Heather Boerner, an NYC-based speech-language pathologist explains common treatments for feeding disorders in children, including how to treat reflux, low muscle tone, aspiration, and an oral sensory deficit.
There are many things you can do to improve the variety of textures a child eats, but the type of treatment you provide is indicated by how the child presents and the underlying cause of difficulty with feeding.
1. If it's reflux, we'll start the child on Nexium or a similar drug to mediate the reflux so the child can have a more positive feeding experience and progress in the variety of foods they’re eating.
2. A child may present with low muscle tone, which is a common scenario. If they have a weak jaw, fatigue very easily during meals, and have difficulty transitioning from hard textures to soft textures, then I would know that this child needs jaw-strengthening exercises to help improve the strength and mobility of his jaw muscles. I put them on what’s called an oral motor program, which involves exercises to improve the strength of the jaw. By training family to do these exercises with the child every day, the child will strengthen their jaw and build up endurance, and they’ll consume larger amount of harder texture food as their strength and endurance improve.
3. Signs that a child is aspirating are a wet, gurgly voice after drinking, a consistent low-grade temperature, and stress during feeding. It’s important to note that sometimes, in 50 percent of cases, there are no signs of aspiration. The only way to know exactly what’s going on is to do a swallow study. A lot of times I will recommend that, before I treat the child, because I want to make sure they’re safe. Aspiration happens a lot in premature infants, but as they grow and their bodies gain strength and their physiology matures and strengthens naturally over time, the issue may improve—but it's important to keep an eye on it.
4. When a child walks into my office with an oral sensory deficit, that means they’re sensitive to certain textures or temperatures or tastes. An oral-sensory issue means they’re less tolerant of a variety of textures. In this instance, I would introduce new textures into the child’s diet slowly during mealtime. We would create a food log and determine what textures the child is tolerating well and what textures the child is not tolerating well, and then I would introduce those textures into the child’s diet that they’re not tolerating, using a progressive approach. First we have the child touch the food, then kiss the food, then lick the food, and then the final step is allowing the food into the mouth to be swallowed. We start working as far away as we can, then slowly move the food closer to the child’s mouth until they’re able to tolerate it. I always follow the child’s lead, and I only go as far as they let me, because a lot of these children have negative experiences involving food and mealtime, so my primary concern when we first start feeding therapy is building trust with that child and creating a positive experience around feeding.
We definitely ask parents to reinforce treatment outside of therapy. Family education and training is an integral part of feeding therapy. See Boerner's tips on how to reinforce feeding therapy at home.
Heather Boerner, MA, CCC/SLP, is a pediatric speech-language pathologist and the founder of Chatty Child Speech Therapy, PLLC in Manhattan. Boerner graduated from New York University with an MA in speech-language pathology and a minor in education, and she is licensed to teach speech- and hearing-disabled students.