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Baby feeding disorders


Feeding and Swallowing Disorders in Children

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Feeding and swallowing disorders can lead to health, learning, and social problems. Feeding disorders include problems with sucking, eating from a spoon, chewing, or drinking from a cup. Swallowing disorders, also called dysphagia (dis-FAY-juh) are difficulties with moving food or liquid from the mouth, throat, or esophagus to the stomach. Feeding and swallowing disorders are often related to other medical conditions but may also occur without a known cause.

Speech-language pathologists (SLPs) help children with feeding and swallowing problems.

On this page:

  • About Feeding and Swallowing Disorders
  • Signs
  • Causes
  • Testing
  • Treatment
  • Other Resources

About Feeding and Swallowing Disorders

Think about how you eat. First, you have to get the food or drink to your mouth. You may use a fork, spoon, straw, cup, or your hands. Then you have to open your mouth and take the food in. You close your lips to keep the food in your mouth. Then you chew the food or move the liquid to get ready to swallow.

From birth, infants eat by sucking. As they grow, they learn how to eat solid foods and drink from a cup. All children will have some trouble at first. Drinks may spill from their mouths. They may push food back out or gag on new foods. Some degree of this behavior is normal and should go away over time. However, a child with a feeding disorder will keep having trouble or may have an especially hard time eating or drinking. Some children will eat only certain foods, or they may take a long time to eat. These children may also have a feeding disorder. If your child coughs or chokes when eating, refuses food or liquid, has a wet, gurgly voice after eating, starts to lose weight, or has less energy than usual, talk to your doctor about seeing a feeding and swallowing professional.

Swallowing happens in three stages. A child can have a problem in one or more of these stages. They include:

  • Oral phase—sucking, chewing, and moving food or liquid into the throat. Feeding is a part of the oral phase.
  • Pharyngeal phase—starting the swallow and squeezing food down the throat. The body needs to close off their airway to keep food or liquid out. Food going into the airway can cause coughing and choking.
  • 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 a lot if there is a problem with the esophagus.

Signs of Feeding and Swallowing Disorders

Your child may have a feeding or swallowing problem if they:

  • arch their back or stiffen when feeding
  • cry or fuss when feeding
  • fall asleep when feeding
  • have problems breastfeeding
  • 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 (which means to 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

Not every child has every sign listed here. Your child may show a few signs or many of them. Your child may be at risk for:

  • dehydration or poor nutrition;
  • food or liquid going into the airway, called aspiration;
  • pneumonia or other lung infections; and
  • having negative feelings about eating. They may avoid eating or associate it with pain, frustration, or embarrassment.

Causes of Feeding and Swallowing Disorders

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

  • nervous system disorders, like cerebral palsy or meningitis;
  • reflux or other stomach problems;
  • being premature or having a low birth weight;
  • heart disease;
  • cleft lip or palate;
  • breathing problems, like asthma or other diseases;
  • autism;
  • head and neck problems;
  • muscle weakness in the face and neck;
  • medicines that make them sleepy or not hungry;
  • sensory issues; and
  • behavior problems.

Testing for Feeding and Swallowing Disorders

Talk to your child’s doctor if you think they have a feeding or swallowing problem. Your doctor can test your child for medical problems and check their growth and weight. An SLP trained in feeding and swallowing can look at how your child eats and drinks. The SLP will take the following steps:

  • 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

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. Barium shows up on an x-ray so the SLP can watch where the food goes.
  • Endoscopic assessment—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 your child swallow on a screen.

      The SLP may lead or work as part of a feeding team. Other team members may include

      • an occupational therapist,
      • a physical therapist,
      • a physician or nurse,
      • a registered dietitian,
      • a developmental specialist,
      • a social worker, and
      • a 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:

      • referral to a doctor for medical treatment, like medicines for reflux
      • feeding therapy
      • trying different foods or adding calories to their diet
      • trying new ways to get your child to try new foods or textures
      • changing how hot or cold food is or how crunchy or soft it is
      • changing your child’s position while eating
      • trying new ways to handle your child’s behavior
      • seeing another professional, like a psychologist or dentist

      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.

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

      • Making the muscles of their mouth stronger.
      • Helping them move their tongue more.
      • Helping them chew foods.
      • Getting them to try new foods and drinks.
      • Improving how well they can suck from a bottle or drink from a cup.
      • Helping them learn how to breathe while sucking and swallowing. This will be for babies only.
      • Changing food textures and liquid thickness to help them swallow safely.
      • Getting 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.

