Why Feeding Matters
Most of us take eating for granted. However, when you analyze it, eating is more complex than walking or talking. This vital function for survival and growth requires twenty-six muscles and six cranial nerves to produce a single swallow!
Pediatric feeding difficulties prevent the child from thriving physically, cognitively, and/or emotionally. Sucking and swallowing are instinctual only in the first few weeks of life. After that, these actions must be learned, making early intervention critical.
Additionally, there is a general lack of awareness regarding diagnostics and treatment of pediatric feeding difficulties that often causes families to bounce from one medical professional to another trying to pinpoint what is wrong and how to fix it.
Poor sucking and swallowing skills make speech production almost impossible. Nationwide, over a million children have been diagnosed with feeding difficulties and many thousands go undiagnosed. Eighty percent of children with developmental disabilities have accompanying feeding issues.
Feeding challenges also disrupt the typical establishment of bonding and positive interaction between parents and children. Struggles in a feeding relationship further impact social-emotional progression in children and, in turn, can hinder language development.
Certified Treatment Modalities:
Frequently Asked Questions
What is a feeding disorder?
A feeding disorder is characterized by difficulties eating or drinking that negatively effect weight gain and/or nutrition. Difficulties can include deficits such as ineffective chewing and may be accompanied by inappropriate behaviors, like tantrums, associated with mealtimes. Feeding disorders can range from mild to severe, potentially requiring alternative means of nutrition to maintain appropriate weight and nutritional status.
What is a swallowing disorder?
A swallowing disorder, also known as dysphagia, is the decreased ability to manage secretions, transport liquids, or chew solids to adequately initiate and execute an effective swallow. An individual with dysphagia is at an increased risk for aspiration—when food or liquid enters the airway before, during, or after the swallow. Aspiration can lead to respiratory complications such as pneumonia.
Why do some children have feeding or swallowing difficulties?
Children may have feeding difficulties resulting from a complex interaction among multiple factors. Early experiences with pain during eating, which may be related to reflux, may cause the child to stop eating and develop negative behaviors or downright food refusal. This not only makes it difficult for the parent to feed the child, but it can lead to a delay in the development of appropriate oral motor skills required to be a successful, independent eater.
Some children may have peculiar feeding patterns or experience food jags which negatively impact their health or socialization. Medical diagnoses and underlying conditions that contribute to dysphagia include Autism, Cerebral Palsy, cardiac conditions, craniofacial anomalies, prematurity, failure to thrive, gastroesophageal motility disorders, genetic syndromes, oral-motor dysfunction, metabolic disorders, food allergies, and short bowel syndrome.
What are some of the signs or symptoms of a feeding or swallowing disorder?
- Food/drink refusal
- Inability to chew/swallow
- Inability to drink from a bottle/breast feed
- Fear associated with food or swallowing
- Excessive drooling or food spilling from the mouth
- Food selectivity (by type or texture)
- Coughing/choking or increased congestion during a meal
- Mealtime behavior problems (increased fussiness, crying, tantrums, lengthy meals)
- Recurrent gagging or vomiting
- Arching or stiffening of the body
- Poor weight gain
- Alternative means of nutrition nasogastric or gastrostomy tube dependent)
- Frequent, recurrent respiratory infections or pneumonia
How do feeding or swallowing disorders manifest at different developmental stages?
Infants:
Although infants seem to be born with an innate ability to suck and feed successfully, some may experience varied levels of difficulty ranging from mild fussiness, reduced intake (resulting in poor weight gain), to a complete inability to feed by mouth that requires artificial means of nutritional support such as a nasogastric tube. Causes of feeding issues in infants are commonly associated acid reflux, inadequate oral muscular development (such as in premature infants), or an immature neurological system (for example, congenital disorders or fetal alcohol syndrome/drug withdrawal).
Children with a complex medical diagnosis such as Cerebral Palsy, cardiac conditions, craniofacial anomalies, genetic syndromes, metabolic disorders, and the like, may also have accompanying swallowing disorders.
Older Infants:
Most pediatricians now understand and advocate for introducing semi-solid foods like baby cereals no earlier than age five to six months because a baby’s gastric system does not mature enough until then to handle supplemental foods.
Once semi-solids are introduced, progression over textures should occur over the next six to seven months, allowing older babies to develop oral skills from munching increasingly thicker textures to chewing soft-cooked foods that resemble cut-up table foods.
Feeding difficulties at this stage typically result in rapid weight loss (especially if the baby also loses interest in bottle- or breast-feeding), or the child may exhibit excess gagging, vomiting, and food refusal behaviors and have a hard time transitioning to more advanced textures.
Toddlers:
Feeding issues may become evident in young children even if they previously gained weight well on formula/breast milk and some baby foods, or crunchy, quickly-dissolved textures such as crackers, cookies, and cereals. If they continue to rely largely on milk for protein and caloric intake along with an extremely limited selection of foods, they may lose weight and be diagnosed with Failure to Thrive.
These children may have oral sensory dysfunction and oral motor delays that interfere with their ability to accept and manage wet, soft, or mushy textures. Some, however, may also have underlying neurological disorders such as Cerebral Palsy and Autism.
Older Children:
A feeding disorder in older children often manifests as extremely limited food selectiveness, avoiding or omitting an entire food group or even several groups such as absence of vegetables or meats. Although the child’s weight may be stable, it tends to be on the light side. Mealtime anxiety and feeding struggles may also become commonplace. Eating out with family may become impossible.