Feeding and Swallowing Disorders

When you think of speech therapists, you probably think of speech! But while speech-language pathologists treat communication disorders, you may be surprised to know they treat feeding and swallowing disorders as well.

Feeding and swallowing disorders can occur at all ages. These disorders can affect a person’s nutritional intake, health and safety, and overall quality of life. Whether you or your loved one are experiencing feeding and swallowing problems, we’ve put together this expert guide to help.

Here, we answer your questions about feeding and swallowing disorders in children and adults. We explain the causes, signs, and symptoms of feeding and swallowing problems and discuss how these challenges can be treated and managed.

You can also take our easy online speech, language, and feeding quiz to determine if you or your child could benefit from a feeding or swallowing evaluation.

1For kids: What is a pediatric feeding disorder?

2Signs of a feeding disorder in children

3What is a sensory feeding disorder?

4Signs of a sensory feeding disorder

5How are pediatric feeding disorders treated?

6Can pediatric feeding and swallowing disorders be treated via teletherapy?

7Tips for helping a child with picky eating and sensory aversion

8For adults: What is dysphagia?

9What causes dysphagia?

10Signs and symptoms of dysphagia

11Why it’s important to seek treatment for swallowing problems

12How dysphagia is evaluated and treated

13How online therapy works for dysphagia

14How does Expressable treat feeding and swallowing disorders?

For kids: What is a pediatric feeding disorder? 

From learning how to suck, swallow, and breathe as infants, to chewing all foods at 3 years old, lots of exciting milestones happen during early childhood. This time is a period of rapid growth and brain development. So it’s important to notice any problems your child has with eating and drinking. 

Pediatric feeding disorders (PFDs) are complex conditions defined in this way: “impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction.” Pediatric feeding disorders often occur in children who are:

• Neurodivergent

• Autistic

• Bound by routine, or only comfortable with things that are known/routine, which can lead to a limited food diet

Pediatric feeding disorders also often occur in children who have:

• Developmental disabilities

• Oral-motor deficiencies (such as childhood apraxia of speech)

• Tone issues

• Cerebral palsy

• Sensory differences

• Challenges secondary to head injury

Signs of a feeding disorder in children

You may see the following signs or symptoms in children with feeding disorders:

• Eating less food than they should for their age

• Eating fewer varieties of foods than they should for their age

• Disruptive or inappropriate behaviors during mealtime 

• Difficulty feeding themselves by the appropriate age 

• Difficulty using utensils and devices, such as a cup or spoon, appropriately and by themselves during meals

• Slow physical growth and/or slow weight gain

For kids who are at risk for choking or aspiration (when food or liquid falls into the airway), there are symptoms of aspiration to watch for. This is also a sign that feeding therapy is necessary. These are the symptoms of aspiration: 

• Coughing while eating or drinking

• Reddening of the eyes while eating or drinking

• Teary eyes while eating or drinking

• Gurgly or wet-sounding voice during or after eating/drinking 

• Gagging 

• Choking while eating or drinking 

Children who have any of these symptoms, either during infancy or later in childhood, may have a feeding or swallowing disorder. They should be evaluated by a speech therapist.

What is a sensory feeding disorder? 

Some feeding problems are due to sensory issues. One type of pediatric feeding disorder is called a sensory feeding disorder, also known as sensory food aversion. It means a child has difficulty eating because of sensitivities to the smell, look, texture, taste, and/or sound of foods. 

For example, some children may respond negatively to the sensation of mixed textures, like a soup with vegetables in it. Others may not like crunchy textures like crackers. These sensory sensitivities lead to big challenges with feeding, and they often limit the foods a child will eat. This can affect the child’s nutritional intake and growth.

Sensory aversion isn’t just being a "picky eater." Picky eating is considered developmentally appropriate at a certain age. It becomes a problem when a child has a “fight or flight” response when they are exposed to new or non-preferred foods. Examples of this response include running away, hiding, panicking, or shutting down. This may be a sign of a sensory feeding issue, which can be treated by a speech-language pathologist who specializes in that area.

Signs of a sensory feeding disorder

There are some symptoms of sensory aversion to look for. Kids with sensory aversions to food may show the following behaviors:

• Seem grossed out by looking at a new food on their plate 

• Feel uneasy from the smell of new food

• Refuse to try or eat much of certain kinds of flavors, like savory, spicy, etc.

• Dislike certain textures, such as the texture of meat or anything juicy or stringy, like fruit or vegetables

• Frequent gagging

• Covering the mouth or nose and refusing food

• Spitting out food

• Negative reactions or anxiety around eating and mealtimes

Sensory aversions can look different in different kids. Some children may have many types of sensory aversions, and some may have just a few. Some children may show big reactions to foods they don’t like, while others may be more quiet when refusing food.

We want kids to be able to eat a wide variety of foods, as well as an adequate amount of food. It’s important to watch your child and note anything you see. Chances are, if your child has a sensory aversion, you’ll catch on to it.

How are pediatric feeding disorders treated?

Pediatric feeding therapy helps children who have some type of difficulty with the physical act of eating or swallowing. Feeding therapy can help make mealtimes easier and more enjoyable.

