Feeding and Swallowing Disorders in Children

1. Feeding and Swallowing Disorders in Children

2. What are feeding and swallowing disorders? • Feeding disordersinclude 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 phase • starting 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 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

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 feeding • irritability or lack of alertness during feeding • refusing food or liquid • failure to accept different textures of food (e.g., only pureed foods or crunchy cereals) • long feeding times (e.g., more than 30 minutes) • difficulty chewing • Pocketing food- food remaining in the mouth after swallowing • coughing or gagging during meals • excessive drooling or food/liquid coming out of the mouth or nose • difficulty coordinating breathing with eating and drinking • increased stuffiness during meals • gurgly, hoarse, or breathy voice quality • frequent spitting up or vomiting • recurring pneumonia or respiratory infections • less than normal weight gain or growth

8. Children may be at risk for: • dehydration or poor nutrition • aspiration(food or liquid entering the airway) or penetration • pneumonia or repeated upper respiratory infections that can lead to chronic lung disease • embarrassment 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: • Parent • Classroom teacher • School nurse • Occupational therapist • Physical therapist • Physician • a dietitian or nutritionist • a 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 Intervention • modified 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 Continued • direct feeding therapy designed to meet individual needs • nutritional changes (e.g., different foods, adding calories to food) • increasing acceptance of new foods or textures • food temperature and texture changes • postural or positioning changes (e.g., different seating) • behavior management techniques • medicine for reflux • referral to other professionals, such as a psychologist or dentist

16. SLP feeding intervention may include the following: • making the muscles of the mouth stronger • increasing tongue movement • improving chewing • increasing acceptance of different foods and liquids • improving sucking and/or drinking ability • altering food textures and liquid thickness to ensure safe swallowing

17. Modified Diets • Food Consistencies can be any of the following: • Pureed • Ground • Mashed- soft mechanical • Chopped • Bite sized • Mixed consistencies • NPO – nothing by mouth-tube fed only • Tube fed for nutrition and oral feedings

18. Modified Liquids • No liquids • Thin liquids • Thickened liquids • Nectar • Honey • pudding

19. Feeding Tools

21. Eating is a Social Thing