Pediatric Feeding and Swallowing Program

The Pediatric Feeding and Swallowing Program at The University of Alabama Speech and Hearing Center offers diagnostic and intervention services aimed at helping families manage feeding and swallowing disorders.

What is Feeding and Swallowing?

The American Speech-Language-Hearing Association provides the following information related to Pediatric Feeding and Swallowing. Pediatric Feeding and Swallowing (asha.org)

Feeding is the process involving any aspect of eating or drinking, including gathering and preparing food and liquid for intake, sucking or chewing, and swallowing (Arvedson & Brodsky, 2002). Feeding provides children and caregivers with opportunities for communication and social experiences that form the basis for future interactions (Lefton-Greif, 2008).

Swallowing is a complex process during which saliva, liquids, and foods are transported from the mouth into the stomach while keeping the airway protected. Swallowing is commonly divided into the following four phases (Arvedson & Brodsky, 2002; Logemann, 1998):

  • Oral preparatory—This is a volitional phase during which food or liquid is manipulated in the mouth to form a cohesive bolus, and that includes sucking liquids, manipulating soft boluses, and chewing solid food.
  • Oral transit—This is a voluntary phase that begins with the posterior propulsion of the bolus by the tongue and ends with the initiation of the pharyngeal swallow.
  • Pharyngeal—This phase begins with a voluntary pharyngeal swallow that, in turn, propels the bolus through the pharynx via an involuntary contraction of the pharyngeal constrictor muscles.
  • Esophageal—This is an involuntary phase during which the bolus is carried to the stomach through the process of esophageal peristalsis.

Feeding and Swallowing Milestones: Age Ranges

Each child develops uniquely and may meet certain milestones earlier or later than others. These milestones are designed to help you know what to expect as your child grows and develops and to know when to seek the guidance of a speech-language pathologist. (ASHA)

Feeding and Swallowing Milestones: Birth to 1 Year (asha.org)

Feeding and Swallowing Milestones: 12 to 18 Months (asha.org)

Feeding and Swallowing Milestones: 18 to 24 Months (asha.org)

Feeding and Swallowing Milestones: 2 to 3 Years (asha.org)

Common Feeding and Swallowing Difficulties

 The American Speech-Language-Hearing Association provides the following information related to Pediatric Feeding and Swallowing Disorders. Pediatric Feeding and Swallowing (asha.org)

Feeding Disorders

Feeding disorders are problems with a range of eating activities that may or may not include problems with swallowing. Pediatric feeding disorder (PFD) is “impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction” (Goday et al., 2019). PFD may be associated with oral sensory function (Goday et al., 2019) and can be characterized by one or more of the following behaviors (Arvedson, 2008):

  • refusing age-appropriate or developmentally appropriate foods or liquids
  • accepting a restricted variety or quantity of foods or liquids
  • displaying disruptive or inappropriate mealtime behaviors for developmental levels
  • failing to master self-feeding skills expected for developmental levels
  • failing to use developmentally appropriate feeding devices and utensils
  • experiencing less than optimal growth

Speech-language pathologists (SLPs) are the preferred providers of dysphagia services and are integral members of an interprofessional team to diagnose and manage feeding and swallowing disorders.

Avoidant/Restrictive Food Intake Disorder (ARFID)

According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2016), ARFID is an eating or a feeding disturbance (e.g., apparent lack of interest in eating or in food, avoidance based on the sensory characteristics of food, concern about aversive consequences of eating), as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:

  • significant weight loss (or failure to achieve expected weight gain or faltering growth in children)
  • significant nutritional deficiency
  • dependence on enteral feeding or oral nutritional supplements
  • marked interference with psychosocial functioning

SLPs may screen or make referrals for ARFID but do not diagnose this disorder. ARFID is distinct from PFD in that ARFID does not include children whose primary challenge is a skill deficit (e.g., dysphagia) and requires that the severity of the eating difficulty exceeds the severity usually associated with a certain condition (e.g., Down syndrome). Additionally, the definition of ARFID considers nutritional deficiency, whereas PFD does not (Goday et al., 2019). ARFID and PFD may exist separately or concurrently.

