Feeding and Swallowing Disorders

by Clark Elliott, MD, Chief of Pediatric Otolaryngology,
The Floating Hospital for Children at Tufts-New England Medical Center

We all understand the fundamental importance of feeding and swallowing. The consumption of food and drink is an essential part of the human experience. We celebrate every significant highlight of our lives by sharing some form of beverage or a meal. Whether it is Thanksgiving or Christmas dinners, the bridal feast, a meal to celebrate the birth of a child, a back yard barbecue on the fourth of July or simply a meal with the family, this communion is a focal point for the sharing of thoughts and emotions. Children learn their most vital social skills from these sorts of interactions. It is not surprising that this fundamental need develops early in the life of young humans, before breathing itself. Consequently, it should not surprise us to learn that factors that affect a child’s normal feeding and swallowing can have a profound impact on his or her growth and development, not just as a living organism, but as a member of the social fabric as well.

We have long recognized the intake of nourishment for its medical value. We treat failure to thrive. We ensure proper nutrition for patients who are hospitalized with medical and surgical disease. We now commonly accept the importance of the feeding ritual for early maternal/infant bonding. We are beginning to recognize the influence that feeing issues have on other areas such as the airway, lungs, sinuses, ears and gut. Sinusitis, otis media, pneumonia, GERD, and gut motility problems may all be related to feeding and swallowing issues. Our focus tends to be on the medical consequences of feeding problems at a specific point in time. The challenge for us now is to expand our thinking to anticipate problems before they arise and treat them in a manner that encompasses both their medical and social aspects, to transition a child through his or her illness and help re-establish them within the family unit and community. This is the mandate of a pediatric feeding and swallowing team.

Feeding and swallowing teams have evolved over the years. Initially speech pathologists were consulted to assist in managing post-operative feeding disorders. In other areas, such as neonatal units and rehabilitation facilities, occupational therapists and physical therapists assisted in developing strategies to manage the needs of infants and children who were unable to feed and control their oral secretions. Gradually, pulmonologists, gastroenterologists and developmental pediatricians have come to recognize the benefits of feeding specialists to their respective disciplines.

At the Floating Hospital for Children, we assess patients with feeding and swallowing disorders using a multidisciplinary model. Our core team consists of representatives from speech pathology, occupational therapy, physical therapy and pediatric otolaryngology. We consider both the patient’s medical and social needs, and determine what formal investigations may be required. These can include a videofluroscopic swallowing study (VFSS), fiberoptic endoscopic evaluation of swallowing (FEES), bronchoscopy or ultrasound. We decide what consultations may be needed from our colleagues in other disciplines such as pulmonology, Gastroenterology, nutrition, developmental pediatrics and social work. Based on the team’s evaluation of the test results and consultations, we formulate a plan to address the immediate and long-term needs of the child, at the same time involving family members and caregivers to provide as normal an environment as possible. Our goal is to go beyond the traditional concept of feeding therapy as an “afterthought” in the care of our patients. By using such an approach to feeding and swallowing issues, we hope to avoid eth long-lasting effects that can arise when such a fundamental process is disturbed.

About Tufts-New England Medical Center and the Floating Hospital for Children
Founded in 1796 as the Boston Dispensary to care for sick and needy Bostonians, Tufts-New England Medical Center is the oldest health care facility in New England. It serves as the primary clinical and teaching affiliate of Tufts University School of Medicine. Tufts-NEMC is a world-class, academic medical institution that is home to both a full-service hospital for adults and the Floating Hospital for Children and has long been recognized as a leader in cancer care, cardiology, organ transplantation and pediatrics. For more information, access our web site, https://www.tuftsmedicalcenter.org/.


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