1 ) Develop coughing - when child coughs, put your hand on sternum and say "oh, you're coughing- firmly press sternum for one second and remove hand- this should stop the tongue from extending forward into a gag and prevent vomiting

2 ) Have child imitate coughing so coughing becomes more voluntary- this aids child in developing control over respiration and coughing/gagging

3 ) Provide firm input to the root of the tongue- try this on yourself first- place your thumb under your chin about -1 inch behind your jaw bone- if you quickly and firmly move your thumb directly up and down you should feel your tongue moving up and down in your mouth- this increases muscle tone in the tongue and should increase voluntary control over gagging- do this for 1-2 minutes about 4-5 times daily- if you are doing it correctly you will hear your child tongue moving - if a child is vocalizing "ah" while you're doing it they will make cute gurgling sound.

4 ) During bottle feeding child may be having difficulty organizing sucking, swallowing, and respiration and as a result the baby will gag and the vomit-watch very closely for infants cues-this is how they communicate-if the child begins to demonstrate stress signals such as turning head, pulling back, changing color, coughing, gagging, choking, irregular breathing, then immediately remove the nipple from the baby's mouth.

4 ) Make sure the child has enough time to reorganize and then continue feeding- it is always better for the feeding to take a longer and be slowly paced, than for the child to bring up everything-alternative stress signals include sighing, sneezing, yawning, nasal flaring, sweating, hiccuping, eye widening, tremor, and respiratory quality ( ie. wet sounding/moist respiration)

5 ). Develop straw drinking (also blowing bubbles in liquid with straw) and whistle blowing- this also improves voluntary control over respiration and increases muscle tone in tongue-(demonstration: blow out or use a straw and feel your tongue retract back)-straw drinking should begin with thicker liquids in wider straws-texture and straw width should be altered as child acquires skill

6 ) Provide stimulation to tongue with spoon during feeding- press right behind (never on) the tip of the tongue- press in a quick downward and forward direction with each small spoonful- this improves muscle tone and improves ability to retract tongue again providing child with improved voluntary control of tongue muscles- "marroon therapy spoons" are available from speech and language catalogs- a white coated baby spoon or a "Charms" lollypop may also be used-the small lollypop is just the right size

7 ) Develop imitation of tongue protrusion in mirror