Feeding is the process involving any aspect of eating or drinking, including gathering and preparing food and liquid for intake, sucking or chewing, and swallowing (Arvedson & Brodsky, 2002). Feeding provides children and caregivers with opportunities for communication and social experience that form the basis for future interactions (Lefton-Greif, 2008).
Swallowing is a complex process during which saliva, liquids, and foods are transported from the mouth into the stomach while keeping the airway protected. Swallowing is commonly divided into the following four phases:
- Oral Preparatory—voluntary phase during which food or liquid is manipulated in the mouth to form a cohesive bolus—includes sucking liquids, manipulating soft boluses, and chewing solid food.
- Oral Transit—voluntary phase that begins with the posterior propulsion of the bolus by the tongue and ends with initiation of the pharyngeal swallow.
- Pharyngeal—begins with the initiation of a voluntary pharyngeal swallow which in turn propels the bolus through the pharynx via involuntary peristaltic contraction of the pharyngeal constrictors.
- Esophageal—involuntary phase during which the bolus is carried to the stomach through the process of esophageal peristalsis (Arvedson & Brodsky, 2002; Logemann, 1998).
Feeding disorders are problems with a range of eating activities that may or may not include problems with swallowing. Feeding disorders can be characterized by one or more of the following behaviors:
- Avoiding or restricting one’s food intake (avoidance/restrictive food intake disorder [ARFID]; American Psychiatric Association, 2016)
- Refusing age-appropriate or developmentally appropriate foods or liquids
- Accepting a restricted variety or quantity of foods or liquids
- Displaying disruptive or inappropriate mealtime behaviors for developmental level
- Failing to master self-feeding skills expected for developmental levels
- Failing to use developmentally appropriate feeding devices and utensils
- Experiencing less than optimal growth (Arvedson, 2008)
Swallowing disorders (dysphagia) can occur in one or more of the four phases of swallowing and can result in aspiration—the passage of food, liquid, or saliva into the trachea—and retrograde flow of food into the nasal cavity.
The long-term consequences of feeding and swallowing disorders can include
- food aversion;
- oral aversion;
- aspiration pneumonia and/or compromised pulmonary status;
- undernutrition or malnutrition;
- gastrointestinal complications such as motility disorders, constipation, and diarrhea;
- poor weight gain velocity and/or undernutrition;
- rumination disorder (unintentional and reflexive regurgitation of undigested food that may involve re-chewing and re-swallowing of the food);
- ongoing need for enteral (gastrointestinal) or parenteral (intravenous) nutrition;
- psychosocial effects on the child and his or her family; and
- feeding and swallowing problems that persist into adulthood, including the risk for choking, malnutrition, or undernutrition.