Feeding Therapy – What can a Speech Therapist help with and how does it work?
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Feeding Therapy – What can a Speech Therapist help with and how does it work?

ByLondon Speech and Feeding

Feeding our child can be the most satisfying time of the day or it can be the worst, stressful and hardest thing to do. Parents usually contact a Feeding Therapist once things have become totally stressful and unmanageable as often parents feel that ‘it will get better’ and ‘let’s wait and see’. Whilst this is generally a good, relaxed way of thinking, when it comes to feeding, eating and drinking, it does not take much to completely put a child off a particular food or texture. Once refusal has set in and not been responded to in quite the right way then feeding rarely gets better without intervention and support.

What can have started as a physical, concrete problem can quickly develop or acquire a psychological and sensory aversion aspect as well. A child may have started out with an allergy to cow milk protein or gastro-oesophageal reflux for example or perhaps our child has an oral motor difficulty such as the tongue not rotating well, or lips not closing tightly enough around a bottle teat. Because those difficulties were not understood we now have a combination of both physical discomfort, oral weakness and sensory aversion making it a heady cocktail of feeding difficulty and refusal, which needs careful unpicking before each issue can be addressed sensitively and effectively.

A dyad

We call the relationship between the feeder and the child a dyad: both individuals play their part and both need ‘to work together’ to ensure meal times are happy events. The parent/feeder is responsible for offering and providing the meal and the child is ‘responsible’ for taking the food, spoon or drink and swallowing it.

Formation

For the past few years Speech and Language Therapist Students in the UK have received basic feeding/swallowing training as part of their undergraduate degree courses. However, relatively few SLTs in the UK end up specialising in this area and take further professional courses to develop this area of specialist knowledge and input. To be sure that an SLT is able to work in the complex field of eating, drinking and swallowing they must undertake further training and complete increasing levels of competency in this field. This is something to bear in mind for parents when looking for a suitable feeding therapist for their child.

Important to know

Parents are not alone. Many families are experiencing the same difficulty and there is help available both in the NHS and in the private sector.

Children’s feeding can be improved greatly and the best approach is a joint team centred around the child between the parents, the dietician, medical and therapy professionals.

By working closely together we can build confidence and skill and find ways of making mealtimes enjoyable and free of stress.

What happens in my feeding clinic

Parents feed their child and I coach them, model strategies, and support the feeding process.

I provide information on their child’s developmental skill level, oral motor skill. I advise on appropriate food consistencies, optimal positioning. We talk about self-feeding and parent feeding. And we look at strategies during feeding that will improve feeding skills.

I can help with mealtime planning and scheduling. And we decide together on when to practise what type of strategy.

We create our meal goals together based on what is important to the families.

Parents are invited to videotape strategies and advice I give to serve as reminders for home practice.

I offer episodes of follow-up which sometimes can be online. Or parents can bring their child back to the clinic for another mealtime and practice of certain strategies, to follow on from our current status, and take things forward gently and steadily.

If I can be of help with your child’s feeding journey, please get in touch on via my contact form.

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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A bite-sized guide to Speech and Language Therapy: feeding and swallowing
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A bite-sized guide to Speech and Language Therapy: feeding and swallowing

ByLondon Speech and Feeding

What is a Speech and Language – Feeding Therapist?

You’ve probably heard of speech therapists helping people who stutter or struggle to pronounce words. But did you know that they also work with children and adults who have problems with eating and swallowing? This specialised area is called Speech and Language Therapy: Feeding and Swallowing, or Dysphagia Therapy.

Why does a Speech Therapist help with eating and swallowing?

The mouth, tongue, and throat are all involved in both speech and swallowing. When there’s a problem with any of these parts, it can affect both your ability to talk and to eat. For example:

  • Weak tongue muscles: Can make it hard to chew food and to form sounds.
  • Difficulty coordinating swallowing: Can lead to choking or aspiration (when food or liquid goes into the lungs).
  • Sensory issues: Can make certain textures or tastes feel unpleasant or overwhelming.
  • Communication: If we are not able to express ourselves we are likely to have difficulties during daily mealtimes: how do we ask for ‘more’ of something, how do we say we have had enough or we don’t like a particular food?

How does a Speech and Language Therapist help?

Our work involves a combination of assessment and therapy. We carefully observe how your child feeds, eats and swallows, and we look into your child’s mouth to help us see what the cause of the difficulties are: could be a very highly-arched palate, it could be a very flaccid/low tone tongue, it could be poor dentition. Then, we create a personalised treatment plan to address your specific needs.

Here are some of the things we might do:

  • Teach swallowing techniques: We can help your child learn strategies to improve or facilitate a safe swallow.
  • Recommend dietary modifications: We may suggest changes to your child’s diet to make it easier to eat and swallow.
  • Provide sensory therapy: If your child has sensory needs we can help your child become more comfortable with different textures, tastes, and smells.
  • Work on oral motor skills: We can help to encourage more effective chewing, or drinking skills, or we can help your child to close his/her mouth more during chewing or drinking from a straw.
  • Collaborate with other professionals: We often work closely with doctors, nurses, occupational therapists, and dietitians to provide comprehensive care.

What kinds of problems do Speech and Language Therapists help with?

