2 What are feeding and swallowing disorders? Feeding disorders include problems gathering food and getting ready to suck, chew, or swallow.For example, a child who cannot pick up food and get it to his or her mouth or cannot completely close his or her lips to keep food from falling out of his or her mouth may have a feeding disorder.
3 Different stages in the swallowing process: Oral phase- sucking, chewing, and moving food or liquid into the throat
4 Pharyngeal phasestarting the swallow, squeezing food down the throat, and closing off the airway to prevent food or liquid from entering the airway ( aspiration ) or to prevent choking
5 Esophageal phaserelaxing 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
6 Signs & symptoms of swallowing problems in children? Not all signs and symptoms are present in every child.
7 Signs of problems in young children arching or stiffening of the body during feedingirritability or lack of alertness during feedingrefusing food or liquidfailure to accept different textures of food (e.g., only pureed foods or crunchy cereals)long feeding times (e.g., more than 30 minutes)difficulty chewingPocketing food- food remaining in the mouth after swallowingcoughing or gagging during mealsexcessive drooling or food/liquid coming out of the mouth or nosedifficulty coordinating breathing with eating and drinkingincreased stuffiness during mealsgurgly, hoarse, or breathy voice qualityfrequent spitting up or vomitingrecurring pneumonia or respiratory infectionsless than normal weight gain or growth
8 Children may be at risk for: dehydration or poor nutritionaspiration (food or liquid entering the airway) or penetrationpneumonia or repeated upper respiratory infections that can lead to chronic lung diseaseembarrassment or isolation in social situations involving eating
9 How are feeding and swallowing disorders diagnosed? If you suspect that a child you are working with is having difficulty eating, what should you do?Contact the school nurse and they in turn will contact the Speech and Language Pathologist in your building.The speech-language pathologist (SLP) who specializes in treating children with feeding and swallowing disorders can evaluate the child.
10 What the SLP will do Next. The SLP will contact the child’s parents and ask if they can screen the child for swallowing difficulties.The SLP will ask questions about the child's medical history, development, and symptoms .The SLP will look at the strength and movement of the muscles involved in swallowing.The SLP will have the school nurse take the child’s temperature both before and after the child has eaten to establish baselines.The SLP will observe the child feeding to look at the child' s posture, behavior, and oral movements during eating and drinking.The SLP will examine child's posture, self-feeding abilities, medical status, and nutritional intake.The SLP will then write up a report and discuss the findings with the team.
11 Who is on the feeding team? Team members may include:ParentClassroom teacherSchool nurseOccupational therapistPhysical therapistPhysiciana dietitian or nutritionista developmental specialist
12 What happens next?The team will then make recommendations on how to improve the child's feeding and swallowing.
13 Treatments that are Available Treatment varies greatly depending on the cause and symptoms of the swallowing problem.Based on the results of the feeding and swallowing evaluation, the SLP or feeding team may recommend any of the following:
14 Medical Interventionmodified barium swallow -child eats or drinks food or liquid with barium in it, and then the swallowing process is viewed on an X-ray.This is commonly called a “Cookie Swallow”
15 Treatments Continueddirect feeding therapy designed to meet individual needsnutritional changes (e.g., different foods, adding calories to food)increasing acceptance of new foods or texturesfood temperature and texture changespostural or positioning changes (e.g., different seating)behavior management techniquesmedicine for refluxreferral to other professionals, such as a psychologist or dentist
16 SLP feeding intervention may include the following: making the muscles of the mouth strongerincreasing tongue movementimproving chewingincreasing acceptance of different foods and liquidsimproving sucking and/or drinking abilityaltering food textures and liquid thickness to ensure safe swallowing
17 Modified Diets Food Consistencies can be any of the following: Pureed GroundMashed- soft mechanicalChoppedBite sizedMixed consistenciesNPO – nothing by mouth-tube fed onlyTube fed for nutrition and oral feedings