Feeding and Swallowing Disorders

  1. placeholderFeeding disorders include problems gathering food and getting ready to suck, chew, or swallow it. For example, a child who cannot pick up food and get it to her mouth or cannot completely close her lips to keep food from falling out of her mouth may have a feeding disorder.  Pediatric swallowing and feeding disorders are seen in 25-35% of normally developing children and 50%-70% of children born premature or with chronic medical conditions.  Swallowing disorders are often the result of structural weakness or dysfunction and result in the difficulty with the actual act of moving good from the mouth to the stomach.  Whereas, a feeding disorder is often behaviorally motivated and results in the refusal of or an aversion to food.
  2. Swallowing disorders, also called dysphagia (dis-FAY-juh), can occur at different stages in the swallowing process:
      1. Oral phase – sucking, chewing, and moving food or liquid into the throat
      2. Pharyngeal phase – starting the swallow, squeezing food down the throat, and closing off the airway to prevent food or liquid from entering the airway (aspiration) or to prevent choking
      3. Esophageal phase – relaxing and tightening the openings at the top and bottom of the feeding tube in the throat (esophagus) and squeezing food through the esophagus into the stomach
  3. Children with feeding and swallowing problems have a wide variety of symptoms. Not all signs and symptoms are present in every child.

The following are signs and symptoms of feeding and swallowing problems in very young children: arching or stiffening of the body during feeding, irritability or lack of alertness during feeding, refusing food or liquid, failure to accept different textures of food (e.g., only pureed foods or crunchy cereals), long feeding times (e.g., more than 30 minutes), difficulty chewing, difficulty breast feeding, coughing or gagging during meals, excessive drooling or food/liquid coming out of the mouth or nose, difficulty coordinating breathing with eating and drinking, increased stuffiness during meals, gurgly, hoarse, or breathy voice quality, frequent spitting up or vomiting, recurring pneumonia or respiratory infections, less than normal weight gain or growth

As a result, children may be at risk for: dehydration or poor nutrition, aspiration (food or liquid entering the airway) or penetration, pneumonia or repeated upper respiratory infections that can lead to chronic lung disease, embarrassment or isolation in social situations involving eating

  1. Treatment: Treatment varies greatly depending on the cause and symptoms of the swallowing problem.  Based on the results of the feeding and swallowing evaluation, the SLP or feeding team may recommend any of the following: medical intervention (e.g., medicine for reflux), direct feeding therapy designed to meet individual needs, nutritional changes (e.g., different foods, adding calories to food), increasing acceptance of new foods or textures, food temperature and texture changes, postural or positioning changes (e.g., different seating), behavior management techniques, referral to other professionals, such as a psychologist or dentist.  If feeding therapy with an SLP is recommended, the focus on intervention may include the following: making the muscles of the mouth stronger, increasing tongue movement, improving chewing, increasing acceptance of different foods and liquids, improving sucking and/or drinking ability, coordinating the suck-swallow-breath pattern (for infants), altering food textures and liquid thickness to ensure safe swallowing
  2. Causes:  The following are some causes of feeding and swallowing disorders in children: nervous system disorders (cerebral palsy, meningitis), gastrointestinal conditions (reflux), prematurity and/or low birth weight, heart disease, cleft lip and/or palate, conditions affecting the airway, autism, head and neck abnormalities, muscle weakness in the face and neck, multiple medical problems, respiratory difficulties, medications that may cause lethargy or decreased appetite, or problems with parent-child interactions at meal times.