Pediatric Feeding and Swallowing

The scope of this page is feeding and swallowing disorders in infants, preschool children, and school-age children up to 21 years of age.

See the Pediatric Feeding and Swallowing Evidence Map for summaries of the available research on this topic.

Feeding and Swallowing

Feeding is the process involving any aspect of eating or drinking, including gathering and preparing food and liquid for intake, sucking or chewing, and swallowing (Arvedson & Brodsky, 2002). Feeding provides children and caregivers with opportunities for communication and social experiences that form the basis for future interactions (Lefton-Greif, 2008).

Swallowing is a complex process during which saliva, liquids, and foods are transported from the mouth into the stomach while keeping the airway protected. Swallowing is commonly divided into the following four phases (Arvedson & Brodsky, 2002; Logemann, 1998):

  • Oral preparatory—This is a volitional phase during which food or liquid is manipulated in the mouth to form a cohesive bolus, and that includes sucking liquids, manipulating soft boluses, and chewing solid food.
  • Oral transit—This is a voluntary phase that begins with the posterior propulsion of the bolus by the tongue and ends with the initiation of the pharyngeal swallow.
  • Pharyngeal—This phase begins with a voluntary pharyngeal swallow that, in turn, propels the bolus through the pharynx via an involuntary contraction of the pharyngeal constrictor muscles.
  • Esophageal—This is an involuntary phase during which the bolus is carried to the stomach through the process of esophageal peristalsis.

Feeding Disorders

Feeding disorders are problems with a range of eating activities that may or may not include problems with swallowing. Pediatric feeding disorder (PFD) is “impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction” (Goday et al., 2019). PFD may be associated with oral sensory function (Goday et al., 2019) and can be characterized by one or more of the following behaviors (Arvedson, 2008):

  • refusing age-appropriate or developmentally appropriate foods or liquids
  • accepting a restricted variety or quantity of foods or liquids
  • displaying disruptive or inappropriate mealtime behaviors for developmental levels
  • failing to master self-feeding skills expected for developmental levels
  • failing to use developmentally appropriate feeding devices and utensils
  • experiencing less than optimal growth

Speech-language pathologists (SLPs) are the preferred providers of dysphagia services and are integral members of an interprofessional team to diagnose and manage feeding and swallowing disorders.

Avoidant/Restrictive Food Intake Disorder (ARFID)

According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2016), ARFID is an eating or a feeding disturbance (e.g., apparent lack of interest in eating or in food, avoidance based on the sensory characteristics of food, concern about aversive consequences of eating), as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:

  • significant weight loss (or failure to achieve expected weight gain or faltering growth in children)
  • significant nutritional deficiency
  • dependence on enteral feeding or oral nutritional supplements
  • marked interference with psychosocial functioning

SLPs may screen or make referrals for ARFID but do not diagnose this disorder. ARFID is distinct from PFD in that ARFID does not include children whose primary challenge is a skill deficit (e.g., dysphagia) and requires that the severity of the eating difficulty exceeds the severity usually associated with a certain condition (e.g., Down syndrome). ARFID and PFD may exist separately or concurrently.

Swallowing Disorders

Dysphagia can occur in one or more of the four phases of swallowing and can result in aspiration—the passage of food, liquid, or saliva into the trachea—and retrograde flow of food into the nasal cavity.

The long-term consequences of feeding and swallowing disorders can include

  • food aversion;
  • oral aversion;
  • aspiration pneumonia and/or compromised pulmonary status;
  • undernutrition or malnutrition;
  • dehydration;
  • gastrointestinal complications, such as motility disorders, constipation, and diarrhea;
  • poor weight gain and/or undernutrition;
  • rumination disorder (unintentional and reflexive regurgitation of undigested food that may involve re-chewing and re-swallowing of the food);
  • an ongoing need for enteral (gastrointestinal) or parenteral (intravenous) nutrition;
  • psychosocial effects on the child and their family; and
  • feeding and swallowing problems that persist into adulthood, including the risk for choking, malnutrition, or undernutrition.

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