Swallowing Disorders

Dysphagia can occur in one or more of the four phases of swallowing and can result in aspiration—the passage of food, liquid, or saliva into the trachea—and retrograde flow of food into the nasal cavity.

The long-term consequences of feeding and swallowing disorders can include

  • food aversion;
  • oral aversion;
  • aspiration pneumonia and/or compromised pulmonary status;
  • undernutrition or malnutrition;
  • dehydration;
  • gastrointestinal complications, such as motility disorders, constipation, and diarrhea;
  • poor weight gain and/or undernutrition;
  • rumination disorder (unintentional and reflexive regurgitation of undigested food that may involve re-chewing and re-swallowing of the food);
  • an ongoing need for enteral (gastrointestinal) or parenteral (intravenous) nutrition;
  • psychosocial effects on the child and their family; and
  • feeding and swallowing problems that persist into adulthood, including the risk for choking, malnutrition, or undernutrition.

If you are concerned about your child’s ability to eat and drink, you may benefit from completing the Feeding Matters Infant and Child Feeding Questionnaire.  Feeding Matters – Infant and Child Feeding Questionnaire© This screening tool is a questionnaire which involves 19 different questions and can be completed in 30 minutes or less. Completion of this questionnaire will provide you with information to discuss with your pediatrician so that an appropriate referral can be made.

Our Pediatric Feeding and Swallowing Assessment and Treatment Service Delivery Model

  • The Speech and Hearing Center serves as a clinical learning facility for students training to become Speech-Language Pathologists. Feeding Assessment and Therapy services are provided to those in need by nationally certified and state licensed SLP’s working with student clinicians.
  • Assessments are comprehensive in nature and designed to identify areas of concern related to medical, nutritional, feeding skill, and/or psychosocial dysfunction.
  • When treatment is initiated, goals are set collaboratively with the family based on evaluation findings and family concerns.
  • Treatment appointments are scheduled on a semester-by-semester basis with the care plan being reviewed and reassessed at the close of each semester.
  • Treatment appointments include working with the child directly and empowering caregivers to implement learned strategies in the child’s natural environment at home.
  • Treatment appointments are offered weekly, bi-weekly, or monthly and typically are scheduled in 30–45-minute increments.
  • The Speech and Hearing Center operates on the University of Alabama’s academic calendar, providing two 12-week clinic sessions (fall, spring) and one 8-week clinic session (summer) per year.
  • Teletherapy appointments are available for those in need and to aid in transitioning learned skills to the home setting.
  • Our goal is to help children and their families develop the skills necessary to consume a safe and efficient diet while encouraging positive eating and mealtime success.

General Feeding and Swallowing Tips

Here are some tips to help families support their child’s feeding and swallowing development:

Feeding and Swallowing Milestones: Age Ranges (asha.org)

  • Have your child try a new food many times—this gives them the chance to decide if they like it.
  • Serve a variety of foods to your child. Don’t get discouraged if they don’t like it the first few times.
  • Cook with your child. Share new smells and tastes. Cooking together can make tasting new foods exciting when your child knows that they helped to prepare it!
  • Children learn through play, so expose them to new foods by making meals exciting or playful. For example, have a picnic lunch outside, or finger paint with applesauce.
  • Build on what your child already likes to eat by taking food one step further. For example, if they like chicken nuggets, try a chicken patty.
  • Ask your child to try new foods, but don’t bribe or push your child too much. Pushing can cause your child to have negative associations with the act of eating—or with food in general.
  • Help your child learn their hunger and fullness cues. This creates healthy eating habits and a long-term positive relationship with food.
  • You know your child best, so don’t wait to get help if your child is having trouble breastfeeding, bottle-feeding, or eating solid foods. Getting help early can prevent problems with eating and can foster a healthy relationship with food for you and your child.

Parent and Caregiver Resources 

Please call the University of Alabama Speech & Hearing Center at 205-348-7131 if you have any questions. Thank you!