Rehabilitation Services

For most children, eating is a fun and routine part of the day. One in four children, however, will experience some type of feeding problem. Feeding issues can affect a child’s ability to eat enough to grow and develop.

Pediatric feeding and swallowing issues can be extremely complex, and children are not always able to communicate the specific symptoms they are experiencing. The program at Johns Hopkins All Children’s is dedicated to providing quality care in a family-centered environment.

Our speech-language pathologists are experienced in treating children whose feeding issues may be caused by a range of complex conditions, including:

• Neurological disorders
• Digestive conditions
• Failure to thrive and malnutrition
• Prematurity and/or low birth weight
• Heart conditions
• Cleft palate and craniofacial disorders
• Neurodevelopmental and genetic disorders
• Breathing difficulties and conditions affecting the airway
• Head and neck abnormalities
• Muscle weakness in the face and neck
• Multiple medical problems
• Sensory disorders that interfere with meeting nutritional needs

Our team includes specialists trained in evaluating feeding issues in infants, including infant bottle and breastfeeding evaluations.

Personalized care for feeding and swallowing disorders

We work with patients and families to create treatment plans customized to each child’s individual needs. Our team of speech-language pathologists with specialized training in pediatric feeding may work with other specialists throughout the hospital, such as a gastroenterologist, nutritionist, occupational or physical therapist, lactation consultant, developmental specialist, nurses and other physicians to assist with care and treatment, depending on your child’s condition.

Some children may only need a one-time feeding and swallowing evaluation to get them on track. The speech-language pathologist will work with the family to demonstrate specific techniques and provide them with a home program and later follow-up as needed. Other children may need a period of more direct treatment. We provide a range of treatment options.

Signs your child may have a feeding or swallowing condition can include:

• Arching, crying, pulling away or other signs of discomfort during feeding
• Color changes or eyes watering during feeding
• Coughing, gagging or choking during feeding
• Difficulty advancing to age-appropriate textures or utensils
• Difficulty chewing
• Fear of swallowing, including following a traumatic choking incident
• Increased congestion during or after meals
• Limited acceptance of certain textures (for example, chewable solids) or whole categories of feed (for example, vegetables)
• Pocketing or spitting out solid food pieces
• Poor intake
• Poor weight gain or growth
• Recurring pneumonia or respiratory infections
• Refusing food or liquid
• Significant family struggles with mealtime
• Significantly restricted diet or rigid mealtime preferences
• Sleep feeding or eating well only in a drowsy state
• Wet or hoarse voice quality or low volume

Evaluation

Feeding evaluations provide a comprehensive assessment of feeding and swallowing abilities. We’ll first review your child’s medical records and medical history, and discuss your child’s overall development and growth, feeding intake, mealtime schedule and environment, symptoms and any other concerns.

During a feeding evaluation, we will:

• Examine your child’s oral reflexes and the strength and movement of the muscles involved in feeding and swallowing
• Observe a typical mealtime and examine your child’s positioning and posture, oral movements, breathing and swallowing, and other behaviors during eating and drinking
• Determine if the issues your child is experiencing are part of a typical developmental stage or a true feeding issue
• Identify any problems or risk factors with your child’s feeding and swallowing abilities; most importantly, safety and ability to meet nutritional needs
• Demonstrate and test the effectiveness of techniques to improve feeding
• Assist you with feeding methods, including navigating through the wide variety of nipple, bottle and cup systems available to help you and your child

When you bring your child for his or her evaluation, please bring a completed feeding history form. You can find the form online here (en Espanol) or call our office at 727-767-4141 to receive a copy.

Based on your child’s evaluation we will develop a treatment plan and if needed recommend additional tests to evaluate swallowing and other concerns. We may recommend a video X-ray swallow study depending on your child’s symptoms and needs.

Some of the additional types of evaluations we provide include:

• Infant bottle and breastfeeding evaluations
• Acute care feeding and swallowing evaluations for hospitalized infants and children
• Acute care follow-up evaluations

Treatment

Therapy frequency may range from once per month to two or more times a week. We involve parents directly in their child’s therapy sessions with hands-on practice and coaching so we can all work together to maximize your child’s progress, including strategies to:

• Establish and expand positive eating experiences
• Decrease behaviors that interfere with eating
• Improve oral motor behaviors that impede eating
• Improve eating safety
• Increase the types and amount of food your child will eat
• Decrease dependence on tube feeding and/or supplements

We prioritize safety and nutritional needs, so intake and weight gain are closely monitored throughout the process.