Pediatric Feeding and Swallowing Disorders
Eating is one of the core functions of the human body, and a child who struggles with proper feeding and swallowing can be a difficult challenge for the entire family. Our team of therapists work intimately with an affected family to provide developmental supportive care to infants and toodlers with feeding difficulties.
What Are Feeding and Swallowing Disorders?
According to the American Speech-Language Hearing Association, feeding disorders include problems gathering food and getting ready to suck, chew or swallow it. For instance, some children who are unable to pick-up food and get it into their mouth or cannot completely close their lips to keep food from falling out of their mouth may have a feeding disorder.
Swallowing disorders, also called dysphagia, can occur at different stages in the swallowing process:
Oral phase- sucking, chewing, and moving food or liquid in 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 or to prevent choking
Esophageal phase- relaxing and tightening the openings at the top and bottom of the feeding tube in the throat (esophagus) and squeezing food through the esophagus into the stomach
The program at Boulder Community Hospital is unique because we provide a continium of care from our hospital nursery to our Pediatric Rehabilitation Department at the Mapleton Center. Therapists design a program centered on each child's medical and nutritional status, motor skills, sensory systems, and behavioral/emotional capabilities to achieve efficient and safe oral feeding in line with developmental milestones.
Developmental Patterns in Feeding and Swallowing
1-3 months: Typically a child's lips are able to form a tight seal around the nipple. Sucking and swallowing should be rhythmical and coordinated.
6 months: A child is able to accept and swallow pureed foods presented by spoon. Children enjoy mouthing toys and teething biscuits.
9 months: A child can use the upper lip to remove food from the spoon. Mashed table foods can be introduced at this time.
12 months: A child can bite and munch a soft cookie. Children typically tolerate soft finger foods and mashed table foods at this age.
18 months: A child can drink from a cup with assistance, but experiences some liquid loss from the cup. Children can experiment with a variety of tastes and textures at this age.
24 months: A child can chew most table foods easily. At this age, children typically tolerate all food textures, but do show food preferences. Children can drink well from a cup or straw by 2 years of age.
Parents and caregivers are typically the first to notice when a child has difficulties with feeding and/or swallowing. Because these challenges can result in malnutrition, dehydration and respiratory problems if left untreated, parents need to recognize the symptoms which can include (but are not limited to) the following:
- Failure to thrive
- Oral motor difficulties
- Difficulty with solid foods or table foods (i.e. gagging, spitting out, vomiting)
- Children fed via tube (i.e. G-Tube, NGT, OGT)
- Behavioral feeding difficulties
- Feeding/Swallowing difficulties secondary to neurological impairment
- Difficulty sucking
- Picky eaters
- Coughing or choking with feeding
- Recurrent respiratory infections
- Changes in breathing patterns with oral feeding
- Hyper/Hypo sensitivity
At BCH, we take a multi-disciplinary approach that includes:
Feeding can be impacted by medical issues that involve primary organ systems such as the respiratory tract, gastrointestinal tract and brain. We examine potential medical concerns to minimize their effect on the child. We also recommend interventions such as medications, changes in formula or nutrition, and/or changes in feeding times or amounts.
Proper feeding and swallowing can be affected by postural support, rib cage or spinal mobility, muscle imbalance or respiratory issues. Our therapists offer treatment that can include rib cage and spinal mobilization, muscle stretching, and therapeutic exercises. Families are encouraged to take part in this therapy and to continue it in the home.
Inefficient movement of the muscles of the mouth or other difficulties with fine or gross motor skills can sometimes affect feeding and swallowing. Our speech-language pathologists provide suggestions and therapies to maximize the child’s oral-motor skills to facilitate improved feeding and swallowing. A videofluoroscopic swallow study (swallow x-ray) may be performed to objectively assess the swallow mechanism and determine developmentally appropriate and safe textures for your child.
It can be challenging for children who struggle with feeding and swallowing to adopt methods to eat new or higher textured foods. Behavior analysis can aid in the development of proper feeding and swallowing skills by identifying possible learned patterns, developing treatment procedures and evaluating those treatments over time to ensure maximum results. Behavior strategies can help children learn to consume new or more food, advance texture and self-feed.
Feeding issues can affect every member of the family. Our therapists involve the entire family in the treatment process, and offer support, counseling and encouragement throughout the rehabilitation process.
Click here for typical development patterns as well as a list of signs and symptoms that are typically present with a feeding and/or swallowing disorder. If you’re concerned about your child, call 303-441-2385 today for more information on our holistic approach.
Adult Feeding and Swallowing Disorders
Dysphagia is the medical term for difficulty in swallowing. Boulder Community Hospital provides comprehensive evaluation and treatment for adults experiencing a swallowing disorder. These services are provided through Speech Therapy and are available across our continuum of care.
Swallowing disorders in adults can be associated with stroke, degenerative neurological conditions such as Parkinson's disease or Multiple Sclerosis, and following head and neck cancer.
Signs and symptoms of swallowing disorders may include:
- Difficulty controlling food or saliva in the mouth
- Difficulty initiating a swallow
- Extra effort or time needed to chew or swallow
- Coughing during or immediately after eating or drinking
- Recurring pneumonia or chest congestion after eating
- Weight loss or dehydration from not being able to eat enough
- Nasal regurgitation
Swallowing disorders can occur at different stages of the swallowing process and require a comprehensive evaluation to determine the nature of the problem. Treatment options depend on the cause, the symptoms and the type of swallowing problem.
Treatment typically begins with a comprehensive evaluation that includes the following:
- Careful review of the medical history
- Observations of strength and movement of the muscles important for swallowing
- Structured trials of drinking or eating with different consistencies of food or liquid
- Specialized tests to evaluate swallow functions
- Modified Barium Swallow Test (Videofluoroscopic Swallow Test)- The individual eats or drinks food or liquid containing barium; the swallowing process is observed by the Speech-Language Pathologist and Radiologist on an X-ray to identify problems and implement effective treatment strategies
Treatment recommendations and strategies are individualized to the needs of each person. The treatment of swallowing disorders often requires the assistance of family members and caregivers and the involvement of a number of medical disciplines, including the primary care physician, medical specialists, nurses, dietitians and other therapy services.
Treatment may include:
A wide range of dysphagia therapies are available for outpatients being treated by therapists at the Mapleton Center. To schedule an appointment please call 303-441-0493, and to schedule a Videofluoroscopic Swallow Test please call 303-441-6447. In addition, some dysphagia services are available in the home setting through Boulder Community HomeCare, 303-441-0444.
SWALLOWING PROBLEMS AFTER HEAD AND NECK CANCER
Individuals who have been treated for head and neck cancer can experience different swallowing problems related to the type and nature of the treatment, the size and location of the tumor, the nature of the reconstructive surgery and/or the presence of a tracheostomy tube. Boulder Community Hospital Speech Therapy provides evaluation and treatment of swallowing problems following head and neck cancer as part of our comprehensive services.
Signs and symptoms of swallowing disorders following head and neck cancer may include:
- Need to swallow many times to clear food from the mouth and throat
- Throat clearing while eating
- Sensation of food "getting stuck"
- Coughing or choking
- Wet or gurgly voice after swallowing
- Pain and dryness when swallowing
Treatment may include:
- Specific swallowing exercises to improve muscle movement or function
- Patient and family education with Speech Therapy
- Head posture to maximize swallow safety
- Determining a safe diet
- Techniques to improve safety and swallowing patterns when a tracheostomy is needed
- VitalStim- neuromuscular electrical stimulation to improve swallow function
If you would like more information or to schedule an appointment please call 303-441-0493.
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