Thursday, September 9, 2010

Need to Stop Talk Tools Straw Hierarchy?

I'm going crazy so I thought I would turn to all of you for some sound advice.  I am being told by our current SLP that we need to stop using the Talk Tools straws immediately because of Sweet Pea's aspiration issues.  The SLP believes that the straw brings too much liquid into her mouth too quickly and it increases the likelihood of her silently aspirating.  We are seeing this SLP due primarily to the aspiration since we know that she does aspirate, at least on thin and nectar thick liquids.  The SLP has lots of experience with aspiration so I do tend to trust her.

However, I am a Talk Tools worshiper and really believe in the benefits of the straw hierarchy. We are on straw #2 and I think Sweet Pea is doing great with them.

We emailed Sara Rosenfeld-Johnson and she thinks that if she can drink the thickened liquid through the straw that it should be okay, but recommended that we ask the person monitoring her aspiration to ask if straw drinking is allowed.  Sweet Pea's GI referred us to the OT at Children's Hospital to get the swallow study, but the GI has left the monitoring to whomever is doing the therapy (he suggested either an OT or SLP).  Maybe I could contact the OT that did the swallow study?

Our SLP gave us two options for drinking if we ditch the straws:

1) Sippy Cups: I don't believe that sippy cups are a good option because they teach the child to drink with their head back which also increases the risk of aspiration.  Plus they don't help with tongue retraction at all.

2) Open Mouth Cups (regular cups): Um, I'm not a neat freak (anyone that has seen my house knows how extremely true that is), but yikes!  I don't think I'm ready for her to make such a huge mess every time we give her some milk or juice or water!  Many of you don't actually know Sweet Pea, but this sweet little girl is really a major league baseball player in hiding and has an arm on her that would surprise anyone.  Putting a cup of liquid in her hand is a recipe for disaster for anyone within a 5 mile radius!

So, I'm stumped.  What do we do?  It really sounds like some people think it is an issue and others don't.  I don't believe there is a way to get a definitive answer unless we do another swallow study, which would subject her to even more radiation and we are just not willing to do that to her again...for now at least.  I'm leaning towards being cautious and not chancing it since aspiration is so dangerous.

Does anyone think that a cup like the coffee cups that have the lid set down with a little hole might work?  I just did a search on Babies R Us and this is the only cup that looked like a possibility:

That is the only thing I can come up with on my own so far.  I'm desperate for opinions and advice!!!!


  1. I can relate to your frustration. My son doesn't have aspiration issues, but several months ago when I wanted to switch my son from the bottle to a straw cup, our ST was completely opposed to it! She said that he was "wrapping his tongue around the straw" & that I should try to use the little cut out nosy cups only. Well, like Sweet Pea, my son throws all objects in his path, & when he would actually drink from the cup, the liquid was just pouring out of his face. I was so frustrated that I actually burst into tears during a therapy session. In the end, I ended up switching to a new ST who supports the Talk Tools ideas & now my son drinks from a straw like a champ. Being that Sweet Pea aspirates, I think that it makes it more difficult for you to know what to do. I would check with your ST about using the thicker liquids through the straw. I'm also wondering if you could use one of those infatrainer (spelling?) cups with the lids? I think those are shown on the Talk Tools website. I suppose that you could still try the Honey Bear, since you would be able to control the amount of liquid going into her mouth. Whatever you do, good luck! Who knew that cup drinking could be so complicated??? :)

  2. Have you seen this one? It's from TalkTools, too: It was a little pricey, but our therapists bought it for Piper (maybe an option through your EI?). It has two lids with different sized holes so that the flow can be controlled a bit more. And I really like the idea of having handles on it. Just a thought! :)

  3. I wish I knew, but I'll have to remember what they say when we are working with Makayla!

  4. I don't have any advice but I do think it's kind of funny. Why would straws make a difference from straight drinking from a cup? I would think the liquid would come in just as fast? Lucas started aspirating a little with the straws but we thicken and he does fine now. We also count to three then pull the straw away so he doesn't get too much liquid. If I were you I would not use sippy cups, I think your idea of a coffee type cup is best. You'll have to let us know how it goes.

  5. Super interesting. I guess our feeding therapist/SLP who was instrumental in getting LC to safely consume fluids by ONLY using straws.

    She did begin with thickened fluids and wider mouthed straws. The more narrow the straw, the less effort that was required to do the suck and LC needed to focus on the steps and coordination involved in sucking.

    I think the cause of the conflict in recommendations may be because of the two intents behind using them. I would determine an SLP it safe swallowing or articulation...and focus on it. I know the Talking Tools program allows some individualization based on the needs of each specific child, so perhaps as safe-swallowing is addressed, you could work with the horn hierarchy or some other element within the program that won't conflict with the swallowing instruction.

    That said, LC didn't learn to swallow using fluids. She practiced lateral tongue movements and transfering using hard foods like crackers, etc. Once she had the coordination in her tongue, the liquids were introduced with thickened fluids and valved straws.

    I think it's absolutely fair to invite your SLP to share her principles in feeding therapy/instruction and what experience she's based them on. If you don't think she has the best strategies in place for Pea, look until you find someone with a known reputation whose philosophies more closely align with yours and your goals for SLP.

  6. Emily is aspirating on thin and nectar consistency and we use the playtex straw cup, it's a straw, but the valve is so small that she really has to suck hard to get the honey consistency through it. I watch her when she drinks and I haven't seen signs of her aspirating like I was without the thickener.

  7. We had a feeding eval a month or so ago, and they also said, no straws yet. Start with sippy cups - they recommended the Dr Brown for the least head tilt, or the Gerber ones... pictured on my post:

  8. My daughter did not aspirate, but she would cough and choke a lot. I used Thick-it and the Munchkin straw cups.
    There is a small valve in the straw that slows the liquid down. Replacement straws are affordable for when the valve wears out. She may be able to manage the liquid better this way.

    My daughter is 3 1/2 and we have recently been able to stop thickening her drinks and she is starting to drink from a small open cup. HTH.