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Feeding and Swallowing in Infants and Toddlers
By Molly Singleton, M.S., CCC-SLP
Parents may have concerns about their child’s ability to nurse or eat, or may notice their child is not growing at the same rate as other children; they may be concerned that their child is not getting enough nutrition because he or she is not able to nurse, chew or swallow food. Parents of infants may be concerned that their baby seems distressed when attempting to nurse: the baby may arch his or her back, stiffen, cry more than usual, or start gagging and choking. Other signs that a baby is having trouble with feeding include becoming less alert, nursing times of greater than a half hour, or difficulty breathing while nursing. Parents of an older child may be concerned that the child refuses to eat or drink, or is eating and drinking a limited variety of foods and liquids. If a child cannot keep food and liquid in his or her mouth, has a gurgly voice or seems out of breath when eating, these are signs that the child may have difficulty with feeding and swallowing. A swallowing problem may cause a child to sound stuffy when eating, vomit or gag, or develop frequent pneumonias. If your child is demonstrating these signs of feeding and swallowing difficulty, tell your pediatrician.
Why is my child having trouble feeding and swallowing?
There may be many different reasons why a baby or child is having difficulty nursing or eating enough to obtain the proper nutrition needed to grow. Muscle weakness, especially of the muscles of the mouth and face, can impact a baby’s ability to latch and suck when nursing, and can impact a child’s ability to chew and to keep food and liquid in the mouth and move it back in the mouth to swallow. Disorders of the nervous system such as cerebral palsy and meningitis can affect the timing and movement of muscles needed to feed and swallow safely. Feeding issues can often be associated with premature birth or low birth weight, conditions of the heart, esophagus, stomach, and lungs, cleft lip and/or palate, and developmental disorders such as autism or Down ’s syndrome. Knowing the medical history of your baby or child is very important because this information can help a swallowing specialist determine the cause of a feeding or swallowing problem.
Who will help my child?
You may be referred to a speech therapist or a speech therapist may work with you in your home as part of Early Intervention if your child is suspected to have a feeding or swallowing problem. Feeding and swallowing throughout the lifespan is an area of focus in which a speech therapist may have specialized experience and knowledge. As part of a team including your child’s pediatrician and a dietician and other therapists such as occupational and physical therapists, a speech therapist will evaluate your child’s feeding skills and swallowing function, and will develop a plan to help your child develop feeding skills and obtain proper nutrition and hydration.A speech therapist will watch your infant or child while he or she is feeding in order to evaluate your child’s feeding skills and look for signs of dysphagia, which is a swallowing disorder. The therapist may recommend other tests in order to get information about your child’s swallowing function if necessary; for example, a Modified Barium Swallow evaluation or a FEES study. These tests utilize technology that provides a view of what happens when your child swallows so that the speech therapist can examine the swallow and diagnose a swallowing disorder. Based on the results of your child’s evaluation, the therapist may refer you and your child to other specialists for medical treatment, such as a dentist or a gastroenterologist, and may also recommend feeding therapy.
How will a speech therapist help my baby or child through therapy?
A speech therapist will utilize a variety of treatment techniques in therapy to help your baby or child meet goals for obtaining proper nutrition and hydration. In order to help an infant with a swallowing disorder, a therapist may recommend changing the baby’s position or posture, changing the type of nipple, or manipulating the thickness of breastmilk or formula in order to help your baby suck and swallow safely. Therapy with older children may include changing the type of food or liquid presented to the child, focusing on helping the child chew and move food in the mouth, and possibly using a head posture in order to help your child swallow safely. As the parent, you are the most important member of the therapy team except for your child, and the therapist will provide you with the education and training needed to help your child when the therapy session is over and dinner time begins.
Remember – the therapy team is there to help you and your child. If you have any concerns about your child’s nutrition or you have questions about your child’s feeding and swallowing, tell your pediatrician and therapist!
Molly Singleton-Coyne, M.S., CCC-SLP is a Speech-Language Pathologist at North Shore University Hospital, where she focuses on diagnosing and treating speech and swallowing disorders. During her graduate education in speech pathology at Teachers College, she had the opportunity to travel to Angkor Hospital for Children in Cambodia, where she observed treatment of swallowing disorders in children who were affected by malaria-related disorders of the nervous system and malnutrition. In her free time, she enjoys spending time with her nieces and her nephew, her husband, and their cat Indiana Jones. She can be reached at email@example.com.