How Speech Therapy Can Solve ‘Swallowing’ Issues (Dysphagia)

December 11, 2020 The Ed Psych Practice No Comments Referrals ARFID, Developmental Delays, Dysphagia, Obstructions, Oral Motor Skills, Speech Therapy, Swallowing and Feeding Skills, Swallowing Difficulties

Children who struggle to swallow begin to dislike food and feeding, which means they don’t get the nutrients and water they need. A speech therapist can help address these swallowing difficulties (dysphagia) and transform your child’s relationship with food.

Swallowing is so much more complicated than you’d think. It involves coordinating 50 muscle-pairs and 6 nerves from the brain!

Moving food along from mouth to past the throat is surprisingly complicated. First, we break down the food by chewing it, then saliva adds some digestive enzymes, and finally, we push the mixed product (called the ‘bolus’) down our oesophagus into our stomach. We can control the initial parts of the process, but once the food gets to the pharynx (near the top of the oesophagus), it’s shunted along by an involuntary ‘peristaltic’ squeezing motion.This involves a lot of coordinating,as we use 50 pairs of muscles and 6 cranial nerves to get it done.

Paediatric dysphagia is the term used to describe problems infants and children have with eating, drinking, and swallowing.

Dysphagia is surprisingly common in children, with about 1 in 4 struggling with some form of it. And it pops up in different ways, depending on your child’s age. For example, with infants and toddlers, you might notice them arching their back, coughing, choking, vomiting, or struggling to breathe while eating. With older children, you might notice different signs. Perhaps they eat slower than usual, complain about food being stuck at the back of their throat, or cry at mealtimes? You might even notice that their voice starts sounding different or they regularly get with lung-related illnesses (asthma, pneumonia, etc.) Often, they’ll start losing weight, or at least, don’t gain weight like they’re supposed to. And they might go off certain types of food because they don’t like its texture.

There are many causes for these swallowing difficulties.

For example, some children’s brains develop differently and dysphagia is one of the consequences. For others, it could be because of a genetic difference like Down’s Syndrome. Then, premature birth can cause it (just over a quarter of preterm babies have dysphagia). It could also be the result of an illness like heart/lung disease, or a brain disorder like cerebral palsy or meningitis. In fact, any brain damage (from a car accident, for example) can trigger swallowing difficulties. The problem could also be physical — like a cleft lip/palate or a differently-structured oesophagus. And there could be social factors, too — for example, problems in the way a mother interacts with her child while feeding her.

Recognising dysphagia early is the challenge, though. Because left undiagnosed, it can cause all sorts of problems.

Struggles with swallowing can trigger a surprisingly long chain of consequences. At one level, there’s the problem of not getting enough energy. Children are continually growing and developing, so they need a regular supply of calories, nutrients, and water. So, swallowing issues can cause them to get malnourished and dehydrated. Eating and drinking become traumatic experiences for them that they start avoiding food, which then affects mealtimes and family dynamics. Kids sometimes might, for example, choke on food that goes down the wrong pipe. This ‘breathing in’ of food and drink or saliva is obviously quite emotionally unsettling, but it can also damage the lungs and lead to lung infections like pneumonia. It also puts children at risk for breathing problems like sleep apnea.

Here’s where speech and language therapists (SLTs) can help. They can assess your child, diagnose her dysphagia, and come up with a treatment plan.

SLTs are trained to pick up on subtle cues that can be easily missed. For example, if your child struggles with dysphagia, she might begin to avoid certain types of food because they’re harder to swallow. Soon this list of ‘acceptable’ foods becomes very short. She’ll eat only similarly textured food (only crunchy things, for example) that have been prepared in a very particular way. This might seem like simple ‘fussiness’ to the casual observer, but SLTs will spot the deeper behaviour pattern — i.e., that these could all be signs of ARFID (Avoidant/Restrictive Food Intake Disorder). And they’ll know which assessment tests to use, how to evaluate the assessments, and how to devise a ‘swallowing and feeding’ plan tailored to your child’s and family’s needs.

Most treatment plans involve the following four elements.

An SLT will choose a plan based on how bad your child’s dysphagia is, but these are the variables she’ll work with.

1. Strengthening the mouth

Your child might not have the physical ability to swallow properly. So, an SLT will teach her exercises to strengthen all the parts that help in feeding — i.e., the jaw, lips, tongue, and cheeks. The exercises will also improve these parts’ mobility.

2. Changing swallowing patterns

An SLT will teach your child new swallowing patterns to prevent food from going down the wrong pipe and getting into the lungs. This might involve changing the feeding posture (sitting up/laying sideways, lifting/dropping the chin, rotating the head into a different angle, etc.) or teaching your child different swallowing techniques. There’s the ‘effortful swallow’ (consciously using the back of the tongue to push food into the throat), the Mendelsohn manoeuver (purposefully keeping the larynx raised while swallowing), the Masako (keeping the tongue between the teeth while swallowing), and so on.

3. Changing food and eating habits

The key is to make sure your child gets enough nutrients and water. So, an SLT will adapt her diet so that she can avoid problem foods but still get nourished. She’ll experiment to find the textures, temperatures, portion sizes, tastes your child prefers and experiment with various types of feeding equipment. So younger children might need different kinds of nipples, bottles, and cups. Older children might benefit from weighted/angled forks and spoons, sectioned plates, and non-tip bowls.

4. Making feeding fun

An SLT will also help change how your child approaches meals — because eating is as much a social and emotional event as it is a biological and physical one. So your child will need to re-learn how to eat with her friends at school and family at home. At home, for example, you might change your feeding strategy — like slowing down your feeding pace, alternating eating with drinking, swallowing twice per bite or sip, etc. For infants, you’ll learn to recognise cues that your child is struggling to coordinate breathing and swallowing. And you’ll change your feeding style accordingly. By focusing on your child’s experience of feeding, rather than just getting the food into her, you’ll be training her to see eating as a fun activity.

But skilled SLTs go beyond an initial diagnosis and treatment. They’ll also work with the broader network of people who can help your child.

Issues like dysphagia are solved when people collaborate. And SLTs can help with this collaboration. If your child’s swallowing difficulties are connected to other health concerns, your SLT can refer you to the relevant specialists — physicians, physical therapists, nutritionists, etc. And she can serve as an advisor to these specialists for feeding and swallowing issues. She can also help educate your family and other caregivers about why your child is struggling and how best they can help.

Are you concerned that your child might have dysphagia? Consider consulting a specialist for support.

The Ed Psych Practice offers consultation, advice, and problem solving for parents, nurseries, schools, and colleges, in London. We have psychologists and therapists who can help assess your child and offer guidance and support.

Phone: +44 (0) 78 3344 7356
E-mail: Office@TheEdPsych.com