Feeding and Swallowing Therapy
Feeding Aversions: Children with feeding aversions often limit their diets to a small variety of foods. They often refuse food that is not in their diet or gag when they do try it. Sometimes just the smell of foods they don’t eat will upset them. This can greatly affect their nutrition when they aren’t getting all the vitamins and minerals they need to grow. Occupational therapists work with the children, parents and other medical personnel to help the child eat new foods. We also help the parents make meal times at home less stressful for the child and the parents.
Dysphagia, or problems with swallowing function, is a difficulty found in many patient populations. The difficulties with swallowing function can occur in the mouth, the throat, and/or the esophagus. As many as 15 million Americans, including children, suffer from dysphagia, with 1 million new patients diagnosed annually.
The primary goals of dysphagia therapy are to promote adequate nutrition/hydration and develop age-appropriate feeding/swallowing skills. Therapy is customized to meet the individual needs of each child. To ensure adequate training, therapists work closely with the child's caregivers to provide education for the development of the child within his or her family system.
Orofacial Myofunctional Disorders (OMD), or tongue thrust, is a problem where the tip of the tongue protrudes against or between the front teeth or the middle of the tongue bulges too forcefully against the side teeth during swallowing or when at rest, The result of these atypical swallowing patterns can be speech sound disorders, malocclusion, mouth breathing, and/or tempo-mandibular joint dysfunction/pain. The experienced therapists at LTG utilize techniques designed to correct tongue placement during speech, swallowing and when at rest, along with exercises to develop correct lip posture.
What is dysphagia?
Swallowing disorders, also called dysphagia (dis-FAY-juh), can occur at different stages in the swallowing process:
• Oral phase/Feeding phase - sucking, chewing, and moving food or liquid into the throat
• 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
• 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.
What are the warning signs?
What are some signs or symptoms of feeding and swallowing disorders in children?
Children with feeding and swallowing problems have a wide variety of symptoms. Not all signs and symptoms are present in every child.
The following are signs and symptoms of feeding and swallowing problems in very 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
• 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
As a result, 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
Related links:
http://www.asha.org/public/speech/swallowing/FeedSwallowChildren.htm
How is dysphagia diagnosed?
If you suspect that your child is having difficulty eating, contact your pediatrician right away. Your pediatrician will examine your child and address any medical reasons for the feeding difficulties, including the presence of reflux or metabolic disorders. Your pediatrician may refer you to a speech-language pathologist (SLP) who specializes in treating children with feeding and swallowing disorders.
At Laskin Therapy Group, a feeding/swallowing evaluation consists of:
• A parent interview including your child's medical history, development, and symptoms
• An oral mechanism examination to look at the strength and movement of the muscles involved in swallowing
• A feeding examination to see your child' s posture, behavior, and oral movements during eating and drinking
• Referral for special tests, if necessary, to evaluate swallowing, such as:
o A 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.
If you choose to bring your child to Laskin Therapy Group for a feeding/swallowing evaluation, you will need to bring the following items with you:
• Bottle
• Cup with lid
• Plate
• Spoon
• Bowl
• A bib the child is used to wearing
• Small amounts of food the child particularly likes
If feeding therapy with an SLP is recommended, the focus on 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
• coordinating the suck-swallow-breath pattern (for infants)
• altering food textures and liquid thickness to ensure safe swallowing