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

      • ask questions to understand the problems your child has,
      • make sure you understand what the SLP will work on and why they will work on it,
      • go with your child to treatment,
      • follow suggestions from the SLP for eating and drinking at home and at school,
      • talk with your child’s teachers and other family members about your child’s feeding problems and what others can do to help, and
      • let the SLP or feeding team know what is or is not working at home.

      Other Resources

      This list does not include every website on this topic. ASHA does not endorse the information on these sites.

      • American Board of Swallowing and Swallowing Disorders
      • MayoClinic webpage on dysphagia
      • National Foundation of Swallowing Disorders

      To find an SLP near you, visit ProFind.

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      Feeding Disorders - Developmental and Behavioral Pediatrics - Golisano Children's Hospital

      Golisano Children's Hospital / / / Feeding Disorders

       

      Services In DBP

      • Behavior Treatment Services - Provides assessment and short-term treatment for children and teens with developmental delay or disability and challenging behaviors.
      • Pediatric Feeding Disorders Program - Provides assessment and treatment for children who have difficulty eating related to food selectivity, food refusal, and disruptive mealtime behavior.

      Related Services At URMC

      • Pediatric Gastroenterology - Evaluates and offers suggestions for treatment for problems with slow bowel motility, constipation, or gastroesophageal reflux (GER).
      • Physical Medicine and Rehabilitation - Provides outpatient evaluation and intense and targeted therapy programs for children and teens.

      Description

      Pediatric feeding disorders (also termed avoidant/restrictive food intake disorders) are conditions in which a child avoids eating or limits what or how much he or she will eat. This leads to problems including weight loss, nutritional deficiency, need for nutritional supplements, or problems with daily functioning. These disorders often limit a child’s ability to participate in normal social activities such as eating with others, and disrupt family functioning.    

      Causes

      For most children, there is not just one thing that causes a feeding disorder. Most often, it is a combination of factors. Things that can contribute to the development of a feeding disorder include:

      • Child temperament (slow to adapt, easily over-stimulated)
      • Pain or discomfort with feeding (from things like reflux and allergy)
      • Negative experiences with feeding (pain, coughing, vomiting or gagging during feeding)
      • Negative experiences related to the mouth (history of NG tubes, oral procedures, being on a ventilator, surgeries)
      • Slow emptying of the stomach
      • Poor oral motor skills (dysphagia)
      • Low muscle tone or high muscle tone
      • Developmental delays
      • Certain developmental disabilities, such as autism spectrum disorder
      • Anxiety
      • ADHD
      • Sensory differences (hypersensitivity to taste, smell, texture)
      • Chronic health problems (ear infections, frequent respiratory infections, dental problems, seizures)
      • Parent-child conflict, parental anxiety

      Diagnosis

      Depending on the child’s history and current problems, the evaluation may include some or all of the following:

      • Review of medical history, growth pattern, developmental history, and current symptoms
      • Assessment of dietary intake by a registered dietician
      • Evaluation by a physician or nurse practitioner with expertise in feeding  and feeding disorders
      • Evaluation of feeding behaviors by a clinical psychologist
      • Evaluation of oral motor skills, chewing and swallowing by a speech-language pathologist
      • Special tests to evaluate swallowing, such as a barium swallow or endoscopic assessment
      • Evaluation by a pediatric gastroenterologist to determine if problems of the GI tract (GE reflux, constipation, delayed emptying, or other GI disorders) are contributing to feeding problems
      • Evaluation of motor skills, posture, and sensory issues by a pediatric OT or PT
      • Blood work to evaluate nutrition status or to screen for medical conditions that can contribute to feeding problems

      Feeding Disorder Prevalence

      Pediatric feeding disorders are common. 1 of every 4 children are reported to have some sort of feeding disorder. A smaller number have symptoms severe enough to cause big problems or need specific treatment. The rate of feeding disorders is much higher in children with developmental disabilities. As many as 8 of every 10 children with a disability has a feeding disorder.

       

      Breastfeeding and child's bite depend on each other

      Breastfeeding not only gives the child a sense of security, helps to maintain an emotional connection with the mother, but also contributes to the proper formation and development of the baby's dental, respiratory and digestive systems. The child absolutely differently sucks mother's breasts and other objects (bottles, nipples).

      Shakhnoza Usmanova

      Osteopath. Dentist-therapist. MD, DO, CST-D, BCST

      The process of sucking begins with the tip of the tongue moving upwards and continuing with a “swaying wave” movement from front to back and from top to bottom. This powerful muscular dynamics contributes to the development of the dentoalveolar system, the muscles of the floor of the mouth, the tongue with its surrounding muscles, and the mimic muscles.