Childhood feeding therapy is provided by a speech-language pathologist, also known as a speech or feeding therapist, who specializes in this area. The speech therapist helps the child safely eat the least restrictive diet possible, which means as many foods and liquids as possible. Feeding therapy can make a big difference in your child’s experience with food. 

Therapy for feeding safety

If feeding safety is a concern, that will be a top priority of feeding therapy. Feeding safety has to do with airway protection. The esophagus and the airway are very close together. If food goes down the airway instead of the esophagus, this can lead to choking or aspiration.

Some children may have muscle weakness, oral-motor weakness, or incoordination. This can raise their risk for problems with feeding safety and complications. For children with these difficulties, therapy will focus on finding foods and liquids they can safely eat and drink. Some children are unable to eat safely by mouth at all. They may need alternative means of nutrition, such as a g-tube. 

Feeding therapy may include oral-motor exercises to increase a child’s strength and coordination. This also supports safe eating. As an example, some children may have poor jaw strength and need to increase their strength in order to chew adequately.

Therapy for food aversions

For children who don’t eat enough food or different types of foods, feeding therapy will focus on increasing the volume and variety of food. These children have sensory issues or behavioral responses that limit what they eat.

The speech therapist will help the child decrease sensory aversions or negative responses to foods. Some ways to do this include: 

• Playing with non-preferred foods

• Food chaining, which means trying new foods that are similar to foods the child likes

• Child-led interactions with food

For example, playing with food can help the child get used to interacting with the food before eating it. The speech therapist may walk the child through steps working up to taking a bite, such as smelling, touching, kissing, and then licking the item. The speech therapist will observe the child’s reactions in order to determine when they’re ready to try eating the food.

The speech therapist may also help the child eat a larger volume of food. To do this, a structured meal may be offered. The child is prompted to take bites while playing a game or eating a highly preferred food.

For more details and examples of what happens in sensory feeding therapy, check out this article.

Can pediatric feeding and swallowing disorders be treated via teletherapy?

The goal of feeding therapy is to improve a child’s ability to safely eat as many foods and liquids as possible. Some types of feeding therapy can be done through online therapy, but not all. This decision should be made by your child’s pediatrician and speech therapist. The speech therapist may need to be physically present to observe the child’s oral motor and swallowing abilities. 

Because of potential safety issues, children who can’t safely eat by mouth may not be a candidate for teletherapy. This would depend on their current condition, goals, and their parent or caregiver’s comfort with serving as a facilitator during therapy. This should be decided by the speech therapist and doctor.

It’s more likely that children who don’t have known airway safety concerns may be seen via teletherapy. This will take some planning and communication by the speech therapist and parent or caregiver. The speech therapist will ask for certain foods to be brought to the session. The speech therapist will then guide the child through different exercises to do with each food. 

No matter what goals are being targeted in therapy, and whether it’s online or in person, it’s extremely important for the parent or caregiver to be involved. This way, the caregiver will learn what can be done at home to support what the child is learning in therapy.

Tips for helping a child with picky eating and sensory aversion 

Here are some ways you can support your child with sensory aversion or picky eating behaviors and encourage them to try new foods:

• Create a food-positive environment. Use positive, calm, and supportive language to reduce the pressure to try new foods. For example, instead of saying, “Try it, you’ll like it,” try saying, “This is a food we’re learning about.”

• Serve new or non-preferred foods in small portions. This helps to avoid a potential fight-or-flight response.

• Encourage your child to learn about the food(s) in new ways. Talk about the food using descriptive, child-friendly language. What does it look like? What does it smell like? What does it feel like?

• Get your child involved. Have them help you create a grocery list, and take them shopping.

Reach out to a speech therapist if you're concerned about your child’s feeding or swallowing. However, an important note: If your child is losing weight or you are concerned about malnutrition, be sure to speak with your pediatrician.

For adults: What is dysphagia?

Dysphagia means difficulty with swallowing. There are 4 main types of swallowing problems in adults:

• Oral dysphagia – Involves the oral cavity, such as the lips, tongue, and soft palate

• Pharyngeal dysphagia – Involves the throat

• Esophageal dysphagia – Involves the esophagus

• Gastroesophageal junction dysphagia – Involves the connection point between the esophagus and the stomach

These dysphagia types can occur together, meaning a person can have oral and pharyngeal dysphagia at the same time (known as oropharyngeal dysphagia).

What causes dysphagia?

Dysphagia can be related to nerve and/or brain damage associated with stroke, traumatic brain injury (TBI), spinal cord injury, head and neck cancer, multiple sclerosis (MS), Lou Gehrig's disease (ALS), dementia, Parkinson's disease, and other neurological diseases.

Swallowing problems can also be associated with pulmonary diseases, acid reflux, muscle weakness, and side effects from certain medications.

