What is feeding therapy?
Are you curious about what feeding therapy is and if you child would benefit from it? Well you are in the right place! But first let’s discuss feeding development, what a feeding disorder is, red flags and then we can dive in to what it is.
Feeding Development
First, we recommend you checking out our blog post “Feeding Development” to learn more about the development of feeding skills. If you have any questions with what your child ‘should’ be doing at their age it will be able to help answer “what” is to be expected. Those milestones are a ‘general’ rule of thumb and should be interpreted with caution as all children develop differently!
What Is A Feeding Disorder?
Now let’s dive in! Let’s look at the difference between feeding and swallowing and the differences between a feeding disorder and a swallowing disorder.
Feeding is the process involving any part of eating or drinking (gathering and preparing food/liquid to consume, sucking/chewing and swallowing). A feeding disorder is characterized by problems with a range of eating activities (impaired oral intake that is not age appropriate and is associated with medical, nutritional, feeding skills and/or psychosocial dysfunction).
A Feeding Disorder is characterized by:
Refusal of age appropriate foods/liquids
Having a restricted variety or quantity of foods/liquids
Producing disruptive/inappropriate behaviors for developmental norms during mealtime
Difficulties mastering developmentally normal self-feeding skills
Difficulties using developmentally normal feeding devices/utensils
Experiencing less than optimal growth
Verse, swallowing which is the transportation of saliva/liquids/food from mouth to stomach while keeping the airway protected. A Swallowing Disorder/Dysphagia can occur in one or more of the four phases of swallowing and can result in aspiration (entry of food/liquid/saliva into the airway).
Long term consequences may include
Food aversion
Oral aversion
Aspiration/Pneumonia
Undernutrition
Dehydration
Gastrointestinal Complications
Poor weight gain
Rumination disorder
Ongoing need for enteral nutrition
Psychosocial effects
Feeding/Swallowing problems that persist into adulthood.
Causes
Causes of Feeding/Swallowing Disorders may include:
Complex medical conditions (allergies, GERD, heart disease)
Developmental disability
Neuromuscular coordination
Prematurity
Low birth weight
Hypo/hypertonia
Genetic syndromes (Down syndrome)
Medication side effects
Neurological disorders (cerebral palsy, encephalopathy, meningitis, and autism)
Sensory issues
Structural abnormalities (cleft lip/palate, tethered oral tissues - tongue ties, cheek ties, lip ties)
Behavioral factors
Social-emotional factors
Red Flags/Signs + Symptoms:
If your child demonstrates any of these signs and symptoms you may want to consider receiving a feeding evaluation to see if they would benefit from therapy!
Breathing difficulties
Noisy/wet vocal quality
Frequent nasal congestion/respiratory illnesses
Back arching
Crying during mealtimes
Decreased responsiveness during feeding
Difficulty chewing foods that are developmentally appropriate
Difficulty starting the swallow
Difficulty managing secretions
Loss of food/liquid
Taking only small amounts of food
Overpacking/stuffing mouth
Pocketing food in mouth
Tongue thrust passed developmentally appropriate age
Refusal
Refusing certain textures, temperatures, brands, colors, etc
Avoidance behaviors
Taking longer to finish meals
Difficulties breast feeding? bottle feeding?
When did they transition to solids? purees?
Delayed development of mature swallow?
Why Do We Treat?
Functional feeding and swallowing skills allows for our children to receive adequate nutrition/consumption of foods and liquids in order to maintain a diet to support child development. It also provides children and caregivers opportunities for social experiences and communication that create the foundation for future interactions. We treat both sensory and motor based feeding disorders.
What is Feeding Therapy?
Feeding therapy focuses on helping a child learn how to eat and/or expand the variety of developmentally appropriate foods in their repertoire. Therapists work with children and their families to provide them with the skills (both sensory and motor) that they need to make meal time more enjoyable and nutritious. RELATIONSHIP and TRUST always come FIRST.