      When breastfeeding, sucking has a significant mechanical effect on various respiratory, digestive, anatomical structures. At this time, the lower jaw drops, resulting in a decrease in pressure inside the mouth, which creates an influx of milk. Milk enters the esophagus through swallowing, coordinated with the movement of the tongue. The mother's nipple adapts completely to the baby's mouth.

      When breastfeeding, the ratio of the upper and lower jaws equalizes by the end of the first year of life, which ensures the correct position of the tongue at rest and its functioning. And the correct kinetics and position of the upper and lower jaws contribute to the full physiological functioning of the human respiratory and digestive systems.

      In the long term, breastfeeding causes the correct formation of the facial part of the skull, prevents the development of dentoalveolar anomalies, malocclusion and ENT pathologies.

      The bottle sucking mechanism is completely different. The pacifier does not have the same anatomical resistance as the breast, it does not adapt to the baby's mouth. A child sucking on a pacifier strains the muscles of the temporomandibular joints and cheek muscles much more.

      Under these conditions of feeding, almost all chewing and facial muscles take part, the tongue gets used to the lower position and at rest, too, which contributes to the narrowing of the upper jaw and the delay in the development of the middle third of the facial skeleton and the base of the skull. This changes the space of the oral cavity.

      With age, the tongue cannot take its physiological position, as there is simply no place for it in the upper jaw. He begins to look for him, moving back and squeezing, while the tongue pulls the lower jaw back. Since the starting position of the tongue is changed, its kinetics during chewing, swallowing and speech will be disturbed. The low position of the tongue leads to the formation of a mouth type of breathing. This entails a decrease in the concentration of carbon dioxide in the blood, a violation of the acid-base balance and the accumulation of underoxidized metabolic products.

      The body's natural response to metabolic disorders is the development of a chronic stress state. Also, with the oral type of breathing, chronic oxygen starvation is formed.

      Thus, violations of the physiology of the respiratory process form dysfunctions of the facial part of the skull, provoke the development of dentoalveolar anomalies, developmental delay, ENT pathologies, snoring and sleep apnea, significantly worsen the quality of human life.

      Solve five breastfeeding problems after the first month

      Expert advice on the top five breastfeeding problems you may experience after the first month.

      Share this information

      Cathy Garbin, child health nurse, midwife and lactation consultant:
      Cathy, a mother of two, was a research fellow at the renowned Human Lactation Research Institute, founded by Peter Hartmann, for seven years, providing support to breastfeeding mothers in clinics and at home. Today, she still works as a family counselor, and also conducts seminars for attending physicians and speaks at international conferences.

      You and your baby have already fully established the process of breastfeeding and know what and how to do. It seems that all difficulties are left behind. However, some more surprises await you. The following are suggestions for dealing with breastfeeding problems that may arise later.

      Problem #1. I need to be away from my baby

      Whether it's social events, travel or medical treatment, at some point you may need to be away from your baby for a while.

      Solutions

      • Express milk so that someone else can feed the baby. Now that breastfeeding is established, you can express and store your breast milk in the refrigerator or freezer. Try different options to find the most convenient time for pumping in your daily routine. Some mothers manage to pump more breast milk in the morning when the baby wakes up after a long night's sleep. For others, it's best to express 60 minutes after feeding. Remember that everyone is different. Don't be discouraged if you don't get enough milk the first time: it's possible that you'll be able to express enough for one feeding in just two or three pumpings. As with feeding, it may take time for your body to adjust to pumping.
      • Take your breast pump with you, if you plan to skip a feed. Even if you leave your baby with expressed milk, but will be absent for more than two hours, you will need to empty your breast. Pump at the same frequency as you would breastfeed your baby. This will support milk production and prevent discomfort. Express milk regularly throughout the day without waiting for your breasts to overflow. 1 Most electronic breast pumps are battery operated, so you don't have to look for an outlet nearby.

      Problem #2. How to continue breastfeeding after returning to work?

      You will likely have to leave your baby more often and for longer when you go to work, so it's especially important to find ways to continue breastfeeding and pumping that work for both of you. As mentioned above, you can build up a supply of breastmilk before you go to work and then pump regularly to support milk production, prevent discomfort, and make sure your baby has enough pumped milk the next day. Many companies now provide dedicated pumping rooms, and modern breast pumps work efficiently and reliably. If you have a regular work schedule or work part-time, you can still breastfeed your baby before and after work and at night.

