Straw drinking is one of the most commonly taught functional skills in speech therapy, used primarily to develop lip closure, tongue retraction, and the kind of coordinated oral movement that supports both feeding and broader oral-motor control. Among speech-language pathologists (SLPs) who use non-speech oral motor exercises, straws are the single most popular tool. But the relationship between straw drinking and actual speech improvement is more complicated than it might seem, and the techniques that work best depend heavily on the patient’s age, diagnosis, and specific goals.
Why Straw Drinking Shows Up in Speech Therapy
Drinking through a straw is surprisingly demanding from a motor standpoint. The lips have to form a tight seal around the straw and maintain it. The tongue has to retract and create negative pressure inside the mouth, pulling liquid upward. The cheeks have to stay taut rather than collapsing inward. And once the liquid arrives in the mouth, the whole swallowing sequence has to fire in coordination. Videofluoroscopic studies of straw drinking show that the hyolaryngeal complex (the structures around the voice box that elevate during swallowing) follows distinct movement patterns, and the liquid bolus frequently reaches the lower throat before the swallow itself begins, which means the airway-protection timing has to be precise.
These demands are exactly why SLPs gravitate toward straws. For children who have weak lip closure, limited tongue mobility, or poor oral awareness, learning to drink through a straw is a way to practice those skills in a functional, motivating context. A child who won’t tolerate five minutes of structured lip exercises might happily spend that time drinking a smoothie through a straw. For adults recovering from stroke, surgery, or conditions affecting facial nerve function, straw drinking serves a similar role. One case study of a patient following full facial transplantation documented that lip-closure exercises led to measurable improvements in lip strength, speed of movement, and range of motion during speech, and the patient herself reported that her ability to drink from a straw improved alongside these gains.1American Journal of Speech-Language Pathology. The Effects of Lip-Closure Exercise on Lip Strength and Function Following Full Facial Transplantation: A Case Report
The Important Distinction Between Feeding Goals and Speech Goals
Here is where the picture gets more nuanced, and where clinicians and parents sometimes talk past each other. Straw drinking is well supported as a feeding goal. Teaching a child to drink from a straw is a legitimate functional milestone, and the oral-motor skills involved in straw use are directly relevant to safe, efficient feeding. Nobody seriously disputes that.
The controversy is about whether straw drinking (and other non-speech oral motor exercises) transfers to speech production. A widely cited review of the evidence concluded that despite years of popularity among some SLPs, non-speech oral motor treatments lack sufficient evidence to support their effectiveness in improving speech.2PubMed. The application of evidence-based practice to nonspeech oral motor treatments The reasoning is that speech is a highly specific motor activity, and exercising the same structures in a non-speech task (like sucking through a straw) does not necessarily improve the rapid, precise movements those structures perform during actual speech. The review went further, arguing that limited evidence existed even for using these techniques to improve non-speech activities, and recommended they not be considered standard treatment.
This does not mean straws have no place in therapy. It means clinicians should be clear about what goal they are targeting. If the goal is to teach straw drinking as a feeding skill, or to strengthen oral musculature for feeding purposes, that is a reasonable and defensible clinical choice. If the goal is to improve articulation of specific speech sounds, the evidence suggests the therapist’s time is better spent on speech-specific practice. The distinction matters because families deserve to understand what each therapy activity is realistically expected to achieve.
Despite the controversy, surveys of practicing SLPs show that straws remain extremely common in clinical practice. A survey of speech-language pathologists found that 84% reported using straws as a therapeutic material, making them the most frequently used tool for oral motor exercises.3PubMed Central. The use of non-speech oral-motor exercises among Indian speech-language pathologists to treat speech disorders: An online survey This gap between the research evidence and clinical practice is one of the ongoing debates in the field.
Assessing Whether a Patient Is Ready
Before introducing a straw, a clinician typically evaluates several baseline skills. The most fundamental is whether the patient can create and maintain lip closure. If the lips cannot form a seal around the straw, no amount of suction effort will pull liquid through it. The therapist also looks at jaw stability, because an unstable jaw makes consistent lip closure harder. Tongue function matters too: the tongue needs enough retraction ability to generate negative intraoral pressure.
For young children, readiness often comes down to developmental stage. Most typically developing children can learn to drink from a straw somewhere between 9 and 15 months, though there is wide variation. Children with Down syndrome, cerebral palsy, autism spectrum disorder, or other conditions that affect oral-motor development often reach this milestone later, which is a common reason for referral. For adults, readiness depends on the nature and severity of the underlying condition. A patient with significant facial nerve paralysis needs enough baseline movement to attempt a seal, even if the seal is imperfect at first.
