Feeding & Swallowing

Feeding is the process involving any aspect of eating or drinking, including gathering and preparing food and liquid for intake, sucking or chewing, and swallowing.

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

Swallowing is a complex process during which saliva, liquids, and foods are transported from the mouth into the stomach while keeping the airway protected.

Swallowing disorders (dysphagia) can result in aspiration—the passage of food, liquid, or saliva into the trachea—and retrograde flow of food into the nasal cavity.

Children

Feeding disorders can be characterized by one or more of the following behaviors:

  • Avoiding or restricting one’s food intake
    • Refusing  age-appropriate or developmentally appropriate foods or liquids
    • Accepting a restricted variety or quantity of foods or liquids
  • Displaying disruptive or inappropriate mealtime behaviors for developmental level
  • Failing to master self-feeding skills expected for developmental levels
  • Failing to use developmentally appropriate feeding devices and utensils
  • Experiencing less than optimal growth

The long-term consequences of feeding and swallowing disorders can include 

  • food aversion
  • oral aversion
  • aspiration pneumonia and/or compromised pulmonary status
  • undernutrition or malnutrition
  • dehydration
  • gastrointestinal complications such as motility disorders, constipation, and diarrhea
  • poor weight gain velocity and/or undernutrition
  • 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
  • feeding and swallowing problems that persist into adulthood, including the risk for choking, malnutrition, or undernutrition.  

Adults

Adults with dysphagia may  experience:
(a) disinterest and/or less enjoyment of eating or drinking and/or
(b) embarrassment or isolation in social situations involving eating.   

Signs of dysphagia may include

  • drooling and poor oral management;
  • food or liquid remaining in the oral cavity after the swallow
  • inability to maintain lip closure, leading to food and/or liquids leaking from the oral cavity
  • food and/or liquids leaking from the nasal cavity
  • complaints of food “sticking”
  • globus sensation or complaints of a “fullness” in the neck
  • complaints of pain when swallowing
  • wet or gurgly sounding voice during or after eating or drinking
  • coughing during or right after eating or drinking
  • difficulty coordinating breathing and swallowing
  • recurring aspiration pneumonia/respiratory infection and/or fever
  • extra effort or time needed to chew or swallow
  • changes in eating habits—specifically, avoidance of certain foods/drinks
  • weight loss or dehydration from not being able to eat enough

Malnutrition and dehydration, aspiration pneumonia, compromised general health, chronic lung disease, choking, and even death may be a consequence of dysphagia.

Causes
Dysphagia may result from: stroke, traumatic brain injury, spinal cord injury, dementia, Parkinson’s disease, multiple sclerosis, ALS, muscular dystrophy etc

It may also occur from problems affecting the head and neck, including: cancer, intubation, certain medications, GERD, pulmonary diseases etc

                                                                                                                                                                                                                                     (ASHA, 2020)

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What To Do?

Contact your speech therapist for a formal assessment

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