Feeding is the process that includes any aspect of eating or drinking, including the collection and preparation of food and liquids for sucking or chewing and swallowing. Swallowing is a complex process in which saliva, liquids and food are moved from the mouth to the stomach while protecting the respiratory tract. Ingestion is generally divided into four phases: oral preparation, oral transit, pharyngeal, and esophageal. The oral preparation phase is the phase in which food or liquid is voluntarily manipulated in the mouth and the bolus is formed. It includes absorbing liquids and chewing solid food. The oral transit phase is the phase in which the food is delivered to the pharynx (pharynx) by pushing the bolus by the tongue. The pharyngeal stage is the phase in which the bolus is delivered from the pharynx to the esophagus (esophagus) by involuntary contraction of the pharyngeal constrictor muscles. The esophageal stage is the stage in which the bolus is transported to the stomach through the process of esophageal peristalsis.
Pediatric nutritional disorders are impaired oral intake that is not age-appropriate and associated with medical, nutritional ability, and/or psychosocial dysfunction. Pediatric malnutrition occurs when a child is unable to consume enough food or fluids by mouth to maintain proper growth and nutritional status and is the result of a dynamic interaction of medical, behavioral, and psychosocial factors. Pediatric nutritional disorders are common in the community, occurring in 25% of children. One or more of the following symptoms may occur in newborns or children as a sign of feeding and swallowing disorders.
- Rejecting age-appropriate or developmentally appropriate foods or fluids
- Accepting a limited variety or amount of food or liquid,
- Exhibiting disruptive or inappropriate mealtime behaviors for developmental levels,
- Failure to master the self-feeding skills expected for developmental levels
- Not using developmentally appropriate feeding utensils,
- Significant weight loss (or failure to achieve expected weight gain in children or stunted growth),
- Significant nutritional deficiency,
The underlying etiologies associated with pediatric feeding and swallowing disorders include:
- Complex medical conditions (eg, heart disease, lung disease, allergies, gastroesophageal reflux disease),
- Developmental disability,
- Factors affecting neuromuscular coordination (eg, prematurity, low birth weight, hypotonia, hypertonia),
- Genetic syndromes,
- Neurological disorders,
- Sensory problems as a secondary or primary cause of limited food availability in early development,
- Structural abnormalities (eg cleft lip and palate, other craniofacial abnormalities, laryngomalacia, tracheoesophageal fistula, esophageal atresia, choanal atresia),
- Behavioral and socio-emotional factors.
Swallowing disorder may occur during one or more of the four stages of swallowing and may result in aspiration (passage of food, liquid, or saliva into the trachea). Signs and symptoms of swallowing disorder are listed below:
- Oral management of drooling and secretions and/or bolus,
- Residue of food or liquid in the oral cavity after swallowing,
- Inadequate lip closure leading to leakage of food and/or fluid from the oral cavity
- Extra time spent chewing or swallowing,
- Return of food and/or fluids from the nasal cavity,
- Complaints of "sticking" or "fullness" of food in the throat,
- Pain when swallowing,
- Changes in sound quality during or after eating or drinking,
- Cough or throat clearing during or after eating or drinking,
- Difficulty coordinating breathing and swallowing;
- Acute or recurrent aspiration pneumonia/respiratory infection and/or fever,
- Changes in eating habits, such as avoidance of certain foods/drinks,
- Dehydration from weight loss, malnutrition, or not eating enough.
Swallowing disorder may develop due to damage to the central nervous system (CNS) and/or cranial nerves and unilateral or bilateral cortical and subcortical lesions.
- Traumatic brain injury,
- Dementia, Parkinson's disease,
- Multiple sclerosis (MS),
- Amyotrophic lateral sclerosis (ALS)
- Myasthenia gravis,
- Polymyositis and dermatomyositis
Swallowing disorder can also occur from problems affecting the head and neck.
- Cancer of the oral cavity, pharynx, nasopharynx or esophagus,
- Radiation and/or chemoradiotherapy for the treatment of head and neck cancer,
- Trauma or surgery involving the head and neck,
- Rotten or missing teeth,
- Critical care, which may include oral intubation and/or tracheostomy.