Pediatric Feeding & Swallowing

What is a Pediatric Feeding Disorder?

A Pediatric Feeding Disorder (PFD) is defined as “impaired oral intake that is not age appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction” (Goday et al., 2019).

Feeding is a complex skill that develops over time. It requires coordination of oral motor skills, swallowing, sensory processing, nutrition, medical health, and positive mealtime experiences. When challenges occur in one or more of these areas, a child may benefit from a comprehensive feeding assessment.

Because feeding is multifaceted, treatment often involves a team of professionals. Depending on a child’s needs, this may include a dietitian, occupational therapist, psychologist, gastroenterologist, otolaryngologist (ENT), social worker, pediatrician, and speech-language pathologist.

A speech-language pathologist (SLP) evaluates the skills needed for safe and efficient eating and drinking. This may include assessing oral motor function, chewing and swallowing skills, a child’s communication during mealtimes, and identifying signs of swallowing difficulty. When appropriate, the SLP may recommend an instrumental swallowing assessment or additional medical investigations to better understand your child’s feeding needs.

Children with a Pediatric Feeding Disorder May…

Refuse foods or drinks that are appropriate for their age or developmental stage.
Eat only a very limited variety or amount of food.
Have difficulty progressing to new textures or advancing feeding skills.
Display challenging or distressing behaviours during meals.
Have difficulty learning age-appropriate self-feeding skills.
Struggle to use cups, straws, utensils, or other feeding equipment expected for their developmental level.
Gag, cough, choke, or show other signs of difficulty while eating or drinking.
Experience poor weight gain, nutritional concerns, or slower-than-expected growth.
Cause mealtimes to become stressful or challenging for the child or family.

What To Expect:

In Assessment:

Every assessment is individualized to your child’s needs and family goals. It typically includes:

A detailed case history, including caregiver questionnaires, medical history, current eating patterns, and mealtime routines.
Review of your child’s food preferences and intake.
Food Diary 7 days – print and log your child’s feeding patterns
An oral mechanism examination to assess the structures and movements involved in eating and swallowing.
Observation of your child eating and drinking familiar foods and liquids (please bring preferred foods and any feeding equipment your child regularly uses).
Recommendations for additional assessment, including an instrumental swallowing assessment (such as a Videofluoroscopic Swallow Study) if clinically indicated.

In Treatment:

Treatment is tailored to each child’s individual strengths, needs, and goals. Depending on your child, therapy may include:

Expanding food variety using evidence-based approaches such as food chaining and systematic food hierarchies.
Developing oral motor skills needed for chewing and safe swallowing.
Teaching strategies to improve swallowing safety and efficiency.
Modifying the mealtime environment to support sensory, behavioural, or motor needs.
Collaborating with other healthcare professionals involved in your child’s care.
Coaching caregivers on practical strategies that can be incorporated into everyday meals.
A Responsive Feeding, Relational Approach that fosters agency and autonomy while respecting the child’s internal cues for hunger, fullness, food preferences, and readiness to try new foods. Family-centred care is central to our approach, with respect for each family’s values, culture, and mealtime traditions.

Frequently Asked Questions

Is my child a picky-eater or is this something more?

If your child is restricted to less than 20 different types of foods, refuses an entire category of food/texture of food, cries or falls apart when introduced to new foods, and does not “re-gain” foods lost to burnout or fatigue, then it is more than “just picky eating” and they will benefit from a feeding assessment.

At what age should I seek help?

You know your child best. If mealtimes have become stressful, your child isn’t progressing with feeding skills as expected, or something just doesn’t feel right, we’re here to help. Early support can make a meaningful difference for both children and their families.

Will my child be forced to eat during therapy?

No! The goal is to reduce pressures on mealtimes and explore different textures and consistencies with curiosity and in fun ways (e.g., making edible play-doh, edible sand, “fishing” for food, etc.). There are many steps to work up toward eating such as tolerating the food (visual presentation on plate), interacting with the food with utensils, smelling, touching, tasting, and THEN eating.

What is a Videofluoroscopic Swallow Study (VFSS), and when is it recommended?

A Videofluoroscopy Swallow Study (VFSS) is warranted when a child is choking or coughing with meals and frequently getting chest infections/pneumonia. During the assessment, the patient is given small amounts of food and liquid of different consistencies. These are mixed with a harmless substance called barium, which allows them to be seen clearly on X-ray.

As the patient swallows, a continuous X-ray video (videofluoroscopy) is recorded. This allows the speech-language pathologist to observe how the muscles involved in swallowing are working and to see how food and liquid move from the mouth through the throat and into the esophagus. It also helps identify whether any material is entering the airway or becoming stuck.

Should we do therapy at home or in the clinic?

Both options have benefits, and the best choice often depends on your child’s needs and therapy goals. Home-based sessions allow us to work within your child’s everyday routines and environment. This can make it easier to practice strategies in real-life situations and support carryover into mealtimes at home. Clinic-based sessions provide a more structured setting with fewer distractions. They also allow access to sensory supports that can be helpful for building new feeding skills. In many cases, a combination of both settings works well, and we can discuss what approach will best support your child.

Do I need a referral?

No, you can simply book an assessment by contacting us via phone, email, or contact form. We can provide you with reports/letters when referring to and collaborating with other healthcare practitioners.