Pediatric dysphagia (known more commonly as pediatric feeding/swallowing) is a speciality area within speech-language pathology that involves additional coursework and training beyond traditional speech and language training. Pediatric feeding therapists can work with a wide range of clients- babies/children with a history of prematurity and a stay in the neonatal intensive care unit (NICU), those with neurological, genetic, or cardiac conditions, reflux/GERD, poor weight gain, bottle or food refusal behaviors, babies with difficulty sucking, babies/ children with oral motor delays and difficulty transitioning to solids, or babies/children being tube fed.
During the initial feeding and swallowing evaluation, a full medical and feeding history will be taken. Often, if a child sees an ENT, GI, or nutritionist, those notes will be reviewed as well (the therapist will also make referrals to such specialists if needed). The therapist will perform an oral mechanism exam to make any observations about the oral motor structures that could impact feeding, observe a feed ( breast/bottle/cup/solids etc) to assess both feeding and swallowing skills, and make recommendations as needed.
A pediatric feeding therapist will look at feeding skills:
- The therapist will look at a child’s oral motor structures and function ( how are the lips, cheeks, tongue, and palate working together to support bottle/breast feeding or transition to solids?
- How efficient is a baby when bottle feeding ( does it take a long time to drink from the bottle? Does the baby seem to be working very hard to get a small amount of milk out of the bottle?)
- How is a baby or child doing once transitioning to purées and solids? Is he chewing appropriately or gagging and vomiting?
While also observing swallowing skills:
- how is the baby handling the milk once they begin swallowing. Is the suck-swallow-breathe mechanism needed for safe and efficient feeding within normal limits or does there need to be a change in position,bottle, or other feeding techniques to help the baby?
- Is the baby or child coughing frequently with food or liquid?
- Is the baby showing signs that the liquid flow rate is too fast or too slow? How is their breathing and overall state during a feed?
- Does the baby or child have a diagnosis of “aspiration” where food or liquid is known to go into the airway and need a special diet?
After a full evaluation, treatment can be provided as needed. Typically for babies and young children, feeding therapy looks different than traditional speech, physical, or occupational therapy. More traditional therapy is usually 1-3 times a week for 30-45 minutes for multiple weeks or months. During the initial feeding/swallowing evaluation, which is typically between 60-90 minutes, parents are given a lot of education and functional treatment ideas/things to work on before the next follow up.
Follow-ups ( if needed) are scheduled as needed and are usually periodic to allow time for parents to practice the techniques provided at the evaluation and to allow the baby/child to make progress in a developmentally appropriate time frame. Treatment frequency is very child and family specific. For most clients treatment/follow-up may look like:
- 1x per week for a month OR
- 2x a month for 1-2 months OR
- once a month follow-up OR
- on an as-needed basis
Treatment is typically 45 minutes. Treatment plans are very specific and individualized and during the initial evaluation will be discussed with families.