OBJECTIVE. A treatment package combining oral–motor and behavioral interventions was implemented for a 6-year-old girl with Down syndrome referred to an intensive day treatment feeding program for gastrostomy tube dependence and food refusal. The participant exhibited a tongue thrust, resulting in the expulsion of all foods presented.

METHOD. An oral–motor procedure was used to reduce the tongue thrust and allow the food to be swallowed. This procedure was paired with positive reinforcement and escape prevention to increase oral consumption of liquids and solids. A multiple-probe design was used to evaluate treatment effectiveness.

RESULTS. By the end of treatment, tube feedings were eliminated and tongue thrust was significantly reduced.

CONCLUSION. This intervention demonstrated the successful combination of oral–motor and behavioral components in the treatment of a severe feeding problem. It could serve as a model for the development of future interventions.

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