What are feeding and swallowing disorders?

Feeding disorders include difficulties with gathering food and getting ready to suck, chew, or swallow it. For example, a child who cannot pick up food and get it to her mouth or cannot completely close her lips to keep food from falling out of her mouth may have a feeding disorder. Feeding disorders occur in 25-35% of developmentally normal children and 40-70% of children with developmental disabilities and/or chronic medical conditions.

Swallowing disorders (dysphagia) can occur at different stages in the swallowing process – oral phase (in the mouth – moving food from side to side, chewing, biting, closing the lips to keep food inside the mouth, moving the jaw to facilitate chewing, tongue propelling the food down to the throat), pharyngeal phase (initiating the swallow, closing the airway to prevent food from entering it while pushing food down to the esophagus) or the esophageal phase (opening/closing of the feeding tube in the throat and squeezing food from the esophagus to the stomach).

Feeding and swallowing disorders can also be sensory or behavioral in nature. Children may have hyposensitive (reduced awareness of non-nutritive and nutritive stimuli in the mouth, heightened sensory threshold to oral input”  or hypersensitive (heightened awareness of non-nutritive and nutritive stimuli in the mouth, decreased sensory threshold to oral input) responses to food experiences. Sensory-based feeding experiences may affect any of the senses – smell of different foods, touching and tolerating different textures of food, visually tolerating different foods and/or tasting different types of food (temperature, textures). Behavioral feeding disorders usually have underlying issues that stem from somewhere else e.g. Bad habits/desperation, poor limit setting, lack of mealtime structure and routine. passive eating with distractions, inconsistent expectations regarding eating.


Signs and symptoms of feeding/swallowing disorders

  • 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
  • difficulty breast feeding
  • 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

 In addition, sensory feeding disorders may present with:

  • Often avoids whole foods or texture groups
  • Difficulty tolerating sensory input sight/smell/touch/taste
  • Eats the same regardless of people/place
  • Overstuffs oral cavity/takes tiny bites
  • Stores food “for later”
  • Gags as a sensory response
  • Excessive drooling
  • Hyposensitivity: Poor suck, liquid pooling, liquid loss, gag (protection vs. rejection), overstuffing/pocketing
  • Hypersensitivity: Heightened gag, refusal of foods, refusal to progress in textures.

Behavioral feeding disorders:

  • Rarely selective avoidance of foods
  • Eats better for certain people/places
  • Gags to get attention
  • Rarely underlying neurological or medical issue.

Diagnosis and Treatment

If you suspect that your child is having difficulty eating, contact your pediatrician immediately. Feeding disorders are diagnosed and treated by a group of professionals (speech-language therapist, occupational therapist, dietician and others). A speech-language therapist who specializes in treating children with feeding and swallowing disorders will assess your child and ask questions about your child’s medical history, development, and symptoms, look at the strength and movement of the muscles involved in swallowing, observe feeding to see your child’ s posture, behavior, and oral movements during eating and drinking and recommend special tests, if necessary, to evaluate swallowing. Depending on the cause and symptoms of the feeding disorder, the team will then make recommendations on how to improve your child’s feeding and swallowing.

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