      Solutions

      • Express as often as you would feed your baby. This will help maintain milk production and prevent discomfort, as well as reduce the risk of clogged milk ducts, mastitis and breast swelling. 1
      • Try double pumping. Double pumping not only takes half the time, but also produces an average of 18% more milk than pumping from each breast in sequence. Milk is more nutritious and has a higher fat content. 2
      • Assemble and bring to work the set, which includes a breast pump, milk storage bags and, if desired, a bustier top for hands-free pumping. You will also need a cooler bag to carry your expressed milk.
      • Know your rights. In many countries, the law allows women to express and safely store breast milk at work. Discuss these options with your employer before returning to work. This will get you both ready.

      Problem #3. It seems to me that the baby suckles only for pleasure

      Sometimes you may feel that the baby takes your breast in order to calm down, and not to eat. However, do not forget that breastfeeding is not only nutrition, it is also comfort for your baby. "Soothing suckling" (when the baby suckles but does not eat milk) helps the baby to calm down and relax. Remember that a sudden increase in the frequency or duration of feedings may indicate insufficient milk production. However, if the baby continues to gain weight and you use enough diapers a day, this is unlikely.

      Solution

      • Please be patient. The baby needs your care - listen to his needs and support him. Usually, the period of soothing suckling does not last too long, but it allows the child to feel your love and protection - and this is the best thing you can give him.

      Problem #4. I want to switch from mixed to exclusive breastfeeding

      Breastfeeding is so good for you and your baby that it's worth trying to fight for it. However, if you have rarely fed lately, your milk production may have been reduced. If your baby has only been mixed-fed for a couple of weeks, you will most likely be able to restore enough milk. Contact a lactation consultant or medical specialist who will help you and give you the necessary advice. This is a very individual process that depends on many factors. In any case, do not despair, because every drop of your milk is important for the child.

      Solutions 1.3

      • Increase milk production. Try to put the baby to the breast more often, because the more milk the baby consumes, the more milk is produced. You can also express milk additionally. As mentioned earlier, double pumping in particular helps increase milk production.
      • Be in physical contact with your baby as much as possible. As in the first days after birth, close physical contact with the baby promotes the production of the hormone oxytocin, which in turn triggers milk production. It will also make both of you feel more calm and relaxed.
      • Reduce the number of formula feedings gradually. Resist the urge to stop supplementing with formula right away. If you gave your baby formula after each breastfeed, start giving it every other time until milk production rises. Keep a close eye on the number of soiled diapers and weight gain during this transition period. It is likely that at first the child will ask for the breast more often, and this is absolutely normal.
      • Speak to a lactation consultant or healthcare professional. He will be able to help you and strengthen the confidence that your baby gets everything he needs.

      Problem #5. My child has lost interest in the breast

      If your child, who always ate with appetite, suddenly began to refuse the breast for no apparent reason - this is a false refusal, the so-called "strike". You may assume that he is ready to switch to solid foods, or that he does not like your milk anymore, but this is most likely not the case. It's just that the child develops vision, and now he is more distracted by the world around him. Or maybe something frightened the child during feeding, or he reacts to a violation of the regimen, perhaps he has a stuffy nose or teething. What you take for lack of interest may actually mean that your baby has simply learned to breastfeed more effectively and therefore takes less time to suckle.

      Solutions

      • Be patient. False rejection is usually a temporary phenomenon that resolves after a few days. To provide the baby with the necessary nutrition during this period, give him expressed milk.
      • Find a quieter feeding area with as few distractions as possible. A baby is more likely to eat better if he or she can relax and focus on the breast.
      • Check in which position you feed. The baby may refuse to breastfeed if he is uncomfortable or unable to move his head to breathe during feeding.
      • Express milk to keep it flowing . You can try feeding your baby with expressed breast milk using the Medela Calma smart pacifier.
      • Do not start formula or solid foods. Supplementing with formula can lead to reduced milk production and will only make matters worse. If your baby is regularly fed with expressed milk and is growing well, and the number of soiled diapers is normal, try not to worry. If the baby is less than six months old, you should not give him solid food: his digestive system is not yet strong and may not be ready for such a load.
      • Do not force-feed. Try to relax and be in skin to skin contact with your baby as much as possible, hug him and often offer the breast so that he can take it on his own. The release of oxytocin that body contact triggers will also help you pump. 4

      Related content: Breastfeeding: what to expect after the first month

      Literature

      1 Kent JC et al. Principles for maintaining or increasing breast milk production. J Obstet , Gynecol , & Neonatal Nurs . 2012;41(1):114-121. - Kent J.S. et al., "Principles for Maintaining and Increasing Breast Milk Production". G Obstet Ginecol Neoneutal Nurs. 2012;41(1):114-121.

      2 Prime DK et al. Simultaneous breast expression in breastfeeding women is more efficacious than sequential breast expression. Breast Med . 2012;7(6):442-447. - Prime D.

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