Safety is another consideration. If a patient is at risk for aspiration (liquid entering the airway), the clinician weighs whether straw drinking is appropriate at all. Straw use changes the dynamics of how liquid enters the mouth and throat compared to drinking from a cup, and the therapist needs to consider how that interacts with the patient’s swallowing ability.
A Graduated Approach to Teaching
The core technique most clinicians use is a straw hierarchy, progressively increasing the difficulty of the task across several dimensions. The starting point is usually designed so that the patient barely has to suck at all, and each step asks a little more of the oral-motor system.
Getting Liquid Into the Straw First
For patients who have never used a straw or who cannot generate suction, the therapist often begins by placing a finger over the top of a short straw, trapping a small amount of liquid inside, and then placing the straw tip on the patient’s lips. When the therapist releases the finger, the liquid drops into the mouth. This gives the patient a taste reward for simply closing the lips around the straw, even before any active sucking happens. Over several sessions, the therapist gradually reduces how much finger assistance is provided, encouraging the patient to do more of the work.
Some clinicians use a similar strategy with a juice box: gently squeezing the box so liquid rises partway up the straw, reducing the suction effort needed. The patient only has to pull the liquid the last short distance. As strength builds, the therapist squeezes less.
Short Straw, Thin Liquid
Once the patient demonstrates even minimal suction, the therapist moves to a very short straw (sometimes just a couple of inches long) with a thin liquid. Less straw length means less negative pressure is needed to draw liquid up. Thin liquids like water or diluted juice are easier to pull through a narrow tube than thick ones. The clinician watches for lip seal, appropriate suction, and whether the patient can manage the liquid once it arrives in the mouth without coughing or losing it out the sides.
Increasing Length and Resistance
From there, the straw gets longer. Then the liquid gets thicker. Then the straw might get narrower. Each change increases the oral-motor demand. A longer straw requires sustained suction over more distance. A thicker liquid (like a smoothie or a puree thinned to liquid consistency) requires more negative pressure. A narrower straw requires more precise lip closure and stronger cheek engagement. The clinician adjusts the pace of this progression based on how the patient responds. Some patients fly through the hierarchy in a few sessions. Others spend weeks at a single level.
Specialty Straws
Various therapeutic straw products exist to give clinicians more control over the progression. Bear and Honey Bear straw cups, for instance, use a valve design that requires the patient to suck actively (liquid does not flow out if the cup tips). Some therapy straws have built-in resistance levels. Curly straws demand more sustained suction because the liquid has to travel a longer path. Clinicians pick among these tools based on the specific deficit they are targeting and how the patient responds to the task.
Positioning and Support During Practice
How the patient is positioned makes a meaningful difference, especially for children. An upright, well-supported sitting position with the head in midline (not tilted back) is standard. When the head tilts backward, gravity pulls the liquid toward the airway before the swallow fires, which increases aspiration risk and removes some of the oral-motor demand that makes the exercise valuable. The therapist usually holds the cup or positions it so the patient does not have to tilt the head to reach the straw.
Jaw support can also help. For children with low tone or poor jaw stability, the therapist may gently support the jaw from below with a finger, giving the lips a stable base to work against. This external support is gradually faded as the child builds independent control. Some clinicians position a finger lightly on the child’s cheeks to prevent them from collapsing inward during suction, particularly in patients with very low muscle tone.
Straw Drinking and Swallowing Safety in Adults
In adult rehabilitation, straw drinking comes up in a different context. When someone has difficulty swallowing (dysphagia), clinicians often have to decide which drinking method is safest. The intuition might be that straws are riskier because they send liquid further back in the mouth, bypassing some of the oral control a cup allows. But the evidence on this is more mixed than you might expect.
Research comparing straw and cup use in elderly adults found that while cup drinking allowed a larger volume to be consumed in a shorter time, it also resulted in significantly more oral spillage. Straw drinking, by contrast, showed better bolus containment within the mouth.4PubMed. Sequential swallowing of liquid in elderly adults: cup or straw? In other words, the straw helped keep the liquid where it was supposed to be before the swallow, even though the cup got the job done faster.
A separate study looking specifically at patients with symptoms of oropharyngeal dysphagia compared aspiration-penetration scores (a measure of whether liquid enters the airway) during straw and cup drinking across multiple bolus volumes. The differences between straw and cup were not statistically significant at any volume tested, suggesting that neither method was clearly safer or more dangerous than the other in that patient group.5PubMed Central. Straw vs Cup Use in Patients with Symptoms of Oropharyngeal Dysphagia This finding matters because some clinical settings default to restricting straws for all dysphagia patients. The research suggests that blanket restrictions may not be necessary, and that the decision should be individualized.
