WHEN SHOULD A PARENT PURSUE FEEDING THERAPY?

Signs and Symptoms

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)
     
  • self-restricting diets
     
  • 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)
     
  • pneumonia or repeated upper respiratory infections that can lead to chronic lung disease
     
  • embarrassment or isolation in social situations involving eating

Diagnosis

If you suspect that your child is having difficulty eating, contact your pediatrician right away. Your pediatrician will examine your child and address any medical reasons for the feeding difficulties, including the presence of reflux or metabolic disorders. A speech-language pathologist (SLP) who specializes in treating children with feeding and swallowing disorders can evaluate your child and will:

  • ask questions about your child's medical history, development, and symptoms
     
  • look at the strength and movement of the muscles involved in swallowing
     
  • observe feeding to see your child' s posture, behavior, and oral movements during eating and drinking
     
  • perform special tests, if necessary, to evaluate swallowing, such as:
     
    • modified barium swallow -child eats or drinks food or liquid with barium in it, and then the swallowing process is viewed on an X-ray.
       
    • endoscopic assessment -a lighted scope is inserted through the nose, and the child's swallow can be observed on a screen.

Your child's posture, self-feeding abilities, medical status, and nutritional intake will be evaluated in order to make appropriate recommendations on how to improve your child's feeding and swallowing.

Treatment
Treatment varies greatly depending on the cause and symptoms and it should be individualized to meet the child’s unique needs. Family involvement is imperative for success.

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) with physician’s approval
     
  • 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 lateralization/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