The first thing I would like to mention is that if you are reading this post please know that you are not alone. Up to 50% of infants and children can present with a feeding/swallowing disorder; about 3-12% turn into a severe impairment. Feeding and or swallowing impairments can be present from birth, have an acute on-set or develop over time. The etiology of the impairment will determine the development and play a key factor in treatment.
Some red flags warranting a feeding and or swallowing evaluation would be:
- Poor sucking
- New onset of feeding difficulty
- Difficult transitioning to age appropriate textures
- Difficultly transitioning to age appropriate methods of intake (ie cup/spoon)
- Limited food repertoire
- Reduced volume of oral intake
- Unexplained food refusal
- Apnea (stops breathing) during feeding
- Gagging or coughing during feeding
- Lengthy feedings or mealtimes (>;30 minutes)
- Wet/gurgly vocal quality after feedings/meals
- Prolonged/multiple intubations
- Oral-motor weakness
- Vocal cord dysfunction
- Failure to Thrive
- Recurrent aspiration pneumonias or unexplained pneumonias
- Diagnosis of a disorder typically associated with dysphagia (e.g. neurological diagnosis, syndromes etc.)
- unexplained weight loss or inability to gain weight.
It’s important to remember no matter how fabulous your pediatrician is, he/she will rarely see your child during mealtimes. Majority of feeding and swallowing evaluations originate from parental concern unless the infant/child is diagnosed with a syndrome, a neurological impairment or is not thriving. A feeding and swallowing evaluation can be completed in a variety of settings. The main settings would be a hospital (inpatient or outpatient), a outpatient clinic, a private practice or at home (typically via early intervention).
First you will need to speak with you pediatrician regarding your concerns. If he or she is in agreement then your child will be referred for a feeding and swallowing evaluation. Depending upon where you choose to go for the evaluation will determine your next step. If you want to go privately then you need to check with your insurance about out-of-network benefits. If you want to stay in-network then contact your insurance company about places that will accept your benefits. Lastly if you want to apply for early intervention (ages 0-3) then you will need to contact you local early intervention office (your pediatrician will need to assist you with this).
For the evaluation it is best to schedule you appointment around your child’s feeding time as he/she will be expected to eat and drink a variety of foods and liquids. Bring a variety of foods and liquids that you know your child will eat and foods that are of concern to you. You should also bring a variety of methods your child feeds from (ie bottle/special bottle (ie special needs feeder), sip/straw cup).
The Speech Pathologist will evaluate your child’s oral motor skills, sucking skills if age appropriate, oral sensory skills, chewing skills, swallowing skills, risks for penetration/aspiration. Some recommendations from the evaluation will be modification of diet (if needed), positioning changes, therapy, determination of the need for instrumental exam (modified barium swallow study) and further speciality consultations (physical and/or occupational therapy, gastroenterology, ENT, nutrition, allergist).
It is important to ask questions and clarification at the end of the evaluation. At the end of the evaluation you should feel a sense of empowerment with a clear plan on how you and your therapist are going to tackle this to help you little one. If you don’t, ask more questions until you do. Parental training is a vital role in the success of feeding and swallowing therapy.
The above is the opinion of this writer. This should not take the place of your pediatrician. You should always consult your pediatrician for medical advise regarding introduction of feedings and related issues.