Feeding and Swallowing Disorders (asha.org)

Think about how you eat. First, you have to get the food or drink to your mouth. You may use a fork, spoon, straw, cup, or your hands. Then you have to open your mouth and take the food in. You close your lips to keep the food in your mouth. Then you chew the food or move the liquid to get ready to swallow.

From birth, infants eat by sucking. As they grow, they learn how to eat solid foods and drink from a cup. All children will have some trouble at first. Drinks may spill from their mouths. They may push food back out or gag on new foods. Some degree of this behavior is normal and should go away over time. However, a child with a feeding disorder will keep having trouble or may have an especially hard time eating or drinking. Some children will eat only certain foods, or they may take a long time to eat. These children may also have a feeding disorder. If your child coughs or chokes when eating, refuses food or liquid, has a wet, gurgly voice after eating, starts to lose weight, or has less energy than usual, talk to your doctor about seeing a feeding and swallowing professional.

 

Swallowing happens in three stages. A child can have a problem in one or more of these stages. They include:

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• Oral phase—sucking, chewing, and moving food or liquid into the throat. Feeding is a part of the oral phase.

• Pharyngeal phase—starting the swallow and squeezing food down the throat. The body needs to close off their airway to keep food or liquid out. Food going into the airway can cause coughing and choking.

• Esophageal phase—opening and closing the esophagus (the tube that goes from the mouth to the stomach). The esophagus squeezes food down to the stomach. Food can get stuck in the esophagus. Or a child may throw up a lot if there is a problem with the esophagus.

 

Signs of Feeding and Swallowing Disorders

Your child may have a feeding or swallowing problem if they:

• arch their back or stiffen when feeding

• cry or fuss when feeding

• fall asleep when feeding

• have problems breastfeeding

• have trouble breathing while eating and drinking

• refuse to eat or drink

• eat only certain textures, such as soft food or crunchy food

• take a long time to eat

• pocket (which means to hold food in their mouth)

• have problems chewing

• cough or gag during meals

• drool a lot or have liquid come out of their mouth or nose

• get stuffy during meals

• have a gurgly, hoarse, or breathy voice during or after meals

• spit up or throw up a lot

• are not gaining weight or growing

 

Not every child has every sign listed here. Your child may show a few signs or many of them. Your child may be at risk for:

• dehydration or poor nutrition;

• food or liquid going into the airway, called aspiration;

• pneumonia or other lung infections; and

• having negative feelings about eating. They may avoid eating or associate it with pain, frustration, or embarrassment.

Causes of Feeding and Swallowing Disorders

There are many possible causes for feeding and swallowing problems, including:

• nervous system disorders, like cerebral palsy or meningitis;

• reflux or other stomach problems;

• being premature or having a low birth weight;

• heart disease;

• cleft lip or palate;

• breathing problems, like asthma or other diseases;

• autism;

• head and neck problems;

• muscle weakness in the face and neck;

• medicines that make them sleepy or not hungry;

• sensory issues; and

• behavior problems.

Testing for Feeding and Swallowing Disorders

Talk to your child’s doctor if you think they have a feeding or swallowing problem. Your doctor can test your child for medical problems and check their growth and weight. An SLP trained in feeding and swallowing can look at how your child eats and drinks. The SLP will take the following steps:

• ask questions about your child’s medical history, development, and the problems they are having

• watch how your child moves their mouth and tongue

• watch your child eat to see how they pick up food, chew, swallow, and drink

• watch how your child behaves during meals

• do special tests, if needed

The SLP can watch how your child swallows using two methods:

• Modified barium swallow study—your child eats or drinks food or liquid with barium in it. Barium shows up on an x-ray so the SLP can watch where the food goes.

• Endoscopic assessment—the doctor or SLP puts a tube with a light on the end of it into your child's nose. This scope has a camera on it, and the SLP can watch your child swallow on a screen.

The SLP may lead or work as part of a feeding team. Other team members may include

• an occupational therapist,

• a physical therapist,

• a physician or nurse,

• a registered dietitian,

• a developmental specialist,

• a social worker, and

• a lactation consultant.

The team will suggest ways to improve your child’s feeding and swallowing.

Treatment for Feeding and Swallowing Disorders

The SLP or feeding team may suggest some of these next steps:

• referral to a doctor for medical treatment, like medicines for reflux

• feeding therapy

• trying different foods or adding calories to their diet

• trying new ways to get your child to try new foods or textures

• changing how hot or cold food is or how crunchy or soft it is

• changing your child’s position while eating

• trying new ways to handle your child’s behavior

• seeing another professional, like a psychologist or dentist

In severe cases, your child may need to get nutrition in other ways. These ways may include a tube inserted through their nose or into their stomach.

Your child may need feeding or swallowing treatment with an SLP. The SLP may work on a variety of tasks:

• Making the muscles of their mouth stronger.

• Helping them move their tongue more.

• Helping them chew foods.

• Getting them to try new foods and drinks.

• Improving how well they can suck from a bottle or drink from a cup.

• Helping them learn how to breathe while sucking and swallowing. This will be for babies only.

• Changing food textures and liquid thickness to help them swallow safely.

• Getting them to participate during meals, including accepting food.

• Helping with sensory issues. Your child may not like the way food feels in their mouth or on their hands. The SLP can help them get used to how food feels.

• Changing the way you hold your baby or the way your child sits when eating.

You are an important part of your child’s treatment. You can

• ask questions to understand the problems your child has,

• make sure you understand what the SLP will work on and why they will work on it,

• go with your child to treatment,

• follow suggestions from the SLP for eating and drinking at home and at school,

• talk with your child’s teachers and other family members about your child’s feeding problems and what others can do to help, and

• let the SLP or feeding team know what is or is not working at home.

Other Resources

This list does not include every website on this topic. ASHA does not endorse the information on these sites.

• American Board of Swallowing and Swallowing Disorders

• MayoClinic webpage on dysphagia

• National Foundation of Swallowing Disorders

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