What is a feeding disorder?
Current research indicates that feeding disorders affect approximately 25-40% of children, from newborns to adolescents. As the science of medicine improves so does the survival rate of premature and at-risk newborns. As a result, more aggressive methods are being incorporated to assist these infants which may affect the infants development. Prolonged exposure to noxious stimuli, such as CPAP, Bi-PAP, nasal cannula, and/or NG/OG feeding tubes can increase the risk for feeding or swallowing dysfunction. For those children diagnosed with developmental disabilities, approximately 80% will have a feeding problem. Feeding and swallowing symptoms are often associated with complex medical diagnoses. A feeding disorder can include problems such as food refusal, selectivity, inability to consume adequate calories, or an inability to consume an age appropriate diet.
Some of the medical diagnoses and underlying conditions, which can lead to feeding issues, include, but are not limited to:
Autism
Broncho-pulmonary dysplasia (BPD)
Cystic Fibrosis
Dysphagia
Failure To Thrive
Food Allergies
Gastroiesophageal Motility Disorders
Gastrointestinal Pain
Gastroesophageal reflux (emesis)
Genetic Syndromes
Human Immune Deficiency Virus
Reactive Airway Disease
Metabolic Disorders
Oral-Motor Dysfunction
Prematurity
Short Bowel Syndrome
Status Post Organ Transplant
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What causes a feeding disorder?
Feeding and swallowing problems are most often attributed to complex medical diagnoses which may include prematurity, reflux, complications secondary to tube feeding for extended periods of time, and disorders of the digestive system. Additionally, anatomical or structural abnormalities may include but may not be limited to congenital diaphragmatic hernia, or tracheo-esophageal fistula. Commonly, allergies, oral-motor dysfunction, and delayed introduction of solid foods contribute significantly to the incidence of feeding disorders in children. The presence of food refusal during mealtimes may increase child and parental anxiety resulting in frustration and maladaptive behaviors (such as gagging, vomiting, retching, crying, temper tantrums by the child and force feeding, coercion, negative/positive reinforcement by the parent.).
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What is a feeding therapist?
A feeding therapist may be a speech pathologist or occupational therapist who has extensive knowledge of the oral-swallowing mechanism and experience with how these structures and function relate to feeding and swallowing. A feeding therapist assesses and treat the child's oral motor skills; mealtime behaviors; reaction to food type and textures; self-feeding skills, and positioning. We have extensive experience evaluating and providing therapy for medically fragile infants and children as well as for infants and children experiencing developmental feeding delays. Our therapists also have a strong background in assessing and treating feeding-related sensory difficulties (i.e. difficulty tolerating various textures of food) in addition to the implementation of strategies targeted at decreasing oral aversive responses in these populations.
Speech Pathologists or Occupational Therapists who specialize or train in feeding therapy can also perform diagnostic x-ray studies of the swallow which may be called Modified Barium Swallow Studies, Cine-esophagram, Videofluoroscopic Swallowing Evaluation, or Swallow Study. We currently cannot perform these studies at our facility however, we will be glad to assist you in choosing the appropriate facility for your child as well as assisting your physician in the referral process. Please contact us at 732-698-1100.
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What signs or symptoms indicate the need for a feeding evaluation or treatment?
Traditionally, your child's physician would determine the need for a comprehensive feeding/swallowing evaluation however, many children are referred by other professionals/programs as well as independent consultation sought by parents and/or caregivers. There are many signs/symptoms that may indicated the presence of a feeding/swallowing disorder. The following is a brief list compiled with the most common symptoms. These may include but may not be limited to:
Issues related to growth and specifically, failure to thrive or failure to consume adequate nutrition to meet the required caloric intake to promote growth. Commonly, children who experience reflux often fall into this category.
Abnormal suck-swallow-breathe synchrony, prolonged feedings ( > than 30 minutes), increased oral loss during breast or bottle feeding which may indicate oral motor dysfunction.
Episodes of gagging, coughing, or choking during mealtimes may be indicative of swallowing dysfunction. Additional concerns may also include upper airway congestion, noisy or "wet" respirations, presence of food nasally during or following the swallow, a previous diagnosis of penetration and/or aspiration.
Difficulty transitioning from breastfeeding to bottle/cup feeding, baby food consistencies (i.e. stage I, II, III, table foods), and NG/G-tube to oral feeds.
Food refusal with any consistency.
Maladaptive or disruptive behaviors at mealtime (temper tantrums, crying, food refusal, food throwing, etc.)
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How will you address my child’s feeding difficulty?
At NJPFA, we take a supportive, comprehensive approach that not only incorporates the infant or child's medical and developmental needs, but also addresses behavioral and oral-motor feeding issues as well as family education and training. During the evaluation process, screening to determine additional assistance needed to support overall developmental progress will be conducted. Medically fragile infants and children often face issues related to sensory integration as well as development of gross and fine motor skills. If needs are identified, appropriate referrals for services will be made. Additional therapies such as speech and occupational therapy are available at NJPFA when necessary for the child's overal developmental progress.
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Click on the links below to learn more about feeding and swallowing issues!
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Who can help me get my child to eat?
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