Feeding and Swallowing Disorders in Children

Trouble eating can lead to health, learning, and social problems. Speech-language pathologists, or SLPs, help children with feeding and swallowing problems.

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About Feeding and Swallowing Disorders

Think about how you eat. You first have to get the food or drink to your mouth. You may use a fork, spoon, straw, or your hands. You have to open your mouth and take the food in. You close your lips to keep the food in your mouth. You then chew the food or move the liquid to get ready to swallow.

Children have to learn this process. They start by sucking and learn how to eat solid foods and drink from a cup. Children will have some trouble at first. Drinks may spill from their mouths. They may push food back out or gag on new foods. This is normal and should go away. A child with a feeding disorder will keep having trouble. Some children will eat only certain foods, or they may take a long time to eat. These children may also have a feeding disorder.

Some children also have swallowing problems, or dysphagia (dis-FAY-juh). Swallowing happens in three stages, or phases. A child can have a problem in one or more of these phases. They include:

  • Oral phase – sucking, chewing, and moving food or liquid into the throat. Feeding is a part of the oral phase.
  • Pharyngeal phase – starting the swallow and squeezing food down the throat. The child needs to close off his airway to keep food or liquid out. Food going into the airway can cause coughing and choking.
  • Esophageal phase – opening and closing the esophagus, or the tube that goes from the mouth to the stomach. The esophagus squeezes food down to the stomach. Food can get stuck in the esophagus. Or, a child may throw up a lot if there is a problem with the esophagus.

Signs of Feeding and Swallowing Disorders

Your child may have a feeding or swallowing problem if she:

  • Arches her back or stiffens when feeding
  • Cries or fusses when feeding
  • Falls asleep when feeding
  • Has problems breast feeding
  • Has trouble breathing while eating and drinking
  • Refuses to eat or drink
  • Eats only certain textures, such as soft food or crunchy food
  • Takes a long time to eat
  • Has problems chewing
  • Coughs or gags during meals
  • Drools a lot or has liquid come out her mouth or nose
  • Gets stuffy during meals
  • Has a gurgly, hoarse, or breathy voice during or after meals
  • Spits up or throws up a lot
  • Is not gaining weight or growing

Not every child has every sign listed here. Your child may show a few signs or many of them. Your child may be at risk for:

  • dehydration or poor nutrition
  • food or liquid going into the airway, called aspiration
  • pneumonia or other lung infections
  • feeling embarrassed about his eating problems. He may eat alone or refuse to eat around others.

Causes of Feeding and Swallowing Disorders

There are many possible causes for feeding and swallowing problems, including:

  • nervous system disorders, like cerebral palsy or meningitis
  • reflux or other stomach problems
  • being premature or having a low birth weight
  • heart disease
  • cleft lip or palate
  • breathing problems, like asthma or other diseases
  • autism
  • head and neck problems
  • muscle weakness in the face and neck
  • medicines that make her sleepy or not hungry
  • sensory issues
  • behavior problems

Testing for Feeding and Swallowing Disorders

Talk to your child's doctor if you think he has a feeding or swallowing problem. Your doctor can test your child for medical problems and check his growth and weight. An SLP who knows about feeding and swallowing can look at how your child eats and drinks. The SLP will:

  • Ask questions about your child's medical history, development, and the problems she has
  • See how your child moves his mouth and tongue
  • Watch your child eat to see how she picks up food, chews, swallows, and drinks
  • Watch how your child behaves during meals
  • Do special tests, if needed. The SLP can watch how your child swallows using:
    • modified barium swallow – your child eats or drinks food or liquid with barium in it. Barium shows up on an x-ray so the SLP can watch where the food goes.
    • endoscopic assessment – the doctor or SLP puts a tube with a light on the end in your child's nose. This scope has a camera on it, and the SLP can watch your child swallow on a screen.

The SLP 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
  • a developmental specialist
  • a social worker
  • a lactation consultant

The team will suggest ways to improve your child's feeding and swallowing.

Treatment for Feeding and Swallowing Disorders

The SLP or feeding team may suggest:

  • medical treatment, like medicines for reflux
  • feeding therapy
  • trying different foods or adding calories to food
  • ways to get your child to try new foods or textures
  • changing how hot or cold food is or how crunchy or soft it is
  • changing your child's position while eating
  • new ways to handle your child's behavior
  • seeing another professional, like a psychologist or dentist

In severe cases, your child may need to get nutrition in other ways. These may include a tube through her nose or in her stomach.

Your child may need feeding or swallowing treatment with an SLP. The SLP may work on:

  • making the muscles of his mouth stronger
  • helping her move her tongue more
  • helping him chew foods
  • getting her to try new foods and drinks
  • improving how well he can suck from a bottle or drink from a cup
  • helping her learn how to breathe while sucking and swallowing. This will be for babies only.
  • changing food textures and liquid thickness to help him swallow safely.
  • getting your child to behave during meals. This behavior may include staying in her seat, not refusing food, and not fussing or crying.
  • helping with sensory issues. Your child may not like the way food feels in his mouth or on his hands. The SLP can help him get used to how food feels.
  • changing the way you hold your baby or the way your child sits when eating

You are an important part of your child's treatment. You can:

  • ask questions to understand the problems your child has
  • make sure you understand what the SLP will work on
  • go with your child to treatment
  • follow the suggestions your SLP makes for when your child is at home and at school
  • talk with your child's teachers and other family members about her feeding problems and what they can do to help
  • let the SLP or feeding team know what is or is not working at home

See ASHA information for professionals on the Practice Portal's Pediatric Dysphagia page.

Other Resources

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