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Feeding Therapy

Feeding and Swallowing Disorders

Feeding and swallowing disorders can lead to health, learning, and social problems. Feeding disorders include problems with sucking, eating from a spoon, chewing, or drinking from a cup. Swallowing disorders, also called dysphagia (dis-FAY-juh) are difficulties with moving food or liquid from the mouth, throat, or esophagus to the stomach. Feeding and swallowing disorders are often related to other medical conditions but may also occur without a known cause.

Speech-language pathologists (SLPs) help children and adults with feeding and swallowing problems.

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About Swallowing Disorders

Feeding disorders affect 25 to 45 percent of typically developing children and up to 80 percent of children with special needs and/or chronic health issues. A “feeding disorder” diagnosis applies to a child who can’t consume a balanced diet of age-appropriate food or liquid to support steady growth and development. When speech-language pathologists and other health care professionals treat a child with a feeding disorder, they work toward improving the child’s ability to eat a variety of foods.

Food insecurity, on the other hand, means a child experiences limited or uncertain availability of nutritionally adequate and safe foods, or has a limited or uncertain ability to acquire acceptable foods in socially acceptable ways. Nearly 50 million people in the United States struggle with food insecurity and 16 million of those are children.

Swallowing happens in three stages. A child can have a problem in one or more of these stages. 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 body needs to close off their airway to keep food or liquid out. Food going into the airway can cause coughing and choking.

  • Esophageal phase—opening and closing the esophagus (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.

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Signs of a swallowing problem might be any of these:

  • coughing during or right after eating or drinking

  • clearing your throat often after eating or drinking

  • having a wet or gurgly voice during or after eating or drinking

  • feeling like something is stuck in your throat or chest after eating or drinking

  • needing extra work or time to chew or swallow

  • having food or liquid leak from your mouth

  • food getting stuck in your mouth

  • having a hard time breathing after meals

  • losing weight

 

A swallowing problem might cause you to have these conditions:

  • dehydration or poor nutrition

  • food or liquid going into the airway, called aspiration

  • pneumonia or other lung infections

  • reflux

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Causes of Swallowing Disorders

There are many possible causes for feeding and swallowing problems, in children 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 them sleepy or not hungry;

  • sensory issues; and

  • behavior problems.

 

Many conditions can cause swallowing problems in adults. Some medications can cause dry mouth, which makes it hard to chew and swallow. Other causes include the following:

Damage to your brain or nerves from any of these:

  • stroke

  • brain injury

  • spinal cord injury

  • Parkinson’s disease

  • multiple sclerosis

  • amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease)

  • muscular dystrophy

  • cerebral palsy

  • Alzheimer’s disease

 

Problems with your head, neck, or mouth, such as these:

  • cancer in your mouth, throat, or esophagus

  • head or neck injuries

  • mouth or neck surgery

  • bad teeth, missing teeth, or dentures that do not fit well

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Treatments for Swallowing Disorders

What treatment you need will depend on the problems you have. You may need medical treatment from a doctor, such as medicines for reflux. In severe cases, you may need to get nutrition in other ways.

These may include a tube through your nose or in your stomach. Your doctor will work with you if you need tube feeding.

The SLP can work with you to improve how you swallow. They may suggest the following:

  • treatment to help you use your muscles to chew and swallow

  • instruction on ways you should sit or hold your head when you eat

  • strategies to help you swallow better and more safely

  • eating softer foods or drinking thicker drinks to help make swallowing easier

 

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

  • Making the muscles of their mouth stronger.

  • Helping them move their tongue more.

  • Helping them chew foods.

  • Getting them to try new foods and drinks.

  • Improving how well they can suck from a bottle or drink from a cup.

  • Helping them learn how to breathe while sucking and swallowing. This will be for babies only.

  • Changing food textures and liquid thickness to help them swallow safely.

  • Getting them to participate during meals, including accepting food.

  • Helping with sensory issues. Your child may not like the way food feels in their mouth or on their hands. The SLP can help them get used to how food feels.

  • Changing the way you hold your baby or the way your child sits when eating.

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