Pediatric feeding and swallowing difficulties can begin as early as the first days following your child’s birth to later in your child’s development when solid foods are introduced. Your child may have feeding and swallowing difficulties as a result of a medical condition related to structural differences in the mouth, throat or esophagus or due to weakness or damage to the muscles involved in swallowing.  It is possible that your child has developed feeding difficulties such as food aversions as a result of medical trauma or texture sensitivities.  Your child may also have a swallowing problem related to the following conditions:

  • Cleft lip and palate

  • Birth defects

  • Prematurity

  • Stroke

  • Heart and/or lung complications

  • Gastroesophageal disorders, such as reflux

  • Brain injury 

  • Cerebral palsy

  • Chromosomal disorder 

  • Neuromuscular disease such as Muscular Dystrophy (Duchene)

  • Head or neck cancer

  • Sensory problems

Swallowing difficulties also known as dysphagia can result in food or liquid entering into the airway or lungs, known as aspiration. Your child may be at risk for developing aspiration pneumonia as a result of food or liquid getting into the lungs. Therefore it is important to recognize the signs and symptoms of aspiration in order to seek medical advice. If you notice any of the following symptoms when your child is feeding (bottle feeding or nursing), eating and/or drinking, then they may be experiencing aspiration:

  • Coughing 

  • Choking (food blocking the airway; you will notice a change in lip and/or face colour)

  • Gagging 

  • Change in vocal quality to a wet gurgly sound

  • History of pneumonia 

  • Redness around the eyes/eye lids 


Other symptoms that your child may experience if they are having difficulties with swallowing can include:

  • Difficulty coordinating sucking, swallowing and breathing during bottle-feeding, nursing or drinking from a cup or straw

  • Increase feeding times (over 30 minutes to complete a meal/feed)

  • Difficulty chewing foods

  • Changes to your child’s rate of breath when feeding

  • Weight loss or difficulty gaining weight

  • Decreased food or liquid intake

  • Refusal of certain foods or your child stops eating foods he previously enjoyed


What does an assessment look like?


Case History: Detailed information is gathered about the nature of your child’s swallowing difficulties, including what they are experiencing, and what you are observing as a parent. In addition, relevant medical history will be gathered along with consultation with your child’s family doctor, and/or pediatrician as well as consultation with other health professionals (e.g. dietitian) involved with your child. 


Non-instrumental Assessment: During a feeding and swallowing assessment, your child will be observed while feeding/eating and observations of how their tongue, lips and jaw move will be made. If your child is bottle fed or nursed, I will watch how they coordinate their suck, swallow and breath while eating, their rate of breath (to note any changes), as well as how they latch with their lips around the teat, and how they use their tongue. I will also make note of your child’s position during a feed and/or meal. 


Consultation/Referral: Often feeding difficulties can be related to other areas of development, including gross motor, fine motor, and social-emotional development. Therefore a team approach to assessment and treatment is often needed. Your child may need to be referred to a physiotherapist (PT) and/or occupational therapist (OT) to determine whether there are other systems (e.g. muscular, sensory, etc.) involved with your child’s eating challenges. If your child is already involved with a PT and/or OT, then consultation with them will be essential in the assessment and treatment of your child’s feeding and swallowing. 


What does therapy look like?

Therapy for your child will depend on the difficulties they present with as well as the severity. Your child may need different feeding equipment such as a different bottle or nipple, or possibly a different type of cup to help them manage liquids more efficiently or safely. Therapy can also involve increasing the strength of the lips, tongue, cheek or jaw and/or improving their range of motion or coordination. Your child might benefit from a sensory oral stimulation (SOS) approach, to help decrease oral sensitivities or oral aversions to foods or liquids. Texture change or thickness of liquids may also be recommended depending on your child’s ability to manage certain foods/liquids. 
Other times your child may be receiving their nutrition via tube feedings such through the use of a G-tube or NG tube. If this is the case, then therapy may involve working on increasing oral feeds, by providing oral stimulation, improving tongue, lip and jaw movement and coordination for eating and drinking.  This type of therapy would only occur after your child has received approval from their medical team (pediatrician, dietitian, etc.) that he or she is safe to manage oral feeds.