Signs and symptoms of dysphagia 

Signs and symptoms of swallowing problems are different for each person. They can vary depending on the type of dysphagia. Some of the signs and symptoms of dysphagia include:

• Drooling and/or difficulty managing food and liquids 

• Extra time and effort needed to chew and swallow 

• Unexplained weight loss

• Pain when swallowing

• Feeling like food is stuck in the throat (known as globus sensation)

• Wet or gurgly voice during or after eating and drinking 

• Coughing/choking during or after eating and drinking 

• Difficulty coordinating breathing and swallowing 

• Recurrent pneumonia

Why it’s important to seek treatment for swallowing problems 

Dysphagia can impact many areas of a person’s life. In addition to medical complications, a person with dysphagia may have less interest in or enjoyment related to eating and drinking. They may feel embarrassed and avoid social gatherings. In some cases, they may need to change their diet in a way that greatly limits what they can eat.

Caregivers and family members of those with dysphagia can also feel a burden to ensure the safety of their loved one.

How dysphagia is evaluated and treated

If you or a loved one is having a hard time swallowing, speak with your doctor. They can refer you to a speech-language pathologist for an evaluation. Speech therapists are the most qualified providers of dysphagia services because of their unique training.

The speech therapist will perform tests to gain a better understanding of your situation and create a personalized treatment plan. The evaluation may include a review of your medical history, cranial nerve examination, and diagnostic tests with imaging. An instrumental swallow study, such as a Modified Barium Swallow Study (MBSS) or Fiberoptic Endoscopic Evaluation of Swallowing (FEES), is often recommended to guide the therapist in creating an effective treatment plan. 

Treatment for swallowing difficulty is individualized. Treatment varies for each person based on the cause(s), symptom(s), and type of dysphagia. Speech therapists create a treatment plan that will improve a person’s swallow safety, support their nutrition and hydration, and improve their quality of life.  

Treatment for swallowing problems can include the following elements:

Exercises

Used to rehabilitate your swallowing skills by improving your physiological functions, such as strength, range of motion, and coordination. 

Compensatory strategies

Used to improve the safety and effectiveness of your swallow. These strategies might include pacing how you eat and drink, as well as changing your posture. Note that compensatory strategies do not improve your function over time like exercises do. 

Changes to diet

Used to increase swallowing safety. Your speech therapist might recommend changing the texture and/or thickness of your food and liquid. You might also change how it’s prepared, such as chopping or pureeing it. The taste and/or temperature of the food can be changed to increase your enjoyment of the food as well. 

Other techniques

Other tools and exercises to treat dysphagia include swallow maneuvers, oral care education*, adaptive equipment, environmental changes, sensory stimulation techniques, prosthetics, and feeding tubes. For people who need assistance with eating, an important goal will be to work toward regaining their ability to feed themselves in order to reduce the risk of aspiration.     

*A clean mouth greatly improves the safety of a swallow. Aspiration of bacteria in the mouth causes health risks.  

How online therapy works for dysphagia 

Some types of swallowing therapy can be done through teletherapy, but not all. Some people may need the therapist to be physically present for safety reasons. This decision should be made by a speech therapist who specializes in swallowing. The speech therapist will consider the person’s diagnosis, severity of swallowing problems, current condition, and goals.

Dysphagia treatment via teletherapy offers a unique approach to managing swallowing difficulties. However, it is different from in-person therapy in some ways. A caregiver or support person must be present during sessions for safety and support. They can help prepare specific foods and liquids to be used in the session and help ensure the client is positioned and equipped correctly. Teletherapy sessions involve educating the client and caregiver about signs of aspiration, compensatory swallowing strategies, and any necessary changes to the person’s diet. The caregiver also plays a key role in learning swallowing exercises alongside the client to help them practice at home between sessions.

Overall, teletherapy for dysphagia relies on teamwork. Clear communication among the therapist, client, and caregiver is needed for safe and productive sessions.

How does Expressable treat feeding and swallowing disorders?

Expressable matches families and adults with a licensed speech therapist trained to evaluate and treat feeding and swallowing disorders. All therapy is delivered online via face-to-face video conferencing. The client's age and development will influence how the speech therapist interacts with them through these video sessions.

Babies and toddlers up to age 3: Caregivers work directly with their child's speech therapist to learn cues and at-home strategies. This way, they can confidently practice with their child outside the sessions and help improve their child's feeding and swallowing skills.

Children ages 3 and up: Caregivers attend video sessions alongside their child so they both learn valuable skills from their speech therapist. Reinforcing these lessons outside the session will continue to promote at-home skill-building.

Adults: For safety reasons, we require a partner or caregiver to be present in the home during sessions. Their participation is encouraged during therapy sessions, so they can learn how to support the client during meals at home.

All Expressable clients have access to our client portal, which features educational Learning Paths covering the strategies taught in therapy sessions. You can access examples, tips, demo videos, quizzes, and more. Plus, through the portal, you'll receive weekly home practice activities tailored to your or your child's needs. The more often feeding and swallowing therapy techniques are practiced at home, between sessions, the faster you'll see progress!

Additional resources for swallowing problems

This article is meant to serve as an informative guide to swallowing problems, but it is not comprehensive. For more information, please visit these organizations: ASHA, The National Foundation of Swallowing Disorders, and the Mayo Clinic.