Feeding and Swallowing Problems

Dysphagia can occur in one or more of the four phases of swallowing and can result in aspiration—the passage of food, liquid, or saliva into the trachea—and retrograde flow of food into the nasal cavity.It is the medical term for difficulty swallowing, which can involve problems in moving food or liquid from the mouth to the esophagus and down to the stomach.
Feeding Disorder are problems with a range of eating activities that may or may not include problems with swallowing.
Pediatric feeding disorder (PFD) is “impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction” (Goday et al., 2019).
Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating or a feeding disturbance (e.g., apparent lack of interest in eating or in food, avoidance based on the sensory characteristics of food, concern about aversive consequences of eating), as manifested by persistent failure to meet appropriate nutritional and/or energy needs.

Key Signs and Symptoms:

Food aversion;
Oral aversion;
Aspiration pneumonia
and/or compromised pulmonary status;
Undernutrition or malnutrition;
Dehydration
Gastrointestinal complications such as motility disorders, constipation, and diarrhea
Poor weight gain velocity and/or under nutrition/ malnutrition
Rumination disorder
Ongoing need for enteral (gastrointestinal) or parenteral (intravenous) nutrition
Psychosocial effects on the child and his or her family
Feeding and swallowing problems that persist into adulthood, including the risk for choking

VLBW (< 1500g) – Birth gestation, duration of invasive ventilation, and the presence of

hypotonia at term age equivalent have been identified as independent predictors for feeding

problems in VLBW infants at 2yrs of age

Extremely LBW (<1000g) – Eating problems at 6 years in extremely low birth weight infants

was significantly correlated with poorer attained growth, which was only partially explained

by other disabilities

Oral motor difficulties and “hypersensitivity problems” – common in ELBW
Cognitive impairment and neuromotor disability – increased prevalence of clinical oral motor

and hypersensitivity problems

Speech-sy’s assessment includes :-

a)Neurodevelopmental History

b)Neurodevelopmental examination

Physical examination – keen observational skills, good judgment, a sense of timing, flexibility, and patience
observations of the caregiver’s behaviors and ability to read the child’s cues as they feed the child
Cognition, Communication, Functional & Daily living skills assessment
weight gain and growth trajectory

c)CNS evaluation – Examination of muscle tone, strength,

stability, reflexes, movement

e)Dysmorphology evaluation – to confirm genetic syndromes

1) Instrumental evaluation includes

2) most commonly used instrumental evaluations of swallowing for the pediatric population are

Speech-sy’s management includes:-