When should I take my child off a bottle?
Children should be transitioned from the bottle to an open cup by 12 months of age. Developmentally, the skill level is present and each additional month the child remains in the bottle is time to grow more dependent on it thereby becoming more difficult to transition.

At what point should I stop allowing my child to use a binky or pacifier?
If you haven't introduced a pacifier to your child I recommend you don't. If your child is taking a pacifier we recommend removing it by 6-9 months of age. Child quickly becomes dependent on pacifiers. They need to learn to comfort themselves instead of using a foreign device. It can also interfere with speech development, acquisition, feeding, and dentition.

At around what age should my child begin speaking?
Developmental studies tell us that children should begin babbling at 3 months of age and first words to come between 9 and 12 months of age with at least 10 words by 15 months of age.

What can I do to encourage my child to eat vegetables?
We have found that flavoring the vegetables with garlic and serving the same vegetable 1-2 times per day for at least 7 days and up to 14 if this child isn't eating them easily by 7 works very well. Insist the smell and touch the vegetable the first introduction, next he should touch it with his tongue, then bite at least twice (each side of mouth) and allowed to spit out, and then have to bite and chew1 time, etc. until the child is consuming at least 1 portion per day.

What is a sign to know that my child has reflux?
Aside from projective vomiting, parents should notice if the child is a restless sleeper, wakes (sometimes for drinks) at night, has difficulty transitioning to chunky foods, rather drink than eat, etc. There are many more overt signs and symptoms which can be found at www.reflux.org.

My child seems to gag when he/she drinks. What is causing that?
Several things could be causing this. We recommend providing thicker and more flavorful liquids to your child such as buttermilk, V-8 juice, yogurt smoothies, etc. and speak with your pediatrician about this. If it continues we recommend getting a FEES (fibro-endoscopic evaluation of swallow). If this is not available, then we would recommend a MBSS (Modified Barium Swallow Study).

My child refuses to eat when the family eats. How can I ensure they eat with the family?
There are many things which may be going on with your child in the realm of feeding and this is the time when it's most noticeable. Try not offering your child snacks during the day, ensuring there are at least 3 hours between the end of eating to the beginning of the next, making everyone remain at the table until the last person has completed his/her meal, turn off the T.V., play classical/instrumental music, etc. If this behavior continues we recommend seeking an evaluation from a specially trained speech-language pathologist to evaluate for possible feeding issues.

Shouldn't my child transition to a sippy cup from his bottle?
We never recommend transitioning to a sippy cup. The sippy cup works exactly like a bottle it just looks more like a cup. Children do not need this product for transitioning to cup drinking and a sippy cup can actually hinder this natural progression. Playtex and Gerber are currently making several good open cups that are spill resistant/proof which was the reason the sippy cup came to be in the first place.

What should I be concerned with in feeding a child with Down syndrome?
Just like other areas gross and fine motor development, children with Down syndrome need more leading to each developmental milestone with feeding and oral function. There are specific nipples/bottle systems that promote significantly better intake rate made by Playtex, coordination, and endurance. They need to be introduced sooner to solids and transitioned quickly through each stage to table foods.

Why does my child continue to drool?
Your child could possess low oral muscle tone and sensation. Please see a specialized speech-language pathologist for an evaluation to further evaluate this issue.

My child has hypotonia. Will this affect his/her speech, language, and feeding?
Hypotonia generally does affect the muscles in the face and neck at well. A child needs strong abdominal muscles for air flow for speaking.

Should I breast feed or bottle feed?
We always recommend breast feeding when possible. Children with Down syndrome and other disorders can be very successful with breast feeding, however may take then up to 2-3 weeks to build up strength and endurance for longer feeds. As long as your child isn't losing weight and can maintain then be patient and work with your newborn to be successful. You may have to feed more often and not allow a feeding to go longer than 30 minutes so you might be feeding every hour and a half initially. As always ensure your pediatrician is on board with your decision to ensure that there aren't any additional medical complications (i.e., significant heart defects, tracheomalyasia, blocked nasal airway, etc) that are prohibiting your child from being a successful breast feeder.

Is there more than one therapy method available for treating Apraxia?
There are many approaches available for treating apraxia. We have received the most success with the PROMPT (Prompts for Restructuring the Oral Motor Phonemic Targets) approach. This is a fully 'hands on' approach and assists the child with creating sounds. We are advanced trained in this technique. To learn more about PROMPT, you may visit the PROMPT Institute web site.

What is PROMPT and what does a therpist need to do to become PROMPT certified?
PROMPT is an acronym for Prompts for Restructuring Oral Motor Phonemic Targets. The PROMPT system is described as one which utilizes tactile cues of pressure, place, and timing to promote and enhance effective neuro-muscular innervation and coordination for the learning and integration of motor-speech behaviours (Chumpelik, (Hayden), D. A., The Prompt System: Theoretical Framework and Applications for Developmental Apraxia of Speech, 1981.)

To become a PROMPT Certified Therapist is quite a tedious and stringent process. First, one must enroll in a 3-day long workshop and then return to their place of practice and utilize the technique for 4 months. After the end of four months the ‘trainee’ must then complete a project of self critiques and video tapes and return this information to his/her instructors. The instructors will then review the information form that individual and decide what step they are ready for next. Options include resubmitting the project, retaking the introduction course, or enrolling in the next course Bridging PROMPT: Technique to Intervention. They may enroll in the final course only after practicing for a full 6-12 months after the completion of the initial course. After taking the 3 day Bridging course, after which trainees may refer to themselves as advanced PROMPT trained, they must then practice for at least one full year before applying to take the certification exam. To complete the examination the trainee is required to complete a four month longitudinal project of analysis, program development and implementation, and critique of performance. This again is sent to the PROMPT Institute for review. They will then determine if the trainee passes or requires additional training. So, as you can see, it is a very structured, rigorous, and monitored program that not everyone is qualified to perform after attending one course. It is a new way to assess and deliver services to the motor disordered population where the results are astounding. To learn more about PROMPT, you may visit the PROMPT Institute web site.