What is a feeding disorder?

A pediatric feeding disorder refers to a condition in which an infant or child fails to consume enough nutrients to promote growth. 

It is a condition that interrupts normal and/or safe eating. These problems can include difficulty eating certain foods, avoiding foods, food entering the airway instead of the stomach (aspiration), or an inability to eat by mouth.

Feeding disorders are a fairly common problem in infants and toddlers. However, it is most common in children with developmental disabilities.

What causes a feeding disorder?

Feeding difficulties are often associated with medical diagnoses that impact the way the brain, lungs, heart, muscles, or stomach and intestines work.

Common risk factors include:

• Prematurity
• Genetic syndromes (e.g. Down’s syndrome)
• Brain injury
• Cerebral palsy
• Reflux, constipation, or other digestive problems
• Allergies

When should I bring my child to see a feeding specialist?

The following symptoms may indicate the presence of a feeding disorder:

• Growth issues such as failure to consume enough nutrients to promote growth. (Often associated with reflux)
• Oral-motor concerns including abnormal suck-swallow-breathe synchrony, prolonged feeding time (over 30 minutes), and excessive fluid loss during feeding
• Swallowing concerns such as frequent episodes of gagging, coughing, or choking while eating; difficulty managing saliva; noisy or gurgling respirations after eating; or a diagnosis of aspiration
• Difficulty transitioning from breast to bottle, baby foods, and solids, as well as from tube feedings to oral feedings
• Active food refusal with any consistency and disruptive mealtime behaviors

Why is a feeding evaluation important?

Feeding and swallowing abilities can affect a child’s health, growth, and even relationships with caregivers that develop during mealtimes. Early or delayed introduction of solid foods and active food refusal may cause child and parental anxiety during meals.

Children have developing brains that are learning to eat and swallow. If there is a problem with that development, therapy should begin right away to take advantage of this period of brain development.

Behaviors associated with mealtimes can worsen as a child gets older.

Pediatric Feeding Evaluation

The goal of a pediatric feeding evaluation at Duke is to provide comprehensive evaluation and treatment planning for children who have problems with feeding and growth due to medical or behavioral difficulties. 

A member of the speech pathology team will work with each child and family to address the multiple factors involved with eating. Individualized family education and training are provided.

During your children’s feeding evaluation:

• A speech-language pathologist will review your child’s medical history, feeding routines, and your concerns.
• Your child will eat and his or her feeding and swallowing skills and mealtime behaviors will be observed.
• Feeding techniques will be tested during the session to help your child’s eating improve.
• You will receive recommendations to improve feeding skills in the home and/or with a local feeding therapy. Recommendations may include changes in your child’s diet, meal schedule, feeding routine, or utensils. The therapist will determine if your child’s difficulties need to be worked on in feeding therapy.
• The therapist may also recommend your child see other medical professionals such as specialty doctors, physical or occupational therapists, and/or a nutritionist.

Therapy Plan

The feeding program offers outpatient feeding services with a speech therapist. The goal of outpatient therapy is to meet children’s needs not only by addressing the oral-motor, sensory, swallowing, and dietary needs, but also by helping caregivers develop and implement an effective home-based feeding program.

The frequency of treatment and disciplines involved are based on the child’s specific needs.

Consultation Services

Many times, patients live a distance from Duke, but require the specialty care and expertise offered by the feeding program. 

In these instances, an initial evaluation is completed at Duke and the family or local therapist can return to Duke for consultative services on an "as needed" basis.

Children and families may not require consistent feeding services or they are unable to find feeding services near their home. These families can come to Duke as needed for additional recommendations, to progress their feeding plan, or for specialty needs. 

Appointments

To schedule an evaluation, contact Duke Speech Pathology and Audiology at 919-684-3859.

A prescription from your physician will be requested indicating the need for feeding evaluation or treatment. A prescription can be faxed to our office at 919-668-2741. When we receive the prescription, we will call you to schedule an appointment.

After an appointment has been made, a questionnaire and food diary will be mailed to the family to be completed prior to the evaluation appointment. Caregivers and other professionals are welcome to attend the evaluation.

Please bring the utensils, foods, and drinks the child currently uses on the day of the appointment.