FEEDING AND SWALLOWING THERAPY

Pediatric feeding and swallowing difficulties can begin as early as the first days after birth to later in development when solid foods are introduced. Feeding and swallowing difficulties may be the result of a medical condition related to structural differences in the mouth, throat, or esophagus, or due to weakness or damage to the muscles involved in swallowing. Feeding difficulties, such as food aversions, can also be a result of medical trauma or texture sensitivities.  

 

Swallowing problems can also be related to the following conditions:

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• Cleft lip and palate

• Birth defects

• Prematurity

• Stroke

• Heart and/or lung complications

• Gastroesophageal disorders, such as reflux

• Brain injury 

• Cerebral palsy

• Chromosomal disorder 

• Neuromuscular disease such as Muscular Dystrophy (Duchene)

• Head or neck cancer

• Sensory problems

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Swallowing difficulties, also known as dysphagia, can result in food or liquid entering into the airway or lungs, known as aspiration. Your child may be at risk for developing aspiration pneumonia as a result of food or liquid getting into the lungs. It is therefore important to recognize the signs and symptoms of aspiration in order to seek medical advice. If you notice any of the following symptoms when your child is feeding (bottle feeding or nursing), eating or drinking, then they may be experiencing aspiration:

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• Coughing 

• Choking (food blocking the airway; you will notice a change in lip or face colour)

• Gagging 

• Change in vocal quality to a wet, gurgled sound

• History of pneumonia 

• Redness around the eyes or eye lids 

 

Other symptoms of swallowing difficulties can include:

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• Difficulty coordinating sucking, swallowing, and breathing during bottle-feeding, nursing or drinking from a cup or straw

• Prolonged feeding times (over 30 minutes to complete a meal or feed)

• Difficulty chewing food

• Changes to breathing rate while feeding

• Weight loss or difficulty gaining weight

• Decreased food or liquid intake

• Refusal of certain foods or no longer eating food your child previously enjoyed

 

What does an assessment look like?

 

Case History: We will gather detailed information about the nature of your child’s swallowing difficulties, including what they are experiencing, and what you are observing. We will also gather medical history in consultation with your child’s family doctor, pediatrician and other health professionals (e.g. dietitian) involved with your child. 

 

Non-instrumental Assessment: We will observe your child feeding/eating and observe how their tongue, lips, and jaw move. If your child is bottle-fed or nursed, we will watch how they coordinate their suck, swallow and breath while eating, their rate of breath (to note any changes), how they latch with their lips around the teat, and how they use their tongue. We will also make note of your child’s position during a feed or meal. 

 

Consultation/Referral: Feeding difficulties can often be related to other areas of development, including gross motor, fine motor, and social-emotional development. Therefore a team approach to assessment and treatment is often needed. Your child may need to be referred to a physiotherapist (PT) or occupational therapist (OT) to determine whether there are other systems (e.g., muscular, sensory, etc.) involved with your child’s eating challenges. If your child is already involved with a PT or OT, then consultation with them will be essential in the assessment and treatment of your child’s feeding and swallowing. 

 

What does therapy look like?

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Therapy for your child will depend on the difficulties they present with as well as the severity. Your child may need feeding equipment such as a different bottle or nipple, or possibly a different type of cup to help them manage liquids more efficiently or safely. Therapy can also involve increasing the strength of the lips, tongue, cheek, or jaw or improving the range of motion or coordination. Your child might benefit from a sensory oral stimulation (SOS) approach to help decrease oral sensitivities or oral aversions to foods or liquids. Texture change or thickness of liquids may also be recommended depending on your child’s ability to manage certain foods and liquids. 

If your child receives nutrition via feeding tubes such G-tubes or NG tubes, therapy may involve working on increasing oral feeds by providing oral stimulation, improving tongue, lip, and jaw movement, and coordination for eating and drinking. This type of therapy would only occur once your child's medical team has determined it is safe to administer oral feeds.