We see a wide range of feeding and swallowing difficulties, including:

  • Delayed feeding: Children who are slow to develop feeding skills or who have difficulty transitioning to solid foods.
  • Tongue-ties: Babies can have significant difficulties with feeding when the tongue is very tightly tethered to the floor of the mouth.
  • Refusal to eat: Children who refuse to eat certain foods or textures.
  • Aspiration: When food or liquid goes into the lungs, which can lead to pneumonia and other serious complications.
  • Chewing difficulties: Problems with chewing food, such as difficulty breaking down food or keeping food in the mouth.
  • Swallowing difficulties: Problems with swallowing, such as feeling like food is stuck or choking.
  • Neurological conditions: Conditions like cerebral palsy, down syndrome or other genetic syndromes can affect feeding and swallowing.
  • Developmental delays: Children with developmental delays may have difficulties with feeding and swallowing.

Is there hope?

If your child is struggling with feeding or swallowing, know that there is help available. Speech and Language Therapy can make a significant difference in your and your child’s quality of life. We’re here to support you every step of the way.

Remember, you don’t have to suffer in silence. If you’re concerned about your child feeding or swallowing, please reach out. You can find a Speech and Language Therapist with a Feeding/dysphagia qualification near you via www.asltip.co.uk or contact me.

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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My child won’t eat! What can we do to help?
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My child won’t eat! What can we do to help?

ByLondon Speech and Feeding
Image by freepik

I get lots of enquiries about this topic, parents up and down the country struggle to feed their children. Mealtimes with toddlers can sometimes feel like a war zone!

Reasons

The reasons for food refusal are many and very varied. Perhaps your child was born prematurely and had lots of tubes and things sticking to his or her face? Or maybe your child had gastro-oesophageal reflux and this caused pain every time he or she swallowed. Some children have motor problems so it was hard to coordinate swallowing with breathing and caused frustration and anxiety? Many children have sensory integration difficulties and these make it difficult for them to grasp all the different textures and colours they are eating.

When I take a case history for a new feeding client, I always try to first establish how the child learned not to feed/eat. I use the word ‘learned’ here with intent as eating is a learned behaviour. We tend to think that it must just be instinctive and natural but this is not the case. Instinct is a small part of the very beginning of feeding, in that a baby naturally roots for the breast but this only works out well and leads to more natural ‘instinctive’ feeding if that initial instinct is not interrupted or impacted on negatively by any of the above reasons.

So just as a baby learns to eat or drink the milk it can also learn not to do so. The baby can learn to avoid eating in order to bypass discomfort, or — and this is another important factor — in order to gain more positive attention from the caregiver!

Research shows that we learn about food in two ways:

  1. A connection is made between a food and a physical reaction. This needs to happen only once and it can stick: think about feeling sick after a binge on a certain food/drink… You won’t want to go near that very food again for some time, if ever! If a certain food causes pain then that connection can be made quickly and we won’t want to touch this food again.
  2.  We learn through reinforcement and punishment:
  1. Reinforcement:
  • If we get praised for eating our plate with a pudding, then we tend to eat more to get the pudding.
  • Equally if granny sits with us for hours at the table reading us a story because we do not eat or don’t eat much/quickly, we will continue this because we want granny to keep reading for us.
  1. Punishment can work in two ways:
  • Child gets punished for not eating and will eat more to avoid punishment.
  • Child eats less as the fear of punishment is so unpleasant and leads to total lack of appetite.

As speech therapists we do not endorse any of those above strategies because none of them give us the desired effect.

What do we want to achieve? We want our children to eat naturally, with enjoyment. We don’t want them to over eat, to binge eat, or to starve themselves. Eating needs to become a joyful, natural and organic behaviour if our child is to be healthy and thrive.

Recommendations

Here are three top recommendations I make regularly with good effect:

  1. Structure: have a routine at mealtimes, eating at the table, in the same room with our favourite utensils. Always helping in food preparation, perhaps setting out the table placemats etc, and then tidying up — taking the plate to the kitchen counter, scraping left overs into the recycle bin can be part of this. This way we can introduce repetition to our food/eating learning.
  • Positioning: the right chair with a good footrest, supporting our child’s trunk well, and facilitating our child eating at the table (instead of sitting in a high chair with a tray) is one of my first and favourite tips. I do favour a Tripp Trapp style chair (I have no association with that company).

Tube fed children ought to also sit at the table with the rest of the family and first of all be offered foods and drinks to handle or play with. Some tube fed children are able to eat a small amount of pureed foods and they ought to be offered this first before being topped up with their tube feeds, whilst sitting down. Lying down for your tube feed is not a normal way of eating. Tube feed infants should be offered a pacifier whilst being tube fed and be in an upright position so that they start having an association between getting full/feeling satiated and their mouth.

  • Sociability: I encourage family mealtimes, or at least the caregiver eating with their child together, so that the child is able to copy and observe what normal eating looks like. We need to be super positive about eating and food consumption so that our child can see and copy this. If the parent is a fussy eater then this may cause the child to copy exactly the same behaviour. Many parents who come to me with their fussy children are themselves also picky about food.

There are many other tips and strategies and I will be more than pleased to assist, please contact me.

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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