Feeding, swallowing, sensory and behavior feeding disorders can affect a child’s ability to develop and thrive. Feeding disorders include problems accepting food and getting ready to suck, chew, or swallow it. Swallowing disorders, also called dysphagia, can occur at different stages of the swallowing process:
- Oral Phase- sucking, chewing, and moving food or liquid from the mouth 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 upper and lower esophagus and squeezing food from the esophagus into the stomach http://www.asha.org/public/speech/swallowing/feedswallowchildren.htm
Sensory/behavioral feeding disorders
- Oral Sensory impairments: Hypersensitivity over-registers, hyposensitivity under-registers or Mixed (hypo/hypersensitivity).
- Stuffing, decreased oral awareness, loss of bolus, refusal, gagging, retching
- Food refusal/limited food repertoire.
- Texture/taste/temperature sensitivities
- Impact of GI issues on feeding; most commonly seen with children that have or had a history of reflux, uncontrollable emesis and/or decreased tolerance of feedings.
- Behavioral component will typically develop after a sensory impairment given mealtime difficulties.
- Prolonged bottle/breast feeding
Common reasons for a comprehensive feeding and swallowing evaluation include:
- 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 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
- Diagnosis of a disorder typically associated with dysphagia (e.g. neurological diagnosis, syndromes etc.)