Feeding and Swallowing Disorders (Dysphagia) in Children
What are feeding and swallowing disorders?
Feeding disorders include problems in 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.
Swallowing disorders, also called dysphagia (dis-FAY-juh), can occur at different stages in the swallowing process:
• Oral phase – sucking, chewing, and moving food or liquid into the throat
• 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
• Aesophageal phase – relaxing and tightening the openings at the top and bottom of the feeding tube in the throat (aesophagus) and squeezing food through the aesophagus into the stomach
Signs or Symptoms of Feeding and Swallowing Disorders in Children
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, and embarrassment or isolation in social situations involving eating.
Diagnosis of Feeding and Swallowing Disorders
If you suspect that your child is having difficulty eating, contact your paediatrician right away. Your paediatrician 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 specialises 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 and look at the strength and movement of the muscles involved in swallowing. They will observe your child feeding to check your child’ s posture, behavior, and oral movements during eating and drinking. They may also 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; or endoscopic assessment – a lighted scope is inserted through the nose, and the child’s swallow can be observed on a screen.
The speech therapist may work as part of a feeding team. Other team members may include: an occupational therapist, a physical therapist, a physician or nurse, a dietitian or nutritionist, and a developmental specialist.
Available Treatments for Children with Feeding and Swallowing Disorders
Based on the results of the feeding and swallowing evaluation, the speech therapist 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 a speech therapist 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