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Hard to Swallow: Recognizing and treating swallowing and feeding disorders - centraljersey.com
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Hard to Swallow: Recognizing and treating swallowing and feeding disorders


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By Sarah Elzayat, MS, CCC-SLP, TSSLD

Feeding your child is an intimate bonding experience. However, feeding and swallowing disorders can affect a child’s emotional and physical growth, so it’s important to know the signs and see a specialist as soon as you suspect an issue.

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Technically speaking, feeding is a complex process involving aspects of eating or drinking that requires accepting and manipulating food or liquid for intake, sucking, chewing, or swallowing. Swallowing transports saliva, liquid, and foods from the mouth to the stomach while protecting the airway. Each process should be completed instantaneously without hesitation, unless there’s an underlying factor disrupting these patterns.

There are a variety of reasons why a child may develop a swallowing or feeding disorder, including premature birth, poor oral intake, respiratory distress, having a nasogastric or gastrostomy tube, developmental delays, medical diagnoses such as autism or cerebral palsy, lack of consistency, negative feeing experiences, physical limitations or anatomical anomalies.

Your child may have a swallowing or feeding disorder if he or she has difficulty latching to a breast or bottle, doesn’t tolerate food well and spits it up, can’t keep a bottle in his mouth, overflows liquid from mouth during mealtime, requires more than 30 minutes to complete a 4-6 ounce feeding, shows signs of distress during feeding, and/or has difficulty chewing or using his tongue.

If a swallowing or feeding disorder isn’t addressed, it could lead to speech and articulation issues, poor weight gain, breathing difficulties (mouth breathing), restricted diets if the child can’t manage certain foods, picky eating, dental issues and/or aspiration pneumonia.

During infancy, your child’s development depends on a regulated sleeping pattern and structured feeding schedule. A structured feeding schedule is crucial, as it’s the driver of the infant’s weight gain.

An infant’s mealtime is like our periods of exercise – meaning that there is a balance between volume fed and time spent feeding; this indirect proportion is the driver of weight gain. An infant’s weight is dependent upon the amount of energy exerted for consumption over a period of time. For example, by six months, a typical child accepts 6-8 ounces during a 30-minute feeding. If the child accepts anything less than this amount within 30 minutes, he will lose weight rather than gain due to the extended exertion of energy. It’s like training for a marathon: most people can’t go from being sedentary to running a marathon. They must train and improve their endurance. It’s the same scenario for a baby. Eating is an aerobic exercise for a baby, so any session over 30 minutes is like running a marathon without preparation—and equally exhausting.

It’s important to note that while some clinicians urge new parents to focus on the volume of food their babies consume, I think it’s more helpful to focus on the quality of the feeding session. I am a firm believer that quality drives quantity. The stronger the oral motor skills, the more the child will consume. I recommend structuring a mealtime consistently with familiar faces while increasing the amount of food presented as your child continues to develop. This helps ensure a positive feeding experience for your baby and helps him or her build on those skills as they grow.

Additionally, feeding disorders may be caused by prolonged pacifier and bottle use. Pacifiers help children build bottle- and breast-feeding skills and establish a strong suck-swallow-breathe pattern. Although the pacifier has its benefits, there are some downsides. Negative effects may include delayed oral motor skills, dental issues, and articulation difficulties. Strive to wean your child off pacifiers and bottles at around 15 months of age.

If you have a picky eater, it may be due to delayed or inconsistent exposure to new foods, flavors and textures. Mealtimes can be exciting when exposing infants to new foods, textures and flavors. However, there may be challenges when something “new” is not introduced consistently. It’s tempting to keep switching foods, especially if your child doesn’t seem to like it the first time. However, it typically takes 10 tastes and three days for a child to determine if they like a food, flavor, or texture.

When introducing a new food, serve it for three days. Initially, your child may place it in her mouth and spit it out, chew it briefly before spitting it out, or grimace. This doesn’t mean she doesn’t like the food – just simply that it’s new. By introducing the same new food for three days, she will begin to recognize it and understand how to manipulate it prior to eating it.

If your child refuses a new food but likes something similar, you can try to “bridge” between foods through color, shape, texture, and/or size. For example, your child likes a yellow veggie stick but spits out broccoli, try introducing a green veggie stick first. When introducing new foods, only change one aspect of the food—its color, texture, shape, or size—instead of leaping from one extreme to another.

Food exploration is a great way to engage children during mealtime. Encourage your child to explore new foods with their hands to increase sensory input and awareness.

Feeding is a process that hinges on building trust with your child. Often, if you or a sibling also eat the food, your child will too. You may gain a bit of weight, but modeling the behavior you want to see in your child is a great way to build trust while building their menu.

Your pediatrician may refer your child to a speech-language pathologist who specializes in feeding. Therapy techniques vary depending on each child’s diagnosis. Therapies can include a family-centered approach, where the clinician engages with the family by teaching appropriate techniques to build the oral motor skills required for varying textures. Parents gain hands-on experience and learn how to continue the techniques at home; a desensitizing approach, where treatment focuses on the whole body, rather than just certain areas, like the mouth; oral motor skill development using hands-on tools to help children learn how to position parts of their mouths while eating and how to move their jaws to chew; or myofunctional therapy to help recorrect resting tongue position for speaking and eating.

In most cases, therapy sessions are held one to two times a week until the child demonstrates age-appropriate oral motor skills. On “off nights,” parents should continue to develop the skills at home.

Feeding time shouldn’t be stressful. It should be a fun, engaging, and a positive bonding experience. Talk to your pediatrician if it’s not a pleasant experience for you or your child.

Sarah Elzayat, MS, CCC-SLP, is a speech-language pathologist who specializes in swallowing and feeding disorders. She is on staff at CentraState Medical Center and can be reached by calling 866-CENTRA7.

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