Our speech-language pathologists specialize in treating babies and children who have dysphagia, or difficulty swallowing foods, liquids, medications or even saliva. We offer comprehensive dysphagia evaluations and treatment for oral motor, oral sensory, swallowing safety and feeding advancement.
Feeding and Swallowing Symptoms in Children
Infants and children with feeding and swallowing problems may have a wide variety of symptoms, including:
- 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 (for example, only pureed foods or crunchy cereals)
- Long feeding times for babies (more than 30 minutes)
- Difficulty chewing
- Difficulty breast feeding
- Coughing or gagging during meals
- Excessive drooling, or food or liquid coming out of the mouth or nose
- Difficulty coordinating breathing with eating and drinking
- Gurgly, hoarse or breathy voice quality (while eating or shortly after eating)
- Recurring pneumonia or respiratory infections
- Less than normal weight gain or growth
As a result, a child may be at risk for:
- Dehydration or poor nutrition
- Aspiration (food or liquid entering the airway)
- Pneumonia or repeated upper respiratory infections that can lead to chronic lung disease
- Embarrassment in social situations involving eating
Feeding and Swallowing Evaluations
Our speech-language pathologists assess dysphagia by examining the mouth and throat muscles and aspiration risk, or the entry of food or liquid into the airway. During an evaluation, we may:
- Ask questions about your child's medical history, development and symptoms
- Look at the strength and movement of the muscles involved in swallowing
- Evaluate overall oral-motor skills, oral sensory awareness and swallowing safety
- Observe feeding to see your child's posture, behavior and oral movements during eating and drinking
- Perform special tests to evaluate swallowing
These tests provide information on the swallowing muscles, how food and liquid are swallowed, and if aspiration occurs. They may include:
Clinical Swallow Evaluation (CSE)
During this non-invasive swallowing evaluation, a speech-language pathologist looks at the movements of the mouth and face and assesses breathing and saliva management. The child is given various food and liquids so that chewing and swallowing can be observed.
Flexible Endoscopic Evaluation of Swallowing (FEES)
A small endoscope is gently placed along the floor of the nose to the back of the child's throat to visualize the throat from above while swallowing. Various foods and liquids are administered and often dyed with food coloring to allow for greater visualization.
Modified Barium Swallow Study (MBS) or Pharyngeal Function Study
The MBS is a video X-ray of the swallowing process. The study enables the speech-language pathologist to see what is happening inside your child's mouth and throat. It can show if food or liquid is going into the airway instead of the stomach, which is called aspiration. It can also help identify which parts of the mouth and throat are not working well.
The MBS is performed in the radiology department in conjunction with a radiology technician. During the exam, the child is placed in a typical feeding position and given a variety of food consistencies (thin liquid, thick liquid, puree, and/or solid) that are appropriate based on age and developmental level. Barium is added to the food or liquid so that it can be seen as it moves in your child's mouth and throat. Barium is not dangerous for babies or young children. However, you may see it in the baby's diaper for a few days after the study. As a parent or caregiver, you may be asked to feed your child during the study. You will be given a lead vest as protection from the X-rays. The X-ray machine is only turned on while your child is swallowing in order to limit the amount of overall radiation.
Test results are discussed with families at the end of the evaluation, and recommendations are made regarding safe and efficient eating and drinking. They may include: removing certain food items, changing the thickness of liquids consumed, altering the child's bottle, nipple, or utensils, and/or specific feeding techniques.
Instructions for Caregivers Before the Swallowing Test
We ask that infants and children do not eat approximately 3 hours prior to their evaluation so that they will be hungry and willing to eat for the evaluation. Please bring a variety of food choices that your child typically eats, including food and liquids. Please bring any certain types of food or drink that your child has difficulty with too. If the child is an infant, bring at least 4 ounces of formula or breast milk.
Feeding and Swallowing Therapy
Our highly trained speech-language pathologists work closely with each patient and family to develop a customized care approach to improve feeding and swallowing function. We provide therapy both inpatient and outpatient. We see in-house patients as frequently as possible during their stay and often provide parents with a self-led program, used in combination with therapy to speech and enhance results.
Feeding and swallowing therapies vary, depending on the child's age and specific health condition. Our speech-language pathologists may:
- Help determine the best positioning for feeding your infant or child
- Recommend feeding techniques to improve the quality of feeding by breast or bottle
- Work together with the medical team to establish feeding schedules that support the health of the baby
- Conduct oral and pharyngeal strengthening massage and exercises that focus on improving response, strength, timing, and coordination of the muscles of the mouth, tongue and throat
- Use thermal/taste stimulation - cold and/or flavored foods (such as lemon flavored swabs, ice chips or popsicles) are given to the patient in effort to create a swallow response. This is performed with traditional swallowing exercises.
Therapy takes time and commitment, but is essential in improving feeding and swallowing function and quality of life. Our speech-language pathologists are very involved with the continuum of care for your child and will participate in discharge recommendations for follow-up care, working closely with physicians, nurses, nutritionists, lactation consultants, social workers, and occupational and physical therapists, as appropriate.
Kids EAT Feeding Clinic
Through our special outpatient feeding program, called Kids EAT, we provide evaluation for infants and children with growth or swallowing feeding disorders. The multidisciplinary clinic includes a speech-language pathologist, developmental pediatrician or nurse practitioner and dietitian. Working together, they provide care for patients who have difficulties with diet, oral intake or need guidance weaning from tube feedings.
Treatment may include referral for outpatient therapy visits, monitoring or consultative visits. Families will also be given strategies to implement in their home environment.
Children that use the program usually have one or more of the following feeding problems:
- Limited or poor oral intake
- Slow or inadequate weight gain/failure to thrive
- Problems tolerating tube feedings
- Suspected or known aspiration or difficulty protecting airway
- Swallowing and chewing difficulties
Kids EAT Team
A speech-language pathologist evaluates the child's overall oral-motor skills, oral sensory component and swallowing safety. A modified barium swallow (MBS) study or pharyngeal function evaluation may be done to assess oral and pharyngeal stages of the swallow. This radiographic study examines all structures involved in swallowing and evaluates how food moves from the mouth to the esophagus.
A registered dietitian assesses the child's growth history, current nutritional status and adequacy of feedings.
Pediatric Nurse Practitioner
A PNP evaluates medical status as related to feeding and growth. Also in the context of developmental and medical needs, management is provided.
Kids EAT Locations
The Kids EAT clinic is open Tuesday - Friday at Brenner Children's on the main campus of Wake Forest Baptist Medical Center (Medical Center Boulevard).
Please contact 336-713-7429 for more information.