Swallowing and Feeding Disorders

Expert Care for Childhood Dysphagia

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Infants and children with feeding and swallowing disorders have difficulty eating or drinking normally or safely. These problems may affect a child’s health, growth, development, and even relationships with caregivers that develop during mealtimes. Duke's feeding and swallowing disorders experts include speech pathologists, dietitians, pediatric gastroenterologists, pediatric pulmonologists, and pediatric ear, nose, and throat doctors. Together, we provide the care and support to help your child thrive.

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Understanding Feeding and Swallowing Disorders

Common Symptoms
Children with feeding and swallowing disorders may experience:

  • Coughing, choking, or gagging when eating or drinking
  • Difficulty chewing food
  • Difficulty eating certain textures
  • Difficulty with breastfeeding or bottle-feeding
  • Need for supplemental nutrition (tube feedings)
  • Pain or irritability with eating
  • Refusing food
  • Slow or inadequate weight gain
  • Stressful reaction to mealtimes

Risks for Swallowing and Feeding Disorders
Feeding difficulties are often associated with medical conditions that affect how the brain, mouth, throat, lungs, heart, stomach, and intestines work. These conditions include:

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Duke Health offers locations throughout the Triangle. Find one near you.


Our pediatric feeding specialists use various tests to diagnose feeding and swallowing disorders. We observe how your child eats and drinks, and we check the strength and movement of the muscles used for swallowing. Different swallow evaluations help to visualize your child's swallowing. Your doctor uses data from these studies and your child’s medical history to develop a treatment plan.

Videofluoroscopy Swallow Study (VFSS)

X-rays are taken as your child eats or drinks food or liquid that contains barium so we can assess swallowing function.

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

A thin, lighted tube equipped with a camera is inserted through the nose to look in the throat while your child eats.


Your child may also be referred for a clinic visit with our ear, nose, and throat surgeons who perform laryngoscopy. The doctor inserts a thin, lighted tube equipped with a camera through the nose and into the throat. This lets us see what happens inside your child's throat when he or she swallows. 

Upper Endoscopy

If a problem with the upper gastrointestinal tract is believed to contribute to swallowing difficulty, your child may need an upper endoscopy. A small tube with a camera at its tip is inserted through the mouth. This allows your gastroenterologist to view the esophagus, stomach, and duodenum, which make up the upper gastrointestinal tract, and to look for any possible contributing problems.

Clinical Swallow Evaluation

A speech-language pathologist takes a detailed feeding history and observes the parent and child with a small meal or snack. They develop a care plan that incorporates the family’s long-term goals, lifestyle, and their child’s strengths and needs.

Transnasal Endoscopy (TNE)

This relatively new procedure allows your child’s gastroenterologist to evaluate the esophagus, stomach, and duodenum, perform biopsies, and obtain good-quality images, without sedation. Rather than pass an endoscope through the mouth to reach the upper gastrointestinal tract, a camera, about the size of a thick noodle, is passed through the nose, then down to the GI tract. Children can eat until four hours before the procedure and return to activities the same day.

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Your child’s treatments may include a variety of approaches and therapies to correct and improve feeding and swallowing.

Feeding and Swallowing Therapy

A therapy plan will be created for your child based on their specific needs. The therapist will help your child improve sucking, drinking, chewing, or swallowing. Your child may also practice with different food and liquid consistencies, utensils, positions, or strategies to promote safe swallowing. 

Feeding therapy may involve eating different foods with varying textures, as well as different feeding and drinking implements and seating positions. Children have developing brains that are learning to eat and swallow. If therapy is recommended, it should begin as soon as possible to take advantage of this period of brain development.


Medication may be prescribed if your child’s condition is related to inflammation. Medication can also 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 perform the most advanced procedures with the best results.

Feeding Tube

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 tube allows your child to receive the proper nutrition without needing to swallow. There are several different types of feeding tubes. Some feeding tubes do not require surgery. Other types are inserted during surgery and require anesthesia. A feeding tube can be used in the hospital or 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.

Follow-Up Care

Your care team will schedule regular follow-up visits to assess progress and make adjustments. Our specialists will monitor your child to ensure they are progressing with feeding and swallowing skills. We frequently collaborate with community-based feeding therapists, teachers, pediatricians, and other professionals involved in your child’s feeding and nutrition.

Best Children's Hospital in NC

Duke Children's Hospital & Health Center is proud to be nationally ranked in 10 pediatric specialties.

Why Choose Duke

A Team of Specialists
Duke’s pediatric gastroenterologists; speech-language pathologists; nutritionists, pulmonologists; and ear, nose, and throat surgeons are experienced in caring for all types of feeding and swallowing disorders. Together, we work to create a treatment plan specific to your child’s diagnosis, including follow-up care as your child grows.

Coordinated Care
If your child has an underlying medical condition causing the problem, we consult with your child’s other providers -- such as cardiologists, neonatologists, oncologists, pulmonologists, allergists, geneticists, pediatric surgeons, plastic surgeons, psychologists, occupational and physical therapists, and social workers. We review the needs of children who require coordinated care and procedures during our regular team meetings. Whenever possible, we work with therapists close to your hometown so your child can continue care without long trips or hospital stays.

Child Life Team
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.

Care Coordination and Support
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 with resources, and manage details related to your child’s care.

This page was medically reviewed on 02/08/2022 by