Feeding and Swallowing Disorders in Children

Pediatric feeding disorder occurs when a child has problems getting food or liquids into their mouth and/or chewing, as compared to children of the same age. The disorder may or may not include problems with swallowing.

Swallowing disorders, also called dysphagia (dis-FAY-juh), occur when someone has trouble:

• Managing food or drink after it’s been put into the mouth, and
• Moving it through the throat, to the esophagus (the tube that connects the throat and the stomach), and into the stomach.

About Feeding and Swallowing Disorders

Think about how you eat and drink:

1. You move the food or drink to your mouth. You may use a fork, spoon, straw, cup, or your hands.
2. You open your mouth and take the food or drink in.
3. You close your lips to keep the food or drink in your mouth.
4. You chew the food or move the liquid to get ready to swallow.

Newborns “eat” by sucking. As they become toddlers, they learn how to eat solid foods and how to drink from a cup. All children may have some trouble at first. They may spill liquids from their mouths. They may push food back out or gag when trying new foods. Some of this is typical and should go away over time. But when a child has a feeding or swallowing disorder, they will continue to have problems eating or drinking.

ASHA’s Feeding and Swallowing Milestones: Age Ranges has information about feeding and swallowing development in children from birth to age 3 years.

There are three parts to any swallow—a child can have a problem in one or more of these parts:

1. Oral phase—sucking, chewing, and moving food or liquid into the mouth. Feeding is a part of the oral phase.
2. Pharyngeal phase—starting the swallow and squeezing food down the throat. The body needs to close off the person’s airway to keep food or liquid out. Food going into the airway can cause gagging, coughing, choking, and problems with breathing.
3. 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 frequently if there is a problem with the esophagus.

Signs of Feeding and Swallowing Disorders

Certain behaviors in babies and children may be signs of a feeding or swallowing problem.

Babies

• arch their back or stiffen when feeding
• cry or fuss when feeding
• fall asleep when feeding
• have problems breastfeeding or bottle feeding
• have trouble breathing while eating
• take a long time to eat
• cough or gag while eating
• drool a lot or have liquid come out of their mouth or nose
• have a gurgly, hoarse, or breathy voice during or after eating
• spit up or throw up a lot
• are not gaining weight or growing
• has less energy than usual

Toddlers and School-Age Children

• 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 (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
• has less energy than usual

Not every child with a feeding or swallowing disorder has every sign listed here. Your child may show a few signs or many of them. If your child does have a feeding or swallowing disorder, they may be at risk for:

• dehydration or poor nutrition
• food or liquid going into the airway, called aspiration
• pneumonia or other lung infections
• negative feelings about eating because of pain, frustration, or embarrassment

Causes of Feeding and Swallowing Disorders

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

• nervous system disorders, like cerebral palsy
• reflux or other stomach problems
• being premature or having a low birth weight
• heart disease
• cleft lip or palate
• breathing problems, like chronic lung disease or other diseases
• autism
• brain injury
• muscle weakness in the face and neck
• medicines that make them sleepy or not hungry
• sensory issues including problems with textures, colors, smells, and taste

Testing for Feeding and Swallowing Disorders

Talk to your child’s doctor if you think your child has a feeding or swallowing problem. Your child's doctor can help you find an SLP who is trained in feeding and swallowing. You can also visit ASHA ProFind to find an SLP.

During testing, the SLP will:

• 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.

Imaging Tests for Swallowing

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. The SLP can watch where the food goes because barium shows up on an X-ray.

Endoscopic assessment (sometimes called a “FEEs”)—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 on a screen as your child swallows.

The SLP may either lead or work as part of the feeding team. Other team members may include:

• occupational therapist
• physical therapist
• physician or nurse
• registered dietitian
• developmental specialist
• social worker
• 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:

• Seeing a doctor for medical treatment, as like taking medicines for reflux.
• Participating in feeding and/or swallowing therapy.
• Trying different foods or adding calories to their diet.
• Learning new ways to help your child try new foods or textures.
• Changing the temperature (e.g., hot or cold) or texture (e.g., crunchy or soft) of food.
• Changing your child’s position while eating.
• Learning new ways to handle your child’s behavior.
• Seeing another professional, such as a psychologist or dentist.

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

• Helping them chew food.
• Supporting them in trying new foods and drinks.
• Improving how well they can suck from a bottle or drink from a cup.
• For babies, helping them learn how to breathe while sucking and swallowing.
• Changing food textures and liquid thickness to help them swallow safely,
• Encouraging 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.

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.

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

• Sharing information about how and what your child eats and drinks at home.
• Telling the SLP or feeding team what is or is not working at home.
• Asking questions to understand your child’s problems.
• Asking questions if you’re unsure what the SLP is working on and why they are doing it.
• Taking part in your child’s treatment.
• Following the SLP’s suggestions for eating and drinking at home and at school.
• Talking with your child’s teachers and other family members about your child’s feeding problems and how they can help.

To find an SLP or audiologist near you visit ProFind.

Resources

Inclusion on this list does not imply endorsement.

• American Board of Swallowing and Swallowing Disorders
• Feeding Matters—Serving Kids With Pediatric Feeding Disorder
• National Foundation of Swallowing Disorders