puts them at risk for aspiration, do not try these methods!
Problem 1: Child just chews on the straw
When this is happening, it’s usually a great sign that this little one has been practicing munching on hard solids and is learning to lateralize their tongue side to side for food! However, they likely don’t understand that they have to do something completely different with the stick-like straw. Try the pipette method here, to help them understand placement of the straw, lip closure, and suction.
- Place a straw into a cup of water
- Cover the open end of the straw with your index finger
- You should now have about ½ a length’s worth of straw primed with water.
- While keeping your index over the top of the straw, lift the straw to the child’s mouth until they open up and lean forward
- Wait until they have made “fish lips” around the end of their straw, and ensure that their chin is neutral or pointed downward, then release your index so they get some fluid
- If they aren’t closing their lips around the end of the straw, consider a straw with tactile input (see Ezpz bumpy straw) or coat the end of the straw with their favourite pureed food
- Keep practicing this until they get the idea that their lips need to be rounded and the straw needs to be centered to their mouth
- Once mastered, only release your index when you feel that they are sucking the straw… It becomes a question of timing!
Problem 2: Child doesn’t know how to draw up liquid
In this case, ensure that the child has sufficient oral motor skills first before proceeding. If there isn’t a question of underlying tone or medical diagnosis that would explain the lack of coordination, it may just be a matter of exposure and practice.
Priming the straw method
- Place the straw at midline
- Ensure that the chin is tucked or in neutral
- For this, you will have to find a straw cup that allows you to slightly squeeze the contents up the straw. Many therapists choose to use the HoneyBear Straw cup. I personally find it very expensive. If it’s just a matter of teaching the concept of straw drinking to a child with typical development, my preferred vessel is the Rubbermaid straw container.
- Gently squeeze the base of the container, so that there is some fluid in the straw
- Again, the short straw allows for less sustained sucking/shorter travel time before they get to the fluid.
- Over time, prime the straw lower and lower so that the child has to suck more and more.
Straw drinking is such a great skill to teach kids for so many reasons! Give it a try!
Ko, J. Y., Shin, D. Y., Kim, T. U., Kim, S. Y., Hyun, J. K., & Lee, S. J. (2021). Effectiveness of Chin Tuck on Laryngeal Penetration: Quantitative Assessment. Dysphagia, 36(6), 1054-1062.
Ra, J. Y., Hyun, J. K., Ko, K. R., & Lee, S. J. (2014). Chin tuck for prevention of aspiration: effectiveness and appropriate posture. Dysphagia, 29(5), 603-609
Love what Lisa has to say? Check out her other blog articles:
- Why Are My Toddler Clients Gagging On Their Foods?
- How to Transition to an Open Cup – Part 1
- How to Transition to an Open Cup – Part 2
Thank you once again Lisa for taking the time to write these wonderful tidbits for us. We hope you enjoyed them.
Charlene and Julie
P.S. Join our growing Facebook group: Pediatric Dietitians – Newbies to Masters
P.P.S. Love what Lisa has to say?! Join our wait list for our next round of our flagship course Infant Nutrition Essentials where she delivers a full module on Feeding Readiness, Safety and Function – An Occupational Therapist’s Perspective