For adult patients re-learning straw drinking after a stroke or other neurological event, the teaching progression mirrors the pediatric one in many respects: start with minimal suction demands, support lip closure externally if needed, and gradually increase difficulty. The key differences are that adults often understand verbal instructions (which can speed things up) and that they may carry emotional weight around losing a skill they once performed automatically, which the clinician should acknowledge.
Common Challenges and What to Try
A few problems come up repeatedly when teaching straw drinking, and each has a practical workaround.
- Biting the straw: Some children chew on the straw instead of sucking. This can be a sensory-seeking behavior or a sign that jaw grading (controlling how much the jaw opens and closes) is underdeveloped. Silicone or rubber-tipped straws survive biting better than plastic, and giving the child something else to chew on briefly before the straw task can reduce the urge.
- Blowing instead of sucking: Children occasionally blow air out through the straw rather than pulling inward. This is not necessarily wrong from an oral-motor standpoint (blowing also exercises the lips and cheeks), but it does not accomplish the straw-drinking goal. Placing the straw in a cup of liquid so the child can see bubbles when blowing, then reversing the instruction, sometimes helps the child understand the difference.
- Losing the lip seal: If the seal breaks repeatedly, the straw may be too wide for the patient’s current ability. Switching to a narrower straw, or even a coffee-stirrer-width straw, gives the lips less distance to cover. External jaw or cheek support from the clinician can also help.
- Gagging when liquid arrives: Some patients, especially children with oral hypersensitivity, gag when liquid hits the back of the tongue unexpectedly. Thickening the liquid slightly can slow its movement through the straw, giving the patient more time to prepare for the swallow. Starting with very small volumes (just a few drops pulled up a short straw) reduces the surprise factor.
- Refusing to try: Behavioral resistance is common, particularly in children with feeding aversions. A gradual desensitization approach works better than forcing the issue. This might mean starting with simply tolerating a dry straw touching the lips, then progressing to dipping the straw tip in a preferred flavor, then encouraging a small suck. Pairing the straw with a highly motivating liquid (a favorite juice, for instance) can also shift the equation.
Home Practice and Carryover
Straw drinking is one of the easier therapy activities to practice at home, which is a genuine advantage. Every meal or snack is a potential practice opportunity. Clinicians typically send families home with specific instructions: what type of straw to use, what consistency of liquid, how to position the child, and how many sips to aim for per session. The key guidance is usually to keep practice sessions short and positive. Five successful sips in a pleasant interaction does more than thirty pressured minutes that end in tears.
Families sometimes wonder whether they should just skip cups and have their child drink exclusively from straws. Most clinicians advise against this. Cup drinking develops a different set of oral-motor skills (jaw grading, lip-on-rim control, managing a free-flowing bolus), and children benefit from experience with multiple utensils. The goal is usually to add straw drinking to the repertoire, not to replace other methods. For children who are transitioning from bottles, a straw can serve as an intermediate step that demands more mature oral patterns than the bottle’s nipple while still being easier to manage than an open cup.
Parents also sometimes purchase progressively challenging straw cups and move through them too quickly at home, outpacing the child’s readiness. The clinician’s role is to set the pace and criteria for advancing. A common benchmark is that the child should be able to drink a reasonable volume (not just a sip or two) consistently and without distress at the current level before stepping up the difficulty. Consistency across several days matters more than one good performance.
When Straw Drinking Is Not the Right Goal
There are situations where straw drinking training is not appropriate, at least not yet. Patients with severe oral-phase dysphagia who cannot safely manage thin liquids by any method should not be started on straw drinking simply because it is a common therapy tool. Children or adults who aspirate on thin liquids may need to work on other swallowing strategies first. Patients with tracheostomies or certain airway conditions need specialized assessment before straw drinking is introduced. And for some patients with severe motor impairment, the amount of effort required to drink through a straw may be disproportionate to the benefit, and adaptive cups or other equipment may be more functional choices.
The therapist’s job is to match the tool to the patient, not the other way around. Straw drinking is genuinely useful for the right patient at the right time, but it is one tool among many, and forcing it into a treatment plan where it does not fit helps no one. For patients whose primary goal is speech clarity rather than feeding, the time spent on straw exercises may be better spent on direct speech practice. As with most things in therapy, the value of the activity depends entirely on whether it is targeting the right goal.