What Is Normal Swallowing?
Normal swallowing function incorporates the ability to manage food or liquid in the oral cavity (mouth), inclusive of chewing when relevant and then using the tongue to propel the food or liquid to the back of the throat where it is then moved into the esophagus and finally into the stomach. There are actually three stages or phases in normal swallowing which include the following:
• Oral Phase – This phase is where the food is prepared for its transport to the back of the throat. It
is here that the child will suck, chew and manipulate the food or liquid in order to push it to the
back of the throat.
• Pharyngeal Phase – It is in this phase where swallowing actually begins. Here the food or liquid
moves down the throat. It is here that the airway (trachea) must be protected from food or
liquid entering the trachea and finally getting into the lungs. If the food or liquid enters the lungs
it is known as aspiration.
• Esophageal Phase – Once food and/or liquid is moved over the back of the tongue and into
the throat (pharynx), it is then propelled into the esophagus and will then make its way into the
What Is A Feeding Or Swallowing Disorder?
When a child demonstrates persistent difficulty managing food or liquid in one or more of the three phases of the swallowing process they are considered to be experiencing a swallowing disorder which is known as dysphagia ( pronounced dis-FAY-juh).
What Are The Signs Of Feeding And Swallowing Disorders In Children?
A child may present with one or more of the following signs which will serve as a warning to the parent to seek medical consultation from the child’s Pediatrician who should then refer them to a Speech-Language Pathologist who specializes in pediatric oral feeding and swallowing disorders. (The following signs are provided courtesy of The American Speech-Language-Hearing Association):
• Less than normal weight gain or growth
• Frequent spitting up or vomiting
• Recurring pneumonia
• Gurgly, hoarse, or breathy voice quality during or shortly after eating
• Increased stiffness during meals
• Difficulty coordinating breathing with eating and drinking, often seen in bottle or breast-fed
babies who require frequent breaks or interruptions in the feeding process
• Excessive drooling or food/liquid coming out of the mouth or nose
• Coughing or gagging during meals
• Difficulty breast feeding
• Difficulty chewing
• Long feeding times (e.g. more than 30 minutes)
• Failure to accept different textures of food ( e.g. only pureed foods or crunchy foods)
• Refusing to accept jarred food, inclusive of difficulty transitioning from breast feeding to bottle
• Irritability or lack of alertness during feeding
• Arching or stiffening of the body during feeding
What Are The Concerns For Children With Feeding And Swallowing Disorders?
Children who are having persistent difficulty with eating and drinking may be at risk for developing one or more of the following problems:
• Dysphagia can result in aspiration pneumonia if food or liquid enters the lungs, typically
associated with aspiration.
• Poor nutrition which can result in poor weight gain and malnutrition.
• Pneumonia or repeated episodes of upper respiratory infections. This can lead to chronic or
permanent lung damage.
• Social isolation due to difficulty experienced during eating and drinking, a problem which may be
observed in pre-school aged children.
• Emotional and behavioral problems due to the fear of eating and/or drinking. The child may
refuse to eat because it hurts to eat or is afraid of gagging, vomiting or choking, often observed in
children with chronic refux problems.
What Are The Causes Of Feeding And Swallowing Disorders In Children?
The following causes of feeding and swallowing disorders in children are provided by The American Speech-Language-Hearing Association:
• Congenital disorders such as cerebral palsy, Down syndrome, muscular dystrophy, and cleft lip or
• Gastrointestinal conditions (e.g. reflux, and food allergies)
• Prematurity and/or low birth weight
• Heart disease
• Head and neck abnormalities
• Generalized muscle weakness often associated with low tone or hyotonia
• Multiple medical problems
• Respiratory difficulties
• Medications that may cause lethargy or decreased appetite
• Behavioral feeding disorders
How Are Feeding and Swallowing Disordered Diagnosed?
Feeding and swallowing disorders may be evaluated by a variety of professionals including a Pediatrician, Speech-Language Pathologist, or Pediatric Gastroenterologist.
A diagnosis of dysphagia will be determined by using a variety of instruments which may include:
• Clinical observation and medical history.
• Modified Barium Swallow Studies (MBS) – this is an X-ray that is taken while the child is eating
food and drinking liquid, as it moves through the various phases of swallowing.
• Fibroptic Endoscopic Evaluation of Swallowing (FEES) – This test uses a lighted scope that is
inserted into the nose and then down into the throat to determine any problems that may be
occurring during swallowing.
Treatment Of Oral Feeding And Swallowing Disorders
If your child has been diagnosed with a feeding and/or swallowing problem then a Speech-Language Pathologist who is a specialist in evaluating and treating children with feeding and swallowing disorders should be consulted.
Our goal is to ensure a menu of delicious meals that are safe, easy to swallow and chew and nutritious for your child so that all meal times can be enjoyable and stress free for both you and your child.