Pediatric Feeding and Swallowing Program

Children of all ages may be affected by a feeding or swallowing problem. Reid Health is pleased to offer a comprehensive, multi-disciplinary Pediatric Feeding and Swallowing Program to evaluate and treat infants and children who have difficulty eating and drinking. The program is aimed at facilitating safe and effective nutrition in the most appropriate method possible for each patient. Treatment options include individual and group sessions. Our therapists are highly trained and experienced in working with children with feeding and swallowing difficulties. The team of feeding and swallowing specialists develops and implements an individualized plan of care for each child and recognizes the importance of empowering parents and families to meet a child's feeding and swallowing needs.

Feeding is the process involving any aspect of eating or drinking, including gathering and preparing food and liquid for intake, sucking, chewing, and swallowing. Swallowing involves a complex process of transporting food and liquid from the mouth to the stomach while protecting the airway. It is defined in four phases - oral preparatory, oral transit, pharyngeal, and esophageal. It is possible for a child to have a deficit in one or all areas.

Feeding disorders are problems with a range of eating activities that may or may not include problems with swallowing. Feeding disorders are generally characterized by:

· Poor coordination of bottle or breast-feeding
· A severely limited diet preventing adequate nutrition, which is typically <20 foods
· Displaying disruptive or age-inappropriate behaviors at mealtime
· Failing to master self-feeding skills
· Experiencing less than optimal growth
· Texture or sensory aversions
· Motor deficits preventing bringing food to mouth
· Coordination deficits leading to spillage and poor accuracy
· Difficulty using utensils and/or cups
· Difficulty transitioning between stages of food or from bottles to cups

Swallowing disorders (dysphagia) can result in aspiration and other long-term consequences such as:

· Food and oral aversions
· Pneumonias and compromised pulmonary status
· Malnutrition and dehydration
· Gastrointestinal complications such as motility disorders, constipation, and diarrhea
· Poor weight gain
· Rumination disorder (unintentional and reflexive regurgitation of undigested food that may involve re-chewing and re-swallowing of the food)
· Ongoing need for enteral (gastrointestinal) or parenteral (intravenous) nutrition
· Psychosocial effects on the child and his or her family
· Life-long feeding and swallowing problems

Dysphagia, or difficulty swallowing, can occur at any age and can be due to many reasons. Further assessment and treatment by a Speech-Language Pathologist is essential to children with swallowing difficulties. Common signs and symptoms of dysphagia include:

· Back arching
· Breathing difficulties and decreased responsiveness during feeding
· Coughing and/or choking during or after swallowing
· Crying during mealtimes
· Difficulty chewing foods that are texturally appropriate for age (may spit out or swallow partially chewed food)
· Difficulty initiating swallowing, managing secretions, or gagging
· Disengagement/refusal shown by facial grimacing, facial flushing, finger splaying, or head turning away from food source
· Frequent congestion, particularly after meals
· Frequent respiratory illnesses
· Loss of food/liquid from the mouth when eating
· Noisy or wet vocal quality during and after eating
· Taking longer to finish meals or snacks (longer than 30 minutes)
· Refusing foods of certain textures or types
· Taking only small amounts of food, overpacking the mouth, and/or pocketing foods
· Vomiting (more than typical "spit-up" for infants)

Occupational therapists (OTs) will address the deficits preventing effective feeding during mealtime. The OT will look at the whole picture of mealtime to assess positioning, environment set-up, sensory concerns, and motor skills.

Speech-Language Pathologists (SLPs) play a central role in the assessment, diagnosis, and treatment of infants and children with oral and pharyngeal phase swallowing disorders. The SLP will determine a safe diet and determine a plan of care to address specific areas of need. SLPs may recommend an instrumental assessment called a Modified Barium Swallow Study (MBSS) in order to assess if food or liquid is going into the child's airway.

The MBSS is used to evaluate a child, adolescent, and/or adult swallow using an x-ray machine. The MBSS uses barium and a low dose of radiation so that an SLP is able to watch the food/liquid as it travels from the mouth to the esophagus in real time. It allows the SLP to see if food and/or liquid is making its way safely to the esophagus or if it is being aspirated (going into the lungs). The information obtained from the examination can be critical to identify and differentiate the type and severity of swallowing impairment, determine if the patient is safe to eat by mouth, and formulate recommendations and treatment planning.

If your doctor/SLP recommends an MBSS, these are important factors:

• The process will last approximately 30 minutes from the time you enter the x-ray suite to when you leave, depending on your child's individual situation.
• The study is voluntary; we are not able to force a child to eat. Patients should always arrive hungry for assessment. Please bring your child's favorite foods and utensils to the visit.
• Depending on the age of your child, he or she will be lying down on the bed of the machine or sitting in chair with straps to hold into place.
• Your child will also wear a protective lead shield during the study.
• Barium is added to the liquids/solids in order to view through the machine. Barium is safe to consume for your child.
• When possible, you will be involved in the feeding of your child in order to see real-life intake of liquids and solids. You will wear protective lead apron during the study.
• The radiologist will control the amount of radiation during the evaluation.
• The swallow study is recorded for the clinician to review and make recommendations to your physician.

Our program for assessing and treating children with feeding, swallowing and weight/growth difficulties may look different for each child. Children may be recommended for individual speech and/or occupational therapy based on their needs, or a group setting may be the best fit to meet a child's feeding needs.

Feeding Groups

Occupational Therapists and Speech-Language Pathologists work together in a group setting with up to 6 children and their parents. Our feeding group therapy team has received extensive training in the SOS Approach to Feeding. This program integrates perceptual, motor, oral, learning, medical, and nutritional factors to treat children with feeding/growth problems. It is based on research regarding the steps, stages, and skills of feeding necessary for good growth in childhood. The SOS program makes sure that all physical reasons or atypical feeding development are examined and appropriately medically treated, as well as identifying any nutritional deficits and how to correct them as appropriate to each individual child's growth parameters and needs. Skills across all areas are also assessed and treated with regards to feeding, as well as an examination of learning capabilities with regards to using the SOS program.

We offer three groups based on age and skill set. Age ranges for groups can vary and children are placed the group most appropriate to their level of need. These groups are tailored to meet the needs of your child at each individual age and stage of feeding. A thorough assessment with your child's Occupational or Speech Therapist will help determine which group best meets their needs.

Tater Tots

Children in our Tater Tots Group are typically between the ages of 2-3 years. Due their young age, this group is often limited in the number of participants to increase individual attention. Out Tater Tots are influenced by sensorimotor components and imaginative thinking, thus a heavy focus on pretend play is utilized throughout sessions.

Mighty Munchers

Children in our Mighty Munchers Group are often developmentally between the ages of 3-6 years. Elements of pretend play may still be incorporated throughout sessions; however, emphasis changes to exploration, direct manipulation, and deconstructing food items.

Snack Pack

Children in our Snack Pack Group are typically aged 5 and older. This group continues with exploration, direct manipulation, and deconstruction. Clinicians incorporate more age-appropriate language to analyze individual components of targeted food items.