Why is my Child having difficulty eating?
The American Speech Language and Hearing Association describes Swallowing disorders, also called dysphagia (dis-FAY-juh), can occur at different stages in the swallowing process:
- Oral phase – sucking, chewing, and moving food or liquid into the throat
- Pharyngeal phase – starting the swallowing reflex, squeezing food down the throat, and closing off the airway to prevent food or liquid from entering the airway (aspiration) 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
Feeding is a developmental process; when interrupted, children may demonstrate oral sensorimotor dysfunction, undernutrition (malnutrition or failure to thrive [FTT]), poor growth, delayed development, poor academic achievement, psychological problems, and loss of overall health and well-being. Oral sensorimotor function, swallowing, and respiration coordination are important processes that relate to development of normal feeding, eating, and speech motor skills. Therefore, the development of functional, safe eating is extremely important.
–ASHA, ,published in Roles of Speech-Language Pathologists in Swallowing and Feeding Disorders: Technical Report
Many people are aware of the feeding complications that coincide with a diagnosis such as cerebral palsy or with disorders that result in abnormal muscle tone or strength, but what most people do not know is that feeding disturbances can occur in children of all ages and in the absence of physical limitations, developmental delays or other underlying diagnoses.
Is Your Child at Risk?
Although there are numerous reasons for feeding difficulties within children of all ages I have compiled a list of red flags to help identify patients who would benefit from a feeding evaluation.
- Difficulty transitioning to solids, gagging on foods with texture
- Chokes, coughs or gags when eating
- Difficulty chewing
- Difficulty with suck-swallow-breathe during bottle feeding, gulping air, difficulty coordinating
- Refusal to eat or drink
- History of reflux, food allergy, or other gastrointestinal complications. Many of these babies and children have associated feeding difficulties.
- Disorders of muscle strength or tone
- Difficulty chewing or absence of chewing/ swallowing foods whole
- Limited intake
- Limiting textures
- Limited repertoire of foods
One misconception of feeding disorders is that if a child is hungry enough he will eat. It has been documented in some cases that children with feeding disturbances will go days without eating and some to eat only enough to take the edge off of hunger.
Another misconception of feeding disorders is that they are strictly behavioral in nature when there is most often an underlying issue leading to the behavioral reaction. This may include a child who is swallowing foods incompletely manipulated, which has led to frustration and later refusal of many foods. Another child may be experiencing silent, or non-regurgitant reflux and every feeding experience is a negative one therefore serious feeding complications have emerged. A dietary change or anti-reflux medication may be needed for such a child in order for the feeding issue to be resolved. Children with Sensory Processing Disorder, Autism, and other sensory related disorders often limit food textures, drop foods out of their diet and have difficulty transitioning to age appropriate eating. Feeding complications can arise from one or more of many factors which is why it is important to properly identify the nature of the problem and work toward safe and efficient oral motor feeding skills.
Pediatric Feeding Program
Why Choose Therapy Tree for Dysphagia management? Therapy Tree has extensive experience in the area of pediatric dysphagia and emphasizes the evaluation and treatment available for a wide range of babies and children in need of dysphagia intervention. Therapists who provide pediatric feeding treatment for Therapy Tree will first complete an interview in order to review current knowledge in the field of pediatric dysphagia and acquire additional training and continuing education in the field as needed before implementing therapy.
We utilize a comprehensive approach to treatment and home programming which may include but is not limited to the following programs and educators: Food Chaining by Cheri Fraker and Laura Walbert, Sequential Oral Sensory Approach to Feeding by Kay Toomey, evidenced based practices and successful treatment techniques by Marsha Dunn Klein, Suzanne Evans Morris, Teresa Gager, Catherine Shaker and Sara Rosenfeld Johnson. We value a holistic feeding program that is tailored to a child’s needs and abilities and encourages manageable home programming with the flexibility to make adaptions to treatment as needed.
Therapy Tree encourages a multidisciplinary team approach to treatment in order for the best possible care, therefore there may be consultation and/or treatment with any or all of the following in addition to a child’s pediatrician: Registered Dietician, Gastroenterologist, Occupational Therapist, Physical Therapist, Behavioral Psychologist, and Teachers or Counselors who may be a part of a child’s school environment.
American Speech-Language And Hearing Association guidelines for Speech-Language Pathologists
- All therapists must adhere to the ASHA code of ethics as outlined in the following pdf file: http://www.asha.org/uploadedFiles/ET2010-00309.pdf
- All therapists must adhere to the Scope of Practice for Speech-Language Pathologists as outlined in the following pdf file: http://www.asha.org/uploadedFiles/SP2007-00283.pdf
For further information about any of the oral motor and sensory feeding programs and treatments that may be utilized in treatment see the following:
- Food Chaining: www.cheriandlaura.blogspot.com
- SOS Approach to Feeding: http://www.sosapproach-conferences.com
- Suzanne Evans Morris: www.new-vis.com
- Marsha Dunn Kleinn: www.mealtimeconnections.com
- Oral Placement Therapy: www.talktools.com
- Catherine Shaker: http://shaker4swallowingandfeeding.com
- Fun with Food–Pediatric Feeding Support: www.facebook.com/pedfeed
- Feeding Matters: www.feedingmatters.org