Picky Eaters, Feeding Difficulties, Swallowing or Dysphagia Disorders in Children

Feeding disorders include problems gathering food and getting ready to suck, chew, or swallow it. For example, a child who cannot pick up food and get it to her mouth or cannot completely close her lips to keep food from falling out of her mouth may have a feeding disorder.

Dysphagia, meaning difficulty swallowing, is when the swallowing of food causes it to not pass easily from the mouth to the stomach. This may cause food to get stuck in the lungs and throat. In addition, children may have difficulty eating enough—leading to nutrition problems and failure to gain weight or grow.

Swallowing disorders, also called dysphagia, can occur at different stages in the swallowing process:

  • Oral phase–sucking, chewing, and moving food or liquid into the throat
  • Pharyngeal phase–starting the swallow, squeezing food down the throat, and closing off the airway to prevent food or liquid from entering the airway (aspiration) or to prevent choking
  • Esophageal phase–relaxing and tightening the openings at the top and bottom of the feeding tube in the throat (esophagus) and squeezing food through the esophagus into the stomach

Feeding skills, oral motor skills, and articulation development are all related to each other in that they develop side by side and one builds upon the other. A child with poor oral motor skills will have feeding deficits in certain areas and delays in articulation. Therefore the information presented below covers development of feeding and oral motor skills and possible interventions that you as a parent can do to improve function.

Oral motor exercises are occasionally necessary to improve weak articulators or muscles in the mouth and face for speech production. These muscles sometimes need strengthening, or need to have better coordination or range of motion.

Improving these muscles can help a child make speech sounds better as well as help with the eating/feeding/swallowing problems some children have difficulty with. The activities below are for children ages 3 and up, to help improve their oral motor skills.

Signs or symptoms

The symptoms of dysphagia vary greatly from person to person. Some individuals will experience only mild symptoms while others may have severe symptoms or complications. Symptoms of dysphagia may resemble other medical conditions. Children with feeding and swallowing problems have a wide variety of symptoms. Not all signs and symptoms are present in every child.

The following are signs and symptoms of feeding and swallowing problems in very young children:

  • difficulty chewing
  • difficulty breast feeding
  • coughing or gagging during meals
  • frequent spitting up or vomiting
  • excessive drooling or food/liquid coming out of the mouth or nose
  • difficulty coordinating breathing with eating and drinking
  • increased stuffiness during meals
  • gurgly, hoarse, or breathy voice quality
  • recurring pneumonia or respiratory infections
  • less than normal weight gain or growth
  • arching or stiffening of the body during feeding
  • irritability or lack of alertness during feeding
  • refusing food or liquid
  • failure to accept different textures of food (e.g., only pureed foods or crunchy cereals)
  • long feeding times (e.g., more than 30 minutes)

As a result, children may be at risk for:

  • dehydration or poor nutritio (food or liquid entering the airway) or penetration
  • pneumonia or repeated upper respiratory infections that can lead to chronic lung disease
  • embarrassment or isolation in social situations involving eating
  • aspiration

Causes

Dysphagia is often the result of another condition or physical characteristic, some of them may include:

  • Prematurely born
  • Diseases that affect the nerves and muscles
  • Craniofacial conditions
  • Objects stuck in the throat
  • Tumors or masses in the throat
  • Cleft lip or cleft palate
  • Large tongue or tonsils
  • Dental problems

Assessment

Child is having difficulty eating will examine your child and address any medical reasons for the feeding difficulties, including the presence of reflux or metabolic disorders. Dysphagia is diagnosed through a complete patient medical history, physical exam and sometimes radiology procedures to evaluate the mouth, throat, and esophagus which may include :

  • ask questions about your child’s medical history, development, and symptoms
  • look at the strength and movement of the muscles involved in swallowing
  • observe feeding to see your child’ s posture, behavior, and oral movements during eating and drinking
  • special tests, if necessary:
    • modified barium swallow–child eats or drinks food or liquid with barium in it, and then the swallowing process is viewed on an X-ray.
    • endoscopic assessment–a lighted scope is inserted through the nose, and the child’s swallow can be observed on a screen.Endoscopy is a lighted, flexible instrument (containing a computer chip and camera that is attached to a TV monitor) examines the upper to lower GI tract for any condition that can cause symptoms.

Treatments

Treatment varies greatly depending on the cause and symptoms of the swallowing problem.

Based on the results of the feeding and swallowing evaluation, the SLP or feeding team may recommend any of the following:

  • medical intervention (e.g., medicine for reflux)
  • direct feeding therapy designed to meet individual needs
  • postural or positioning changes (e.g., different seating)
  • behavior management techniques
  • referral to other professionals, such as a psychologist or dentist
  • nutritional changes (e.g., different foods, adding calories to food)
  • increasing acceptance of new foods or textures
  • food temperature and texture changes

How Improve Oral Motor Skills

  • Lick ice cream as it drips down the side of the cone on a hot day. Can’t use lips- tongue only.
  • Pretend to make faces at one another while you look in the mirror. Make the silliest ones you want.
  • Blowing bubbles. This works the muscles that make our lips round like for the /w/ sound. It also improves breath control.
  • Roll little round lollipops around the mouth, back and forth from in one cheek to inside the other using only the tongue. The sucker should be visible pushing against the cheek if they do it successfully. Also works on lateralization and coordination of tongue movements.
  • Licking peanut butter or marshmallow crème with the tongue only (no fingers) after a glob of it has been placed on the roof of the mouth or behind the top front teeth. This works on tongue elevation/lifting, and if you put it over in one cheek it works to help lateralize the tongue (move it sideways).
  • Put cheerios or apple jacks on the table and have the child “spear” one with his tongue. No hands or lips can be used. The child has to learn to aim and protrude the tongue past the lips.
  • Rub syrup, frosting, or peanut butter on outside of lips (red/pink part) so child must lick lips with tongue to clean them off. No hands for this either.

The focus on intervention may include the following:

  • increasing acceptance of different foods and liquids
  • improving sucking and/or drinking ability
  • coordinating the suck-swallow-breath pattern (for infants)
  • altering food textures and liquid thickness to ensure safe swallowing
  • making the muscles of the mouth stronger
  • increasing tongue movement
  • improving chewing

Followup

  • ask questions to understand problems in feeding and swallowing
  • follow recommended techniques at home and school
  • talk with everyone who works with the child about the feeding and swallowing issues and treatment plan
  • provide feedback to the SLP or feeding team about what is or is not working at home
  • make sure they understand the treatment plan
  • go to treatment plans

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CLINIC FOR CHILDREN Yudhasmara Foundation www.childrenclinic.wordpress.com/ WORKING TOGETHER SUPPORT TO THE HEALTH OF ALL CHILDREN BY CLINICAL, RESEARCH AND EDUCATIONS.  Advancing of the future pediatric and future parenting to optimalized physical, mental and social health and well being for fetal, newborn, infant, children, adolescents and young adult 

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Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider

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