Children with feeding and swallowing difficulties (also called dysphagia) are at risk for malnutrition, dehydration, and respiratory problems. Infants and children with feeding and swallowing problems are a diverse group, ranging from premature babies to teenagers. Parents are often the first to notice a feeding problem.
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Dysphagia
and Swallowing Therapy and Treatment, Diet and Liquid Consistency
“The
best practice for swallowing is swallowing” – Dysphagia in Children and Adults
Causes of feeding and swallowing problems
- Prematurity
- Cerebral palsy
- Autism
- Head and neck abnormalities
- Muscle weakness in the face and neck
- Gastroesophageal reflux
- Multiple medical problems
- Respiratory difficulties
- Medications that may cause lethargy or decreased appetite
- Problems with parent-child interactions at mealtime
Symptoms
Children with feeding and swallowing problems present with a wide variety of symptoms, depending on the nature and cause of their disorder. Typical symptoms include:
- Poor feeding
- Difficulty chewing
- Difficulty drinking from a bottle or cup
- Difficulty breast feeding
- Refusing food or liquid
- Coughing or choking while eating or drinking
- Excessive drooling and food spilling from the mouth
- Liquid leaking out the nose
- Gagging
- Vomiting during meals
- Increased congestion during meals
- Increased fussiness or crying during meals
- Accepting only certain types of food (only pureed foods or only crunchy foods)
- Poor weight gain
- Frequent respiratory infections or pneumonia (may occur when food or liquid is aspirated into the airway, rather than swallowed effectively)
If you suspect that your child is having difficulty eating, contact your pediatrician right away. Your physician will examine your child and address any medical reasons for the feeding difficulties, including the presence of reflux or metabolic disorders. The pediatrician may refer you and your child to a feeding team or speech-language pathologist who specializes in treating children with feeding and swallowing disorders. The SLP will discuss your concerns and observe your child while they eat. The SLP may also conduct an instrumental assessment of your child's swallowing ability. This involves having your child eat and drink foods and liquids mixed with barium while watching them on an x-ray. This procedure is typically called a modified barium swallow (MBS) and is conducted in a radiology office. Sometimes a different instrumental assessment will be completed, which involves having a lighted scope inserted through the nose so your child's swallow can be observed.
If a feeding team is involved, which may include the speech language pathologist SLP, an occupational therapist OT, a physical therapist PT, a physician or nurse, and a dietitian, your child's posture, self-feeding abilities, medical status, and nutritional intake will also be examined. The team will then make recommendations on how to improve your child's feeding and swallowing.
You can watch
normal swallow - animation
abnormal swallow
Learn about basic of videofluoroscopy of swallowing
Treatment
Based on the results of the feeding evaluation, the SLP or feeding team may recommend any of the following:
- Medical intervention, as needed
- Direct feeding therapy designed to meet your child's individual needs
- Nutritional changes
- Postural or positioning changes (different seating, etc.)
- Behavior management techniques
- Desensitization to new foods or textures
- Food temperature and texture changes
- Referral to other disciplines, such as psychology or a dentist
If feeding therapy with an SLP is recommended, the focus of intervention may include:
- Strengthening the muscles of the mouth
- Increasing tongue movement
- Improving chewing patterns
- Increasing tolerance of different foods or liquids
- Improving sucking /drinking ability
- Coordinating the suck-swallow-breathe pattern (for infants)
- Altering food textures and liquid viscosity to ensure safe swallowing
- Other interventions depending on your child's specific needs
Swallowing strategies for dysphagia
A. Compensatory Strategies
- Supraglottic Swallow
- Effortfull Swallow
- Mendelsohn Maneuver
- The Supra-Supraglottic Swallow
B. Postural Techniques
- Head Rotation To Weak Side
- Head Rotation To Strong Side
- Head Back/ Chin Up
- Chin Tuck
- Supraglottic Swallow
- Effortfull Swallow
- Mendelsohn Maneuver
- The Supra-Supraglottic Swallow
B. Postural Techniques
- Head Rotation To Weak Side
- Head Rotation To Strong Side
- Head Back/ Chin Up
- Chin Tuck
Watch video with the swallowing strategies presented by a clinician -
- Keep your baby upright for at least 30 minutes after a feed.
- Use a baby sling; which keeps your child upright, while your hands are free. Avoid baby slumping.
- Try elevating the head of the cot/bassinet.
- Consider using a dumm.
- Avoid vigorous movements or bouncing a baby.
- The best time to lay your baby on the floor is when baby's tummy is empty, i.e. before feeding.
- Change nappy before feeding. Take care to elevate baby's head and shoulders. Avoid lifting legs too high. Turn to the side if possible.
- Avoid any tight clothing around the waist, such as tight nappies, elastic waistbands.
- Avoid overfeeding – if baby vomits, wait until the next feeding rather than feeding your baby again.
- If a baby is bottle-fed, it may be worthwhile to try AR (anti-reflux) or hypoallergenic formula.
- Offer a spoonful of thickened milk (formula or breastmilk) following the feed.
- If breastfeeding, in your diet avoid foods that can aggravate reflux, e.g. citrus, tomato, fatty foods, spicy foods, chocolate and carbonated drinks.
- Some reflux children may suffer from food sensitivities, and may need dietary restrictions (or the mother may consider an elimination diet). If you suspect foods may be responsible for your child's condition, it is essential to discuss this with your health care provider. Do not change your or your child's diet before seeking medical advice.
- Contact a reflux support organisation for further information and support. The support groups can offer the emotional support you may need.
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