Feeding and Swallowing

Assessment and Intervention

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 their mouth or cannot completely close their lips to keep food from falling out of their mouth may have a feeding disorder.

 
 

What are the signs and symptoms of feeding and swallowing disorders?

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

  • 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)

  • difficulty chewing

  • difficulty breast feeding

  • coughing or gagging during meals

  • 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

  • frequent spitting up or vomiting

  • recurring pneumonia or respiratory infections

  • less than normal weight gain or growth

What is Tongue Thrusting?

A tongue thrust habit is the habit of placing the tongue in the wrong position during swallowing, either too far forward or to the sides. It is estimated that every 24 hours, you swallow a total of 1,200 to 2,000 times, with about four pounds of pressure per swallow. This repeated pressure of the tongue will force the teeth and arches out of alignment. In addition to the pressure exerted while swallowing, nervous thrusting also pushes the tongue against the teeth while it is at rest. This is an involuntary, subconscious habit that pushes the teeth out of alignment and tends to reverse orthodontic work.

Tongue Thrusting Intervention

Correction by MyoFunctional Therapy or Tongue-Thrust Therapy, is an exercise technique that re-educates the tongue muscles. It is similar to “physical therapy” for the tongue, which is taught by a trained therapist. There are in-office visits and home exercises. The length of therapy is based upon the child’s cooperation and dedication. Therapy has proven to give the highest percentage of favorable results.

 

Sensory-based feeding disorders

There are two “branches” of sensory-based disorders are 1) hyposensitivity, or a reduced awareness of food items in the mouth and, 2) hypersensitivity, or a heightened awareness of foods in the mouth. Children who are hypo-sensitive to oral input may have a poor suck, liquid pooling and/or loss, and may exhibit overstuffing/pocketing. Those who are hyper-sensitive to oral input may have an increased gag response, refusal of foods, and difficulty progressing to textured foods.

When addressing sensitivity towards food, we gradually increase the child’s comfort with target foods by providing exposure and positive experiences to the sensory systems involved. These include the visual, olfactory, tactile, and gustatory sensory systems.

 
 

  • Includes non-mealtime visual experiences, picture- or object-based experiences, and working on tolerance of food on the table, on the child’s plate, etc.

  • Includes introducing mild smells and increasing comfort with proximity to food smells, working towards increased intensity of smells.

  • Tactile exposure may include water play, sensory bins (such as dry rice, dry or cooked noodles, etc.), painting with food, building with food (such as these cute veggie sculptures!), and cooking activities.

  • Follows a hierarchical approach, such as the pattern: 1. touch 2. kiss 3. lick 4. bite and remove 5. bite, chew and remove 6. bite chew and swallow.

 
 
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