East Tennessee Children's Hospital

Feeding and swallowing disorders in infants and children By LeAnne Legg, MA, CCC-SLP, speech-language pathologist
Children’s Hospital Rehabilitation Center
Mealtimes often provide families an opportunity to share in the simple pleasures of eating while developing a sense of harmony. However, when children have difficulties with feeding or swallowing (“pediatric dysphagia”), mealtimes can become a source of conflict, frustration and stress.

Here we’ll review some of the developmental milestones for feeding and highlight some of the symptoms and causes of feeding and swallowing problems among infants and children.

Children tend to follow a typical pattern when it comes to learning how to feed and swallow. Here is a brief summary of what your child should be doing at various stages of feeding development:

1-3 months
The lips form a tight seal around the nipple. Sucking and swallowing are rhythmical and coordinated.

6 months
Accepts and swallows pureed foods presented by spoon. Enjoys mouthing toys and teething biscuits.

9 months
Uses the upper lip to remove food from the spoon. Mashed table foods are introduced.

12 months
Bites and munches a soft cookie. Tolerates soft finger foods and mashed table foods.

18 months
Drinks from a cup with assistance and experiences some liquid loss from the cup. Experiments with a variety of tastes and textures.

24 months
Chews most table foods easily. Tolerates all food textures, but also shows food preference. Drinks well from a cup or straw.

Parents or caregivers are usually the first to notice a child is having difficulty feeding or swallowing. Because children with dysphagia are at a higher risk for malnutrition, dehydration and respiratory problems, parents need to recognize the early symptoms, which include:

difficulty with breast feeding;
poor weight gain;
refusal of food or liquid;
coughing, choking or gagging during feeding;
difficulty drinking from a bottle or cup;
excessive drooling and food spilling from the mouth;
spitting up or vomiting frequently;
increased crying or fussiness during meals;
frequent respiratory infections, and
refusal to accept new textures.

The causes of feeding and swallowing problems include:

prematurity;
gastroesophageal reflux;
respiratory difficulties;
cerebral palsy;
head and neck abnormalities;
extensive medical history;
medications that cause fatigue or decreased appetite, and
problems with parent-child interactions at mealtime.

If you suspect your child is having difficulty with feeding or swallowing, contact your pediatrician as soon as possible. Your physician will examine your child to see if medical issues are causing the feeding difficulties. You may be referred to a speech-language pathologist who specializes in treating children with feeding and swallowing disorders. The speech-language pathologist will conduct a thorough assessment of your child’s feeding abilities and determine whether your child is functioning within normal limits for his or her developmental age.

For more information on pediatric dysphagia or other topics related to speech, language or feeding, contact the American Speech-Language Hearing Association at www.asha.org.

For more information on the services offered at the Children's Hospital Rehabilitation Center, call (865) 690-8961 or e-mail us. The address for the Rehab Center is 1025 Children's Way, Knoxville, TN 37922. We are located on the Children’s West campus at Pellissippi Parkway and Westland Drive, next to the Children’s West Surgery Center.

We invite your comments and questions. Please complete our comment form or visit our Phone Numbers page for departmental telephone listings.

Revised 9-20-07