WHAT IS DYSPHAGIA? (In layman’s terms, please.)

Dysphagia is defined as "difficulty swallowing". It's a very simple definition for a highly complex process that involves many muscles and nerves. There are 3 phases of swallowing: oral, pharyngeal & esophageal. 

The oral stage includes sucking, biting, chewing and moving food around in the mouth with the tongue to prepare to swallow.

The pharyngeal stage includes "triggering the swallow", closing off the airway to avoid choking and passing food into the esophagus (the tube leading to the stomach).

During the esophageal stage, food is carried to the stomach by the esophagus.

Dysphagia can occur at any point in this complex process of swallowing. It affects a child’s ability to eat and drink comfortably and safely. The length of meals and the child’s caloric intake and nutrition may be impacted.

IS MY CHILD JUST A PICKY EATER?

Family or friends may say your child will "grow out of it" or he is being "picky". Others may tell you to "force your child to eat" or your child "will eat when he gets hungry enough". Sadly, parents of children with dysphagia know that these techniques do not work. In fact, they can negatively impact the child’s behavior toward eating and drinking.

Not treating dysphagia as early as possible is potentially costly to your child's health. Children with dysphagia are at high risk for choking, aspiration pneumonia, upper respiratory infections, failure to thrive, dehydration, malnutrition and delays in learning. 

Dysphagia may evidence itself as early as birth when an infant is unable to successfully breast or bottle feed. However, a child may not show signs of dysphagia until they are transitioning to solid foods and cup drinking.

Trust your judgment as your child's parent. You know your child the best and if you feel that something "just isn't right" with his or her feeding skills, schedule an assessment to rule out dysphagia.

 SIGNS OF DYSPHAGIA

• Fussiness, crying or tantrums at mealtime.
• Inability to breast or bottle-feed.  
• Food refusal.
• Solids or liquids remain in the child’s mouth after meals.
• Significant loss of food or liquid from the mouth.
• Meals last longer than 30 minutes.
• Failure to accept age-appropriate food textures.
• Inability to take age-appropriate quantities of solids or liquids.
• Pieces of food are spit out during meals.
• Failure to accept a variety of food textures or consistencies.
• Gagging, coughing or choking while eating or drinking.
• Wet vocal quality or noisy breathing after eating or drinking.
• Vomiting during or after meals.
• Fatigue or falling asleep during meals or feedings.
• Inability to drink from a cup.
• Inadequate weight gain or poor nutritional status.
• Stress signals at meals such as reddened face, nasal flaring, crying or watery eyes.
• Mealtime is "work" rather than a social time for the parent and child.

Children with disorders such as Down syndrome, Apraxia of Speech, Autism, GERD (reflux), etc. may have dysphagia. However, so may otherwise "typically" developing children.

The assessment and treatment of dysphagia must be completed by a licensed, certified Speech-Language Pathologist with special training in feeding disorders.

ASSESSMENT & TREATMENT

During the evaluation, the Speech-Language Pathologist will complete a non-invasive examination of your child's oral muscles. Then your child will eat and drink foods and beverages of varying textures that you are asked to bring from home (i.e., puree, soft, crunchy).

The Speech-Language Pathologist will assess the function of your child's oral muscles while eating and drinking in addition to your child's response to food and liquid.

If therapy is recommended, a plan of treatment will be created based upon the findings of the assessment.

Your child's therapy program may include exercise, sensory activities, diet modification, diet upgrades and parent training. Parental involvement is essential to the success of the program. Other professionals may be involved in the case such as a nutritionist, allergist and medical doctor. We collaborate with other specialists when needed.

The length of your child's therapy program is dependent upon the severity of the dysphagia, family involvement, his or her individual rate of progress and any co-existing medical conditions. Our Speech-Language Pathologists will assist you and your child through all phases of the remediation process.

THE PICKY EATER 

A picky eater is a child who eats and drinks a significantly limited number of foods and beverages. He may exhibit maladaptive behaviors related to food.

The child's relationship with food impacts his nutrition, his interaction with his family, the lifestyle of his family and potentially his social relationships.

Children of all ages can be picky eaters. Disorders such as Autism and Pervasive Developmental Disorder may impact the child’s feeding issues. However, many picky eaters have no other medical diagnosis.

Families of picky eaters often feel that they are on a roller coaster of emotions and that meals are a struggle. What should be a bonding time for a family may become a control issue. Many picky eaters refuse to sit at the table with their with their family for meals, cry, gag or throw up at meals.

Many families cannot easily eat out at restaurants, visit family or travel because of their child’s eating habits.

SOME OF OUR CLIENT'S REPORTS

• My child eats 4 foods: cheese, cheese pizza, cheese sandwiches & macaroni and cheese.
• My son doesn't eat all day at school.
• We're going on vacation and I'm worried because my daughter won't eat in restaurants. 
• My child screams if we try to bring him to the table for dinner.
• My daughter will only eat alone in the kitchen.
• My son gags and vomits when he doesn't want to eat what I made for him.  
• If these reports sound like yours there is good news. The good news is that help is available!

OUR PROGRAM FOR PICKY EATERS

Our program begins with an assessment completed by a Speech-Language Pathologist who specializes in feeding disorders.

On the day of your child’s assessment, the therapist will take a detailed case history, complete the assessment and counsel you.

Your child will be assessed to rule out Dysphagia (swallowing disorder) as a cause of his or her negative response to food.

Children who can communicate will be interviewed to try to identify why they respond negatively to food. In our experience, children often serve as very good reporters during the interview process. Parents are frequently surprised with the content of their child’s responses.

Based upon the assessment findings, the Speech-Language Pathologist will develop a treatment plan for your child.

Your child’s therapy program will require weekly visits to the clinic. We will address the behavioral aspects of your child’s feeding and incorporate new foods into your child’s diet.

If your child is old enough, he or she will be actively involved in choosing new foods to try. He or she will learn to control their diet in a positive and productive manner. And emphasis on a well-rounded diet is maintained. The therapist and the child’s parents will make the food choices in cases where they are too young to choose.

The length of your child’s program is dependent upon his or her response to treatment and the implementation of a home program. It may take months to incorporate a single new food into your child’s diet. Patience is necessary but the successes are well celebrated.

We collaborate as needed with other professionals involved with your child’s program.

OUR BELIEFS 

We’ve heard it many times. “I’ve been to other programs out there and nothing works”.

We understand and are sympathetic to this. Not every program is effective for every child and not every therapist works well with every child. Finally, not every approach works for all families. This type of therapy grows tedious for families who have been dealing with food aversion for potentially many years.

Food aversion programs in the community are run by a variety of professionals including Speech Language Pathologists, Occupational Therapists, Behavioralists and Psychiatrists. Some programs are intensive emersion programs while some are consultative, on a monthly basis. Each professional brings his or her background and theories to the program.

We believe in individual therapy conducted weekly. Weekly sessions are necessary for family education and support, consistency for the child and ongoing improvements.

We believe in a positive therapy environment. We maintain a calm environment during our sessions. We provide encouragement and positive reinforcement for the child.

We believe in the functional use of food during feeding therapy as we desensitize the child to selected foods.

We believe in actively involving the child. The child is involved, as much as possible, with food selection and discussions about their feelings toward food items. We help the child to react positively toward food as their fear and aversion are decreased.

We believe in using a home program to supplement our clinical sessions. Each family completes a home program and the child is actively involved in creating and executing their home program. Our goal is to positively impact the child’s relationship with food at home.

We believe in communication. Families and children are encouraged to have an open line of communication with us. We invite questions and discussion of familial concerns.