Feeding & Swallowing Disorders


Speech-language pathologists (SLP) have heard it over and over again: “Why is a Speech-Language Pathologist evaluating how my child eats and drinks?!”

This is a great question. Why would a person who works on speech impediments work on eating and swallowing? Well, the structures that we use to speak also happen to be the same muscles that we use for chewing and swallowing our foods/beverages. 

These skills from an early age can certainly dictate how a child eats, swallows, and speaks later in life. SLPs work with children, adults, and their families to overcome the challenges and stressors that surround feeding & swallowing disorders. Our ability to eat food and drink liquids is a complex task that we take for granted until a condition disrupts this process which consequently impacts all areas of life.



Feeding disorders are any conditions that interfere with a child’s ability to adequately take a sufficient amount of nutrition and hydration by the mouth. 

Swallowing disorders are the inability for people to pass food and/or liquid through the mouth, throat and esophagus without it entering the lungs. There are four stages to swallowing:

  • Oral preparation stage:  This is the phase when foods such as steak, vegetables, fruits are chewed to a manageable and safe size and consistency which is assisted by saliva moistening the food to prepare it to be swallowed safely.
  • Oral stage: This is the phase when the tongue moves the food and liquids to the back of the mouth toward the throat.
  • Pharyngeal stage: This is the phase when the food and/or liquid enters the throat. During this time, the muscles of the tongue, pharynx (throat) and the larynx (voice box) work together in a synergistic manner to prevent food and/or liquids from entering the lungs.
  • Esophageal stage: This is the phase when food enters the esophagus and is transported down towards the stomach in a wave-like movement.


Feeding and/or swallowing disorders can develop for a variety of reasons and frequently, the underlying cause can be difficult to pinpoint. The following are risk factors that can contribute to developing feeding and/or swallowing disorder:

  • Prematurity
  • Neurological impairment
  • Structural anomalies
  • Disease processes
  • Cardiorespiratory conditions
  • Autistic spectrum disorder
  • Impairments in family feeding patterns
  • Metabolic disorders
  • Behavioral disorders
  • Severe gastroesophageal reflux
  • Food allergies
  • Eosinophilic esophagitis

The symptoms of a feeding and/or swallowing disorder can vary, and not all children will exhibit all symptoms.

  • Parents may need to force-feed their children by using distractions or dragging out meals over a long period of time in order to get the child to eat
  • Children can be picky eaters and are only willing to eat a limited amount of food, sometimes as few as ten types or less
  • Refusal to eat food (e.g., refusal behaviors)
  • Difficulty chewing different food with various textures
  • May experience pain or distress when eating
  • Poor weight gain (e.g., failure to thrive)
  • Aspiration (e.g., swallowing difficulty)


A comprehensive evaluation is required to diagnose a feeding/swallowing disorder. It draws upon many professionals outside of speech-language pathologists. Therefore, it’s an interdisciplinary effort and necessitates the expertise of the following professionals:

  • General physician/pediatrician 
  • Plastic surgeons
  • Gastroenterologist (GI)
  • Otolaryngologist (ENT)
  • Pulmonologist
  • Neurologist
  • Dental medicine (orthodontist, dentist)
  • Nurse
  • Psychologist
  • Physical/occupational therapist
  • Dietitians
  • Family members

More specifically, speech-language pathologists play an integral role in helping diagnose the following during a feeding/swallowing evaluation:

  • Medical history: pre, peri, and post-natal
  • Feeding/speech development
  • Inventory of foods eaten
  • Oral mechanism examination
  • Observation of eating and swallowing
  • Seating and positioning during meals
  • Behaviors around mealtimes (e.g., fear, hesitation)
  • Instrumental evaluations to examine the mouth and throat muscles (e.g., modified barium swallow study, fiberoptic endoscopy)



A speech-language pathologist who is trained in feeding and swallowing disorders will take a holistic approach in looking at many variables that may be impacting a child’s ability to eat and drink. Treatment may include the following:

  • Helping your child improve all of the muscles responsible for chewing and swallowing
  • Improving the coordination with breathing and swallowing during bottle-feeding and transitioning to cup drinking
  • Introducing different textures in a methodical manner based on a child’s sensory and motor development
  • Changing food textures and liquid thickness to improve chewing and swallowing safely
  • Providing strategies during meal times that could increase a child’s stress levels, preventing them from eating
  • Taking inventory of specific sensory aspects of food and liquids that a child may avoid and developing a plan to slowly introduce new textures and taste experiences
  • Providing seating/positioning strategies during bottle/breast-feeding or seating tips for toddlers during mealtimes
  • Prescribing oral motor exercises that are specifically targeted towards achieving functional chewing and swallowing patterns

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