Huntsville, AL 35801

Feeding & Swallowing

Feeding and swallowing skills within speech therapy focus on the abilities to bite, chew, and swallow safely without pain or discomfort; it may also include some aspects of picky eating!

How are feeding and swallowing different?

Swallowing is part of feeding, but feeding and swallowing are two different areas that speech therapy can provide support for. Feeding focuses on the types of food and drink consumed, motor aspects of consuming food and drink, choking, gagging, or coughing while eating foods, and refusing certain foods. Swallowing focuses on the motor aspects and process of swallowing: biting, chewing, and swallowing.

Feeding

What do feeding or eating problems look like?

Issues with feeding may go hand-in-hand with swallowing difficulties, or may just present on their own. Dysphagia, or swallowing issues, are considered physical difficulties with swallowing, which can certainly impact someone’s feeding skills! Someone avoiding foods may be directly related to pain or discomfort while swallowing, or it may have to do more with personal preferences (picky eating).

Someone who is considered a picky eater may or may not also have signs of dysphagia. Difficulties with eating a variety of foods, especially with patterns based on textures, colors, or temperature, is not uncommon, especially within the neurodivergent community. Oral aversions or sensory difficulties often limit types of foods that people are willing to try and can lead to feelings of frustration or anxiety during mealtime. Picky eating may begin and end in childhood, or persist through adulthood.

When should I seek out services for picky eating?

Picky eating is somewhat normal, especially during development. However, if picky eating extremely limits feeding, or if it inhibits growth and affects nutrition, it may be time to seek professional support.

Feeding difficulties may be addressed by a speech therapist or occupational therapist, depending on the root causes of their feeding issues. If the problem is more sensory-based, or related to a sensory processing disorder, it is typically addressed by an occupational therapist. If the problem is more related to motor difficulties, it is typically addressed by a speech therapist. However, speech therapists can still address some sensory aspects of feeding issues, especially if they’ve received specialized training such as Sequential-Oral-Sensory Approach (SOS).

Sometimes a client may even require a multidisciplinary team of both a speech therapist and an occupational therapist to ensure success!

Treatment for Feeding

Treatments for feeding often depend on what difficulties a client is experiencing with consuming foods or drinks. Someone with difficulties feeding may or may not have difficulties swallowing as well.

Feeding treatment may focus on increasing interactions with a variety of foods, reducing aversions to new foods, teaching compensatory strategies for chewing and swallowing safely, reducing coughing or choking while eating, and more. A client with feeding difficulties may also benefit from specific programs, such as Sequential-Oral-Sensory Approach (SOS) treatment.

Swallowing

For a lot of people, swallowing is not something we have to think much about! Whether you’re grabbing a quick bite on the road or having dinner with friends, you may not have to think much about how you are eating. Swallowing is a complex process that coordinates our breathing and swallowing, activates over 50 muscles, and is sequenced into three different phases: the oral, oropharyngeal, and pharyngeal phases. Who knew snack time could be so complicated?

Swallowing issues may occur at any of the three phases of swallowing! Swallowing issues or disorders are typically categorized and described as dysphagia.

Swallowing Phases

The oral phase focuses on the motor processes of eating that happen in the mouth. Also known as the oral preparatory phase, this phase concerns the way food enters the mouth, chewing patterns, a rotary chew with the jaw, and movement and strength of the tongue to move food around in the mouth for appropriate chewing. Organized chewing involves taking an initial bite with our front teeth and moving that food to the sides and back of the mouth to chew.

The oropharyngeal, or oral transit, phase is more focused on chewed food moving to the back of the mouth to be swallowed. After chewing, your tongue gathers chewed food into a small pile (called the bolus) to the back of your tongue and your soft palate (the velum) closes to prevent chewed food from going up your nose. If you’ve ever experienced the discomfort of laughing or coughing and food or drink ending up in your nose, you have your velum to blame!

The pharyngeal phase of swallowing is the active swallowing. Chewed food moves down into the throat and our epiglottis protects our airways. This is when you can “swallow wrong” - if you feel something wrong while swallowing and start coughing, that’s when food or drink has passed your epiglottis, so you cough to clear it from your airway. Food then moves down to the esophagus.

Speech therapy does not diagnose or treat swallowing issues related to the esophagus. If a speech therapist suspects that there is an esophageal issue with someone’s swallowing, they will recommend that a client sees a gastroenterologist. Esophageal issues, such as reflux, can lead to swallowing issues - if you want an example of such a situation, read more at our blog post here!

