Swallowing

What are swallowing disorders?

A swallowing disorder, also known as dysphagia, is difficulty moving food from the mouth to the stomach. Difficulties may be observed in only one area, such as the mouth, or multiple areas, such as the mouth, throat and esophagus. Children and adults may develop problems with swallowing due to a variety of medical disorders, such as a stroke, brain injury and neurodegenerative disease.

What types of services are offered?

A clinical swallowing assessment is an evaluation by a speech-language pathologist (SLP) of the strength and movement of the muscles involved in swallowing, as well as an assessment of different textures and amounts of foods and liquids. In this evaluation, an SLP may observe a variety of different head or body positions and techniques to eliminate any noted symptoms of dysphagia while the client eats and drinks.

In order to thoroughly evaluate swallowing disorders, speech-language pathology staff may complete an instrumental assessment of the swallow, through a modified barium swallow study (via x-ray) or a fiberoptic endoscopic evaluation of the swallow (via camera) if needed. These assessments allow the SLP to view swallowing in motion and try therapeutic techniques to identify safe ways to swallow.

Once specific problem areas are identified, appropriate swallowing strategies or therapy can be provided. These interventions may involve exercises to improve strength or movements during the swallow, or different postures to keep food and liquids from entering the airway. The goal is always to facilitate independent use of the techniques and exercises to move the individual toward the most normal swallow and diet possible.

SLPs also specialize in the feeding and swallowing skills in newborns and prematurely born infants in the NICU and after discharge from the NICU.  SLPs work closely with the family, occupational therapy and the entire medical team to develop a care plan that supports each baby’s unique developmental needs. SLPs assess how infants use the muscles of the mouth and throat to suck and swallow and determine their ability to coordinate this with breathing. SLPs also utilize techniques and provide education on safe and effective eating through positioning, supports and/or pacing.  The ultimate goal is to help the infant eat orally and empower families with the knowledge and skills needed to guide future feeding and swallowing development of their babies.

What are the symptoms of a swallowing disorder?

Swallowing disorders may present as one of more of the following signs and symptoms in adults:

• Coughing during or after eating or drinking
• Wet sounding voice right after eating or drinking
• Increased effort or time to chew or swallow
• Leakage of foods or liquids from the mouth or foods remaining in the mouth
• Frequent chest congestion after eating
• Unintentional weight loss or dehydration from not eating or drinking enough

In children, swallowing disorders may be demonstrated by one or more of the following:

• Arching or stiffening of the body during feeding
• Refusals of food or liquids
• Poor acceptance of different types of foods
• Extended feeding times (e.g., more than 30 mins)
• Gagging or coughing during meals
• Vomiting or frequent spitting up of foods
• Excessive drooling
• Difficulty coordinating breathing and eating
• Voice changes (e.g., hoarse, wet, breathy) when eating
• Less than normal weight gain or growth

Who benefits from swallowing services?

Both adult and pediatric clients with dysphagia benefit from the expert assessments and recommendations of the SLP. Individuals who have acquired difficulties from a stroke or traumatic brain injury may improve in their swallow function as a result of swallowing services. Adults who have experienced changes in their swallowing skills may gain independence from the direct intervention program designed for them to more safely and effectively manage foods and liquids. Children born with undeveloped swallow skills also benefit from the expertise of an SLP. Families of these children with dysphagia receive training in exercises and techniques to aid their child in eating and swallowing.