What is feeding therapy? Many people don’t seem to know what it is when I tell them what I do. It’s a lot more complex than setting a plate of food out in front of your toddler, or preparing a bottle for your baby. Feeding therapy for a family who has never had a child with a feeding difficulty or disorder can be a lot of new information; at first it may seem like a lot of confusing, unknown information, and sometimes overwhelming for many families I work with. However, your mind can be put at ease when you are working with a knowledgeable, experienced feeding specialist or feeding team. Your specialist or team of specialists should provide you with a lot of resources, education, and techniques to work on at home. Feeding therapy can also become a very rewarding and positive experience. So all that being said, let me introduce you to some “good to know” basics with this quick overview on feeding and swallowing disorders.
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If you are a parent or caregiver of a child with feeding difficulties, there are many professionals that work with feeding disorders. It’s important to know who they are and how each member is contributing to your child’s feeding development. Feeding therapy is of often thought of as a team-based approach. And don’t forget, YOU are a part of the team! You have a say, and your input is very important, because you as the parent/caregiver know your child best.
People that may work with your child for feeding include: speech-language pathologists, occupational therapists, nutritionists, developmental specialists, child psychologists, behavioral therapists, pediatricians, nurse practitioners, lactation specialists, and many others. Many of these specialists play different, yet crucial roles in helping your child become a successful, healthy, and happy eater. Of course, you likely won’t be working with all of these specialists. There are many reasons that your child may need feeding therapy; whether it’s to help with swallowing difficulty, sensory difficulties, or introducing food for the first time after your child has been using a feeding tube. These factors and others will help determine which specialist(s) will work with your child, and the team will look at the current needs of your child.
Here are some common terms you may hear during feeding therapy sessions with your speech therapist or occupational therapist in relation to your child’s feeding:
Picky eater: A child that is selective in food choices; the number of foods she accepts may be very few due to many foods that she dislikes, usually less than 30. Picky eaters will tolerate new foods, try new foods (but may not eat all of it), and will touch new foods.
Problem feeder: A child that has a more serious problem than just being “picky” or selective. They may have accepted less than 20 foods in the past, but now food selection is down to 5-10 items that she will eat. Problem feeders will not accept new foods, may cry and throw temper tantrums, refuse certain textures, and can be very rigid eaters (only certain brands, special colors, temperatures, etc). Extensive feeding therapy is likely needed for a problem feeder.
Preferred foods: Foods that your child likes to eat.
Tolerated foods: Foods that your child may not eat, but she will tolerate it being present (on her plate, in the room)
Dysphagia: Term used for a swallowing disorder. The difficulty in swallowing can occur at any part of the process; from accepting the entry of food and liquid into the mouth, chewing and moving food around in the mouth, to the entry of food into the stomach and intestines.
Feeding tube: A tube that is used to provide nutrients such as foods and liquids to a child. It is inserted into the stomach through the abdomen when there is a medical constraint that prevents your child from eating orally (by mouth) such as an unsafe swallow, or needs help with intake of proper nutrients. See “failure to thrive” below. Feeding tubes may also be used for medications in liquid form when the child cannot take anything by mouth.
Bolus: A small round mass or ball of chewed food that is formed during the oral preparation phase of swallowing. It is then moved to the back of the throat to be swallowed.
Aspiration: A serious problem that occurs during an impaired swallow. Food or liquid enters the incorrect “pipe” and penetrates or enters the airway and lungs, rather than the esophagus and stomach. To put it shortly, it is choking on food or liquid to due entering the airway/lungs.
Oral motor: Refers to the use and function of the tongue, lips, jaw, teeth, and hard and soft palates.
“Failure to thrive”: A term used by medical professionals to refer to a child, usually under the age of 2, who has had inadequate weight gain, ability to maintain weight, and physical growth in comparison to other children that are of the same age and gender on growth charts.
Pediatric Modified Barium Swallow Study: An X-ray video of how the child swallows foods and liquids. It shows the entire process of eating, from entering the mouth, to the foods and liquids traveling down to the stomach and intestines after it has been swallowed. These swallow studies are typically performed at a hospital or other medical center, and done by a licensed professional, such as a speech-language pathologist.
Here at Jenny’s Clinic, we offer a range of services for feeding support. We work on feeding and swallowing skills for straw-drinking and cup drinking, biting and chewing different solid textures, tongue movement, tongue lateralization, mealtimes with various textures and consistencies of foods and liquids, helping anxious eaters, working on oral motor skills related to feeding, and more. We have also teamed up with Feeding Matters, a non-profit organization that provides resources and support for families of individuals with feeding difficulties. Their link is below under the “Resources” section. You may also contact me, Maura Castellanos, MA CCC-SLP for any feeding questions or concerns you may have, directly at firstname.lastname@example.org or our clinic number, (520) 989 – 9799.
Always feel free to ask us, or your doctor to clarify if you are uncertain of a term or phrase that he or she says. When it comes to feeding your child, it is important to understand all parts of your therapist’s notes, recommendations, and comments so that you can help your child become a successful eater.
For determining whether your child is a picky eater or problem feeder, check this article from Early Intervention Support: http://www.earlyinterventionsupport.com/dealing-picky-eater/
To learn about the 4 different phases of a swallow, the American Speech-Language Hearing Association (ASHA) has a brief article you can read here: http://www.asha.org/Practice-Portal/Clinical-Topics/Pediatric-Dysphagia/
For more information on feeding difficulties, check out Feeding Matters, and their website information here: https://www.feedingmatters.org/understanding-pediatric-feeding-struggles