Feeding and Swallowing Disorders

Swallowing is a complex process that involves over 30 muscles and multiple cranial nerves working in a precisely timed sequence. A swallowing disorder (dysphagia) occurs when any part of this sequence is disrupted, leading to difficulty moving food or liquid safely from the mouth to the stomach. Dysphagia can affect the oral phase (chewing and forming a food bolus), the pharyngeal phase (triggering the swallow and protecting the airway), or the esophageal phase (moving the bolus through the esophagus to the stomach).

Pediatric feeding disorders are distinct from adult dysphagia and involve a broad range of difficulties with eating. A child may have difficulty accepting age-appropriate food textures, may eat an extremely limited range of foods, may have sensory aversions to certain tastes or textures, or may lack the oral-motor skills to chew and swallow safely. Pediatric feeding disorders are often multifactorial, involving medical, nutritional, oral-motor, and behavioral components.

Both pediatric feeding disorders and adult dysphagia can have serious health consequences, including aspiration pneumonia (caused by food or liquid entering the lungs), malnutrition, dehydration, and significant reduction in quality of life. Early identification and intervention by a qualified speech-language pathologist are essential for managing these conditions safely and effectively.

The signs of feeding and swallowing difficulties vary significantly depending on the individual's age, the underlying cause, and which phase of swallowing is affected. Some symptoms are overt, such as coughing or choking during meals, while others are subtle and may go unrecognized, such as a wet or gurgly voice quality after eating or frequent respiratory infections.

If you or your child experiences any of the following symptoms, a feeding and swallowing evaluation can determine whether there is a disorder present and identify the most appropriate course of treatment.

Our approach to feeding and swallowing therapy is multidisciplinary and based on a thorough clinical evaluation. For suspected dysphagia, the evaluation may include a clinical swallowing assessment (observing the individual eat and drink various textures and consistencies) and, when indicated, referral for instrumental assessment such as a videofluoroscopic swallowing study (VFSS/modified barium swallow) or fiberoptic endoscopic evaluation of swallowing (FEES) to visualize the swallowing mechanism in real time.

For adults with dysphagia, treatment may include swallowing exercises to strengthen the muscles involved in swallowing (such as the Mendelsohn maneuver, effortful swallow, or Shaker exercise), compensatory strategies to improve swallowing safety (such as chin tuck, head turn, or modified food textures), and education on safe swallowing practices. We work closely with dietitians, physicians, and other rehabilitation professionals to ensure a comprehensive approach.

For children with feeding difficulties, we use a combination of oral-motor therapy, sensory desensitization, behavioral strategies, and parent education. The Sequential Oral Sensory (SOS) Approach to Feeding is a core framework in our pediatric practice. SOS uses systematic desensitization to help children become comfortable with new foods through a hierarchy of interaction steps: tolerating the food in the room, touching it, smelling it, tasting it, and finally eating it.

We also address the mealtime environment and family dynamics that can either support or hinder feeding progress. Mealtimes should be positive, low-pressure experiences. We help families establish structured mealtime routines, reduce mealtime stress, and implement strategies that encourage exploration and acceptance of new foods without force or coercion.

For both children and adults, we provide caregiver training as a critical component of treatment. Safe feeding strategies, appropriate food preparation techniques, and positioning recommendations are taught so that safe and effective mealtimes continue between therapy sessions.

The feeding and swallowing evaluation takes 60 to 90 minutes and involves a detailed history of the individual's feeding development, medical conditions, and current diet; observation of eating and drinking across multiple textures; and assessment of oral-motor structure and function. For adults, we may also assess cognitive and communication factors that affect safe eating.

Therapy sessions are typically 30 to 45 minutes for children and 45 to 60 minutes for adults. For pediatric feeding therapy, sessions involve structured food exploration activities, oral-motor exercises, and parent coaching. For adult dysphagia, sessions include swallowing exercises, strategy practice with real food and liquid, and education. Frequency is typically one to two times per week, with intensive schedules available for acute needs.

Progress is measured through clinical observation, reassessment of swallowing function, dietary advancement (for both children and adults), weight monitoring, and reduction in aspiration risk. Our goal is for every client to eat and drink as safely and enjoyably as possible, with the least restrictive diet that maintains their health and well-being.