Two mastication tests used in children with down syndrome: A feasibility study.
Two quick cracker-and-gum tests reliably show kids with Down syndrome chew less efficiently yet last as long as peers.
01Research in Context
What this study did
The team gave two quick chewing tests to 24 kids with Down syndrome. Ages ranged from 4 to 14 years.
One test counted how many times a child chewed a cracker in 30 seconds. The other timed how long they could keep chewing gum before swallowing it.
What they found
Kids finished a large share of the trials, so the tests are easy to use in clinics. They chewed the cracker fewer times than same-age peers, showing weaker bite efficiency.
Yet the gum test showed no early fatigue. Kids kept going as long as peers, proving endurance is intact.
How this fits with other research
Kınacı-Biber et al. (2026) used ultrasound on the same Down-syndrome group and found thinner lower-leg muscles that predict shorter steps. Both studies use cheap, objective tools to show motor deficits are real and measurable.
MWFaught et al. (2021) tested feeding in autism with a parent checklist. Like A et al., they proved a short screen can flag oral-motor issues early. The difference: A et al. used direct timing instead of parent report.
Siu et al. (2011) asked parents about sleep in Down syndrome and found a large share clinical-level problems. Their survey method contrasts with A et al.'s hands-on tests, yet both reveal hidden health issues parents rarely mention.
Why it matters
You now have two five-minute tests that show chewing weakness without tiring the child. Use them before starting solids or expanding textures. If efficiency is low but endurance is fine, focus treatment on bite strength and tongue lateralization, not rest breaks. Share the numbers with parents so they see progress in black-and-white.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Time a child's cracker chews for 30 seconds; if below age norms, add bite-block and tongue-lateralization drills to the plan.
02At a glance
03Original abstract
BACKGROUND: Children with Down syndrome can have problems with chewing and swallowing. However, no objective tests are available that give information about the efficiency and endurance of mastication. In this study, the feasibility of two mastication tests is studied by answering two research questions: are the Test of Mastication and Swallowing of Solids and the 6-min mastication test feasible to use in children with Down syndrome? Do these tests give information about the mastication efficiency and endurance in these children? METHOD: A total of 24 (4-18 years) children with Down syndrome participated. The collected variables in the Test of Mastication and Swallowing of Solids were masticatory time, discrete bites, masticatory cycles and number of swallows per cracker. The inter-rater reliability of these variables was tested. Collected variables in the 6-min mastication test were total masticatory cycles and percentage difference between minutes 1 and 6. Qualitative ratings of masticatory movements were made. In both tests, a comparison with a typically developing group was made. RESULTS: In both tests, a total of 87.5% of the children completed the test. Both tests are feasible for children with Down syndrome with language comprehension skills of 3 years and over. CONCLUSIONS: The tests give information about the function and endurance during mastication in children with Down syndrome. The results showed that children with Down syndrome do not have endurance problems during mastication, but there is a lack of efficiency in mastication.
Journal of intellectual disability research : JIDR, 2020 · doi:10.1111/jir.12693