Swallowing and Feeding Disorders
Expert Care for Childhood Dysphagia
Infants and children with swallowing and feeding disorders struggle to eat and drink and are at risk for malnutrition and/or dehydration. Duke Children’s swallowing and feeding disorders care team includes pediatric gastroenterologists, speech pathologists, dietitians, and ear, nose, and throat surgeons. We collaborate to provide careful treatment and support to help your child get needed nutrition and gain the ability to eat properly.
Understanding Swallowing and Feeding Disorders
Swallowing and feeding disorders are different but related groups of conditions that involve how a child sucks, chews, and swallows food and drink.
Feeding disorders happen when a child is not eating in a developmentally appropriate way. A child may be unable to close their lips to stop food from falling out of their mouth. Older infants and children may not be able to grab food and bring it to their mouths.
Swallowing disorders (dysphagia) can cause some feeding problems. Swallowing problems are tied to the stages of the swallowing process:
- Oral phase, when sucking and chewing moves food and liquid into the throat.
- Pharyngeal phase, when the tongue pushes food to the back of the mouth, where it is squeezed down the throat. The larynx (voice box) and airway close tightly to prevent choking.
- Esophageal phase, when food is squeezed through the esophagus and into the stomach by the relaxing and tightening of muscles.
Many children with feeding and swallowing conditions were sick at birth or in infancy, when they would normally learn swallowing and feeding skills. The risk for swallowing and feeding disorders is highest in children with:
- Congenital heart defects
- Cleft lip or palate
- Developmental disorders, such as autism
- Short bowel syndrome
- Gastrointestinal reflux
- Head and neck abnormalities, cancer and/or its treatments
- Breathing or airway problems
- Weakness in face and neck muscles
- Complex medical conditions
Duke’s pediatric gastroenterologists, speech pathologists, and ear, nose, and throat surgeons are experienced in caring for all types of swallowing and feeding disorders.
If your child has an underlying medical condition causing the problem, we consult with your child’s other doctors -- such as cardiologists, neonatologists, oncologists, pulmonologists, and social workers. We review the needs of children who need coordinated care and procedures during our regular pediatric aerodigestive team meeting. Together, we work to create a treatment plan specific to your child’s diagnosis, including follow-up care as your child grows. Whenever possible, we work with therapists close to your hometown so your child can continue care without long trips or hospital stays.
How We Diagnose Swallowing and Feeding Disorders
Our pediatric feeding specialists use different tests to diagnose swallowing and feeding disorders. We observe how your child eats, and we check the strength and movement of the muscles used for swallowing.
- Swallow studies can provide more information. Our team will take X-rays as your child eats or drinks a food or liquid with added barium. These images detail the swallowing process. Your child may also be referred for a clinic visit with our ear, nose, and throat surgeons who perform laryngoscopy that lets us see what happens inside the throat when your child swallows. The doctor inserts a thin, lighted tube equipped with a camera through the nose and into the throat.
- If a problem with the upper GI tract is believed to contribute to a swallowing difficulty, your child may also have upper endoscopy to assess the GI tract for any possible contributing problems.
- Your doctor uses data from these studies and your child’s medical history to develop a treatment plan.
SWALLOWING AND FEEDING DISORDERS
Your child’s treatments may include a variety of approaches and therapies to correct and improve feeding and swallowing. We do our best to arrange all of your child’s appointments for the same day, so you can meet with your doctor, a dietitian, and a speech pathologist all in one visit.
May be prescribed if your child’s condition is related to inflammation. These treatments can calm irritation caused by gastrointestinal reflux or more complex conditions like eosinophilic esophagitis.
Some swallowing problems can be improved by throat or airway surgery. Our doctors work closely with ear, nose, and throat surgeons to provide the most advanced procedures with the best results.
If your child is unable to take food and liquid by mouth or cannot consume enough nutrients on their own, we may insert a feeding tube. A feeding system is inserted during surgery and requires anesthesia. The tube goes through the abdomen and into the stomach, allowing your child to receive the proper nutrition while bypassing the need to swallow. A feeding tube can be used in the hospital and at home. Our doctors and nurses will teach you how to administer feedings and how to keep the tube clean. Many premature infants or babies born with heart conditions require this type of supplemental nutrition. Feeding tubes can be removed when the feeding or swallowing problem is resolved.
Your child may work with a speech pathologist to improve his or her ability to swallow. The therapist will help your child improve chewing, sucking, and tongue movements, and strengthen muscles in the mouth and throat used for swallowing. Your child may also practice with different food textures and thicknesses to promote safe swallowing and prevent choking.
A dietitian and speech pathologist can help your child get the calories and nutrition he or she needs while also learning how to accept foods that look and feel different. Feeding therapy can involve eating different foods at hot and cold temperatures and with varying textures, as well as different feeding/drinking implements and seating positions.
Your care team will schedule regular follow-up visits to assess progress and make adjustments. Our specialists will monitor your child to ensure he or she is growing properly and getting the right nutrition. We continuously troubleshoot until your child is on the path to getting better. This may involve long-term therapy, and we work to make sure your child can receive these services close to home.
SWALLOWING AND FEEDING DISORDERS
Family and Support Services
When you bring your child to Duke Children’s, you can rest easy knowing that we are focused on your child’s overall well-being, not just the condition that brought you to us. We connect your child and you to many supportive services designed to make the experience comfortable and positive.
Our child life specialists provide support, education, and guidance to help you and your child during treatment and hospitalization. Child life specialists explain procedures, offer encouragement, and use fun activities to take your child’s mind off treatment.
Our social workers can help you navigate the medical system and coordinate the variety of health services your child needs. We help you work with insurance providers, connect you with resources, and help you manage details related to your child’s care.