Feeding impairments in children: diagnosis and effective intervention

The four main requirements for oral-motor development are stability and mobility of the ingestive system, rhythmicity, sensation, oral-motor efficiency and economy. Ingestion can be divided into oral, pharyngeal and esophageal stages. The main categories of pathology encountered in our swallowing and dysphagia clinic are encephalopathies (including cerebral palsy), genetic disorders (including chromosomal aberrations), syndromes associated with swallowing difficulty (e.g. Rett, Dandy-Walker, DiGeorge), head injuries, brain tumors, developmental delay and the oral deprivation syndrome (e.g. due to prolonged tube feeding on a preterm infant). The behavioral expression of the many different pathologies falls into three categories: (1) resistance to accepting food orally; (2) lack of energy and endurance to do the 'work' of eating; and (3) oral-motor disabilities resulting in an inability to produce the necessary motor skills for ingestion. Expect expression and exacerbation of feeding problems during periods of most active growth, i.e. from birth to 2 years and during the adolescent growth spurt. Identify the source of the feeding problem. Establish its pathology and note the clinical manifestations. Determine if the problem has a strictly physiologic origin or whether it may be exacerbated by the feeding interaction between child and feeder. Determine what diagnostic tests are needed and refer child for testing Formulate the treatment approach based on clinical observations and results of diagnostic tests. Teach and monitor treatment which can be given by caregivers. Set time limits for treatment and clearly state expected results. Evaluate progress by comparing outcome to stated treatment objectives. Refer children with more severe problems to a multidisciplinary treatment team.