Feeding and swallowing

Pathway to dysphagia (eating and drinking) help and support

Dysphagia describes eating, drinking and swallowing difficulties in babies, children, young people and adults.

Respiratory, cardiac, neurological, structural and gastrointestinal problems can all impact on an infant’s ability to feed safely (Azuma and Maron, 2020)

It can significantly impact on the child and their family's quality of life and if not treated appropriately, it can lead to other health complications, serious respiratory illness, lung damage and death. Poor nutrition and hydration have an impact on physical and mental wellbeing.

Some of the signs and symptoms of dysphagia you may see:

If your child has a combination of these symptoms, you need a referral to the dysphagia team.

• Change in alertness around feeding time, becoming sleepy, anxious or distressed.
• Coughing or choking before, during or after food or drink
• Changes in colour e.g. going red or pale, blue tinges on the upper lip
• Changes in breathing - faster or slower than usual
• Sounds of breathing difficulty, for example, wheezing, gurgling, or “wet” breathing when eating or drinking
• Eye watering or widening, passive tears or crying, excessive blinking or grimacing
• Recurrent chest infections and/or pneumonia
• Difficulty with eating or swallowing age-appropriate food/liquid consistencies.

Additional signs:

• Becoming tired during a meal or lengthy meal times
• Difficulty in maintaining/achieving a safe position for eating and drinking
• Deteriorating physical health
• Recurrent vomiting
• Deteriorating condition of teeth and mouth
• Weight loss.

Exclusion criteria for eating and drinking – we do not accept referrals for:

• Orally aversive due to sensory issues – this needs specialist MDT feeding clinic approach
• Children who eat a restricted range or amount - see information available on the Pod.
• Difficulties with initial weaning- contact your Health Visitor/GP for support
• Parental anxiety around weaning – contact your Health Visitor/Family Hub
• Tongue-tie – contact the Infant feeding team up to six weeks of age or GP
• PICA- contact GP
• Feeding disorders/ARFID – refer to NELFT.

Useful websites

• Advice on weaning
• International Dysphagia Diet Standardisation Initiative
• IDDSI testing video (on YouTube)

Referral

Your GP, Health Visitor, consultant, SLT, nursery or school can refer your child to the Kent Dysphagia Service. If you have concerns you can also contact the service. A referral will be accepted from anyone. To refer your child to receive support for feeding and swallowing please use the

• Children’s Therapies Service referral form.

Your child's problems will need to meet the signs and symptoms above to ensure you access the right service at the right time. You may receive a request for more information, or be sign-posted to other methods of support.

If you have an urgent problem, we aim to respond to you within a week, although it can be less.

Assessment

If your child meets the criteria for an assessment they will be offered an individual assessment by a qualified Dysphagia Speech and Language Therapist.

You will be asked to provide some short videos of your child eating and drinking - showing the difficulties you are witnessing with your child. These videos are to be sent via WhatsApp to the Dysphagia Team mobile. This request may be before or after an appointment.

Appointments take place in different settings dependent on the concerns.

Virtual assessments

This allows the therapist to talk through your concerns and the medical history of your child, before seeing your child eating and drinking, in their home environment, so the problems are seen clearly as you see them.

The service will send an appointment letter with a Microsoft Teams link to the email address we have on file prior to the appointment.

It may be possible to trial new ways of using food with the child while the therapist can see the effects of this. Alternatively, the therapist could ask for videos of the issues discussed and analyse these with the information you have given and feedback to you at a later appointment.

Clinic assessments

Please bring some food and drink your child enjoys eating and drinking, and some that they find harder. This will enable us to observe any eating/ drinking difficulty and advise you accordingly. If your child's problems are intermittent or they will not eat in a strange environment, please bring along a video of their feeding behaviours at home.

After the assessments

Having assessed your child’s difficulties and needs, your Speech and Language Therapist will agree with you on strategies or techniques to improve your child’s swallow safety or oral skills development. This may involve changing the consistency of foods or liquids, advice on positioning, advice on pacing, advice on utensils, practising skills safely and/or signposted to a workshop or training. If your child has an unsafe swallow it may be necessary to consider other ways of feeding such as tube feeding into the nose or tummy. We will always work as part of a multi-disciplinary team where necessary, to ensure the best outcome for your child.

A clear plan should be made for the child’s next steps and the ways you can support their eating and drinking. As part of our responsive revolving door policy, your child’s referral will most likely be closed. You will be given the telephone number to contact the Dysphagia Team for a further advice when your child has progressed to the next step, or is not progressing after a period of time.

Workshops

If you have been advised to access our online training resource for restricted eaters or would like to know more about restricted eating please watch the following workshop.

Creating Positive mealtimes for a restricted eater