Feeding/Swallowing Disorders and Children

Some people are surprised to hear that speech-language pathologists help children and
adults with feeding and swallowing difficulties. The truth is that in speech, we work with
the same structures that are necessary for eating and swallowing (i.e., lips, tongue, and
jaw). From the moment your child is born, feeding is an important aspect of his/her life.
Not only does it provide the nourishment they need to grow, but it is also a source of
bonding between parent and child. So when a child has difficulty with one or more
aspects of feeding, such as extended feeding times (i.e., longer than ½ hour to finish a
bottle) or transitioning from pureed baby food to solids, a parent may become concerned.

When should your child start eating solid foods? When should they be able to use a
straw? What is “typical”? What types of feeding and swallowing disorders are there?
Who is predisposed to feeding and swallowing disorders? What can a speech pathologist
do to help? Let’s start with “typical” feeding skills, food, and presentation methods for a

The following is a general overview of when and what skills are acquired as a child develops:

Age in MonthsFood TypeOral Motor/Feeding SkillMethod of Presentation
formula/ breast
mature suck
beginning of cup
milk, purees,
teething biscuits
cleaning spoon with
lips, emergence of
8-12ground foods,
finger foods,
introduce chopped
active upper lip in
spoon feeding
cup introduced
12-15chopped finelicking food off lips,
emergence of true
bite, independence
with utensils
cup, spoon fork,
wean bottle/breast
straw drinking may
be intro.
15-24“table food”decrease in drooling,
no liquid loss during
cup drinking
Cup, spoon, fork
Figure 1: Material from Michelle DiMattia, MS CCC-SLP

What types of feeding and swallowing disorders exist?
Feeding and swallowing disorders may be due to difficulties with the motor or sensory
systems. Motor difficulties stem from problems with the structures of the oral
mechanism (i.e., mouth, lips, tongue, and jaw). Feeding difficulties may affect both
children and adults but are most obvious as a child strives to acquire new feeding skills or
as an adult experiences a medical insult to the brain or nervous system. Pediatric
examples include infants who have difficulty latching onto a nipple, children who have
difficulty chewing and breaking down solid foods into manageable pieces, or children
who have difficulty removing food from a spoon because of insufficient lip closure.

A sensory-based feeding disorder evolves due to environmental factors. Some children
may be predisposed to sensory-based feeding disorders. For example, children with a
history of Broncho Pulmonary Displasia (BPD), cardiac defects, drug exposure,
gastrointestinal diseases, prolonged periods of intubation or suction, or prolonged NG
tube feeds may be at risk. The population of children with sensory-based feeding
disorders, often includes but is not limited to, medically involved or “medically fragile”

How can I tell if my child has a feeding disorder?
Children have a way of letting us know when a situation is difficult or unpleasant for
them. Use the following questions to help informally assess whether your child may be
experiencing difficulties that warrant further evaluation:

  • Is your infant having difficulties transitioning to a new method of feeding
    (i.e., bottle to cup)?
  • Does your child’s diet consist primarily of the same textures (e.g., crunchy
    solids – cheerios, goldfish, crackers, cookies or only pureed food) or the
    same temperature?
  • Does your child prefer to drink water?
  • Does your child reject new flavors of foods?
  • Does your child often cough, choke, vomit, or spit out food when eating?
  • Do mealtimes typically last longer than 30 minutes?
  • Does your child dislike having their teeth brushed or face and mouth

These are questions to keep in mind as you observe your child during mealtimes. If you
have concerns, please contact a speech-language pathologist for a consultation or

What can I expect if my child receives feeding therapy? What can a speechlanguage pathologist do?

Every child is different. Depending on a child’s difficulties, abilities, and even
personalities, therapy will be tailored to address their needs. For children with motorbased feeding disorders, exercises may be utilized to strengthen structures of the mouth
or to retrain muscles. Strategies and techniques may also be introduced to assist your
child in feeding. If there are sensory concerns, the clinician may work with the child on
accepting sensations in or around the mouth. Progression in taste and texture may also be
addressed. Strategies for mealtimes at home may be discussed and implemented. Our
goal is to maximize your child’s eating skills, reduce stressors involved in feeding, and to
teach them that eating can be an enjoyable experience!