Swallowing and Feeding Disorders

Swallowing and Feeding Disorders

Expert Care for Childhood Dysphagia

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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. Together we provide careful treatment and support to help your child get the nutrition they need and gain the ability to eat properly.

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Understanding Swallowing and Feeding Disorders

Swallowing and feeding disorders include different types of conditions that involve how a child sucks, chews, or swallows food and drink.

Feeding Disorders
Feeding disorders are 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
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 move liquid and food 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.

Risks for Swallowing and Feeding Disorders
Many children with swallowing and feeding 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:

  • Prematurity
  • Congenital heart defects
  • Cleft lip or palate
  • Developmental disorders, such as autism
  • Short bowel syndrome
  • Gastrointestinal reflux
  • Head and neck abnormalities or cancer, or their treatments
  • Breathing or airway problems
  • Weakness in face and neck muscles
  • Complex medical conditions
Our Locations
Duke Health offers locations throughout the Triangle. Find one near you.

Treatments

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.

Medication

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.

Surgery

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.

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 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.

Swallowing Therapy

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.

Feeding Therapy

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.

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 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.

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How We Diagnose Swallowing and Feeding Disorders

Our pediatric feeding specialists use various 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. Your doctor uses data from these studies and your child’s medical history to develop a treatment plan.

Swallow Studies
Our team will take X-rays as your child eats or drinks food or liquid that has barium added to it. These images detail the swallowing process.

Laryngoscopy
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 GI tract is believed to contribute to a swallowing difficulty, your child may also have 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 GI tract, and to look for any possible contributing problems.

Best Children's Hospital in NC
In addition to being among the best in the country, Duke Children's Hospital & Health Center is proud to be nationally ranked in nine pediatric specialties.

Why Choose Duke

A Team of Specialists
Duke’s pediatric gastroenterologists; speech pathologists; and ear, nose, and throat surgeons are experienced in caring for all types of swallowing and feeding 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, and social workers. We review the needs of children who require coordinated care and procedures during our regular pediatric aerodigestive team meetingsWhenever 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.