What does dysphagia, or swallowing issues, look like?

Dysphagia is the term used to describe swallowing issues or disorders. Signs of dysphagia may include the following:

Difficulty consuming foods of specific consistencies
Coughing or choking during or after swallowing
Residue in the mouth after swallowing
Clearing your throat after swallowing
Feelings of discomfort while swallowing

What causes swallowing issues?

Issues with swallowing may occur for a variety of reasons. There may be structural or physical issues that make swallowing difficult, as well as muscle weakness or incoordination. Remember, we use over 50 muscles to swallow - issues with any can contribute to difficulties swallowing safely and without pain!

Swallowing issues may also be caused by neurological disorders, medical treatment, surgery that required intubation, and head or neck injuries. Swallowing issues may also start as a symptom of neurodegenerative disorders, such as Parkinson’s.

How do I know that I or a loved one need help for swallowing issues?

If someone is showing any of the signs above (anchor) while eating, avoiding certain foods because they cause pain or discomfort while eating, or having to use tricks to eat safely, you or a loved one may be a good candidate for speech therapy services.

Adults often tend to be better at compensating for their difficulties and may see making little daily changes (avoiding certain foods, eating softer foods, chewing longer, adding extra drinks of water to swallow) as an easy way to address their struggles. However, the fact that one is having to make these changes is a sign that they may have swallowing difficulties. Speech therapy to address any present issues allows people to return to mealtime with preferred foods and without having to worry about their safety while eating.

Swallowing Testing

Dysphagia treatment starts with screenings and instrumental tests. Screenings with a speech therapist are typically done to evaluate the coordination and strength of oral structures, such as the tongue and lips. Instrumental evaluations involve using medical equipment for a more in-depth look at the swallowing process; two types of typically recommended instrumental assessments are the Fiberoptic Endoscopic Evaluation (FEES) and the Modified Barium Swallow Study (MBSS).

In a FEES test, a small camera inside of a tube is inserted into the nose and moved through the nasal passage to look down over the throat. This test may also be performed in assessing voice and the vocal folds. Giving a birds-eye-view of the throat like this allows a clinician to watch a client swallow food in both the oropharyngeal and pharyngeal phase of swallowing. A speech therapist can observe a client consuming different consistencies of food and drink (thin liquids, thicker liquids, harder foods like crackers, softer foods like fruit, etc.) and assess if there may be a weak swallow, if food is left in the throat after a swallow, or if food is being allowed into the airway. Testing different types of foods and drinks allows a speech therapist to ensure that clients can consume food safely.

MBSS assessments observe the swallowing process from the side, rather than the top. A client sits in view of an X-ray machine and foods and drinks are mixed with a small amount of barium. Barium isn’t exactly delicious, but it allows food and drinks to show up on the X-ray. Speech therapists can observe all three phases of swallowing with this test from a side view. It can show a speech therapist if a client has a weak swallow, difficulty chewing, difficulty moving food to the back of the mouth, leaving food residue in the mouth or throat, or having food move to the lungs.

Depending on a speech therapist’s concerns, they may recommend one instrumental assessment or the other. Some speech therapists may have the medical equipment needed to complete FEES or MBSS in their clinic, while others may refer out to a local hospital to get these tests done.

Swallowing Treatment

Dysphagia treatment starts with an evaluation to determine what aspects of swallowing a client struggles with and to ensure that they are able to consume food and drinks safely. Since swallowing is so complex, it’s important to determine which phases a client is struggling with before starting treatment.

Each phase and the root of the problem within that phase may require different techniques, exercises, and compensatory strategies to best support a client and help them overcome swallowing difficulties. Speech therapists may also recommend some diet changes or modifications while they work towards improving swallowing skills to ensure their client’s safety!

I’m worried about my own/a loved one’s swallowing or feeding skills. Now what?

Start with reaching out to a speech therapist or your primary care physician. You will likely require an instrumental swallowing assessment before you start with therapy services to ensure your safety and determine areas of weakness for therapy. If your local speech therapist is unable to complete a swallowing assessment on site, they may have you referred to a nearby specialist with the necessary medical equipment.

After an instrumental assessment, a speech therapist can receive results from this test and create a treatment plan with strategies, techniques, and exercises to improve swallowing skills.