By Melissa Perlee, MS, OTR/L
Pediatric dysphagia is a condition where children have trouble swallowing. This disorder can manifest in various ways, from mild discomfort to severe inability to swallow, and lead to nutritional deficiencies, growth delays, and respiratory issues. The complexities surrounding pediatric dysphagia necessitate a multifaceted approach to diagnosis and treatment, with feeding therapy playing a critical role in managing the condition.
What Causes Pediatric Dysphagia?
Dysphagia in children can have a variety of causes, including neurological disorders, structural abnormalities, prematurity, and developmental delays. The swallowing process, which involves the coordination of multiple muscles and nerves, can be disrupted at any stage—oral, pharyngeal, or esophageal—leading to difficulties safely consuming food and liquids.
Symptoms of Pediatric Dysphagia
- Coughing or choking during meals
- Congestion, especially after meals
- Decreased responsiveness during a feed
- Red, watery eyes during/after feeds
- Prolonged feeding times
- Frequent respiratory infections, like pneumonia
- Weight loss or failure to thrive
Early identification and intervention are crucial to prevent complications associated with dysphagia, such as malnutrition, dehydration, and aspiration pneumonia (caused by food or liquid entering the lungs).
The Role of Feeding Therapy
Feeding therapy is a cornerstone in the treatment of pediatric dysphagia. Therapy is tailored to each child’s needs and typically involves several key components:
- Assessment and Diagnosis: A comprehensive feeding evaluation is necessary to obtain a thorough history and identify the underlying cause of the dysphagia. The feeding therapist completing this evaluation may also recommend a videofluoroscopic swallow study (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES) be completed at a separate facility.
- Development of a Treatment Plan: Based on the assessment, a personalized therapy plan is developed. The plan may focus on improving the child’s oral-motor skills and ability to safely swallow, and on educating parents and caregivers on appropriate exercises and routines to incorporate at home.
- Oral-Motor Exercises: Your feeding therapist may introduce exercises to strengthen the muscles involved in swallowing. These exercises help improve coordination and control, making it easier for the child to manage different food textures and consistencies.
- Sensory Processing: Some children with dysphagia have sensory processing issues that make feeding even more challenging. Your feeding therapist may work on helping your child become more comfortable with various textures, temperatures, and tastes.
- Feeding Techniques and Positioning: Proper positioning during meals can significantly reduce the risk of aspiration. Therapists teach parents and caregivers the best feeding techniques and positions to support safe swallowing. This might include adjusting the child’s posture, using specialized feeding utensils, or modifying the texture of foods.
- Mealtime Routine & Home Program: For children who are reluctant to eat or have developed aversive behaviors around feeding, feeding therapists may employ mealtime routine strategies and develop home programs to encourage positive feeding experiences. This may involve creating structured mealtimes, using positive reinforcement, and strategically introducing new foods.
- Family Education and Support: Feeding therapy extends beyond the therapy sessions. Parents and caregivers are provided with the knowledge and tools they need to continue their child’s progress at home. Ongoing support and education are vital components of successful therapy.
Expected Outcomes
Pediatric dysphagia is a complex condition that requires early recognition and a comprehensive, individualized approach to treatment. Feeding therapy can help children develop the skills necessary for safe and effective swallowing, which in turn can lead to improved health outcomes, including but not limited to: An increase in foods in the child’s diet, enhanced nutrition and growth, and decrease in respiratory illnesses, and peace of mind for parents and caregivers.