So What Does Feeding Therapy Look Like? (It differs depending on your child’s age)
Infant Feeding Therapy:
Your therapist will work with your child and you and your family by providing the following techniques/strategies.
WARNING: This is not medical advice. Please work with a certified feeding therapist before trying any strategies and primary care doctor.
Stimulation - Your therapist may provide input to baby’s cheeks, lips, and tongue to help activate and engage or bring awareness to the muscles in order to facilitate movement for successful feeds.
Timing/Pacing - Your therapist may provide pacing strategies and cues to help baby time a proper suck/swallow/breathe pattern.
Changes in the Environment - Your therapist may use techniques to alert or calm baby including their vestibular (balance/head in space), proprioceptive (position/movement of body), tactile (touch), temperature, olfactory (smell), gustatory (taste), visual (sight), auditory (hearing) senses in order to improve feedings.
Utensil change (bottle, nipples, pacifiers, spoons, cups) - Your therapist may recommend a different flow nipple in order for baby to manage the flow better or change the shape nipple to promote proper oral functioning.
Compensatory Support - Your therapist may apply jaw, cheek and lip support in order for baby to access and achieve appropriate latching and success during feeds.
External Regulation - Your therapist may recommend changing the position of the bottle in order to reduce flow rate and decrease risk of aspiration/achieve successful feed.
Postural Changes - Your therapist may change the position in which baby is lying in order to reduce energy to breathe, require less antigravity movement which allows for regulation of breathing and improve the ability to manage flow of milk.
Toddler & Child Feeding Therapy:
Stimulation - Your therapist may provide input to your child’s cheeks, lips tongue to help activate and engage or bring awareness to the muscles in order to facilitate movement for successful feeds. They also may provide stimulation to the body to help regulate their system for mealtimes.
Timing/Pacing - Your therapist may provide pacing strategies and cues by limiting amount of food present at one time and providing verbal cues for self pacing.
Changes in the Environment - Your therapist may use techniques to alert or calm the child including their vestibular (balance/head in space), proprioceptive (position/movement of body), tactile (touch), temperature, olfactory (smell), gustatory (taste), visual (sight), auditory (hearing) senses in order to improve feedings. They may recommend feeding routines and meal time supports in the home in order to faciliate an environment for successful mealtimes.
Change in Food (texture, temperature, size of bite/sip) - Your therapist may change the texture, temperature, size of bite/sip (for sensory or motor based difficulties) in order to help facilitate successful mealtimes.
Utensil change (bottle, nipples, pacifiers, spoons, cups) - Your therapist may change the utensil provided that may help with the development of appropriate oral motor skills. These tools may also help with sensory input.
Compensatory Support - Your therapist may apply jaw, cheek and lip support in order for your child to access and achieve appropriate latching and success during mealtimes.
External Regulation - Your therapist may recommend changing the position of the utensils and cups in order to facilitate successful mealtimes.
Postural Changes - Your therapist may recommend changing your child’s posture. It is recommended to have a 90/90/90 posture where they are sitting with their hips, knees, and ankles all bent at 90 degrees.
Play Based Hierarchy - May be used to introduce New Foods (look, touch, smell, kiss, lick, bite, chew, swallow).
So There You Have It!
Please let us know if you have any questions. We have provided a list of resources for you below with the organizations we work closely with.
If you would like to set up a free consultation, an evaluation or mentoring you can connect with us here!
-
For more information about feeding, developmental milestones and introduction to solids and please check out the following:
-
Feeding Therpay: A Sensory Motor Appraoch Lori Overland M.S., CCC-SLP, C/NDT
Morris, S. E., Klein, M.D. (2000). Pre-Feeding Skills:A Comprehensive Resource for Mealtime Development. Pro-Ed.
Overland, L., Merkel-Walsh, R. (2013). A Sensory Motor Approach to Feeding . Talk Tool
