Treatment for Dysphagia: A Speech Language Pathologist’s Perspective

  • Laura Brooks


Management of pediatric dysphagia is extremely complex and often requires a multidisciplinary approach. Children with dysphagia are at increased risk for developing respiratory compromise, failure to thrive, feeding refusal, and stressful interactions with their caregivers [1]. Etiologies of dysphagia may evolve from five broad diagnostic categories:

Neurologic (i.e., prematurity, central nervous system conditions)

Respiratory and other conditions impacting suck-swallow-breathe coordination (i.e., respiratory syncytial virus, bronchopulmonary dysplasia, cardiac disease)

Gastrointestinal (i.e., reflux)

Anatomic abnormalities of the aerodigestive tract (i.e., craniofacial abnormalities, vocal fold hypomobility, laryngeal cleft)

Other or unknown [1–4]

When planning treatment for an individual with dysphagia, it is critical to understand the medical history as it impacts feeding. The treatment strategies must target the etiology of the impairment as well as the symptoms that are associated with the dysphagia diagnosis/etiology. The therapist must ask: Why do these impairments exist? What is my rationale for therapy? What impact does the underlying disease have? What is developmentally appropriate for this child?


Pediatric Feeding Strategies Recommendations Aspiration Thickening 


  1. 1.
    Lefton-Greif MA. Pediatric dysphagia. Phys Med Rehabil Clin N Am. 2008;19(4):837–51.CrossRefGoogle Scholar
  2. 2.
    Gewolb IH, Vice FL. Abnormalities in the coordination of respiration and swallow in preterm infants with bronchopulmonary dysplasia. Dev Med Child Neurol. 2006;48(07):595–9.CrossRefGoogle Scholar
  3. 3.
    Khoshoo V, Edell D. Previously healthy infants may have increased risk of aspiration during respiratory syncytial viral bronchiolitis. Pediatrics. 1999;104(6):1389–90.CrossRefGoogle Scholar
  4. 4.
    Sheikh S, Allen E, Shell R, Hruschak J, Iram D, Castile R, McCoy K. Chronic aspiration without gastroesophageal reflux as a cause of chronic respiratory symptoms in neurologically normal infants. Chest J. 2001;120(4):1190–5.CrossRefGoogle Scholar
  5. 5.
    Arvedson JC. Swallowing and feeding in infants and young children. GI Motil. 2006;
  6. 6.
    Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, Maxwell R, Blair J. MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia. 2008;23(4):392–405.CrossRefGoogle Scholar
  7. 7.
    Coyle JL. Dysphagia following prolonged endotracheal intubation: is there a rule of thumb? Dysphagia. 2014;23(2):80–6.Google Scholar
  8. 8.
    Eber E, Zach MS. Long term sequelae of bronchopulmonary dysplasia (chronic lung disease of infancy). Thorax. 2001;56(4):317–23.CrossRefGoogle Scholar
  9. 9.
    Johnston ID, Strachan DP, Anderson HR. Effect of pneumonia and whooping cough in childhood on adult lung function. N Engl J Med. 1998;338(9):581–7.CrossRefGoogle Scholar
  10. 10.
    Lefton-Greif MA, McGrath-Morrow SA. Deglutition and respiration: development, coordination, and practical implications. InSemin Speech Lang. 2007;28(03):166–79.CrossRefGoogle Scholar
  11. 11.
    Shaheen SO, Barker DJ, Shiell AW, Crocker FJ, Wield GA, Holgate ST. The relationship between pneumonia in early childhood and impaired lung function in late adult life. Am J Respir Crit Care Med. 1994;149(3):616–9.CrossRefGoogle Scholar
  12. 12.
    Von Mutius E. Paediatric origins of adult lung disease. Thorax. 2001;56(2):153–7.CrossRefGoogle Scholar
  13. 13.
    Rogers B, Arvedson J. Assessment of infant oral sensorimotor and swallowing function. Dev Disabil Res Rev. 2005;11(1):74–82.Google Scholar
  14. 14.
    Ross ES, Philbin MK. Soffi: an evidence-based method for quality bottle-feedings of preterm, ill, and fragile infants. J Perinat Neonatal Nurs. 2011;25(4):349–59.CrossRefGoogle Scholar
  15. 15.
    Shaker C. Cue-based feeding in the NICU: using the infant’s communication as a guide. Neonatal Netw. 2013;32(6):404–8.CrossRefGoogle Scholar
  16. 16.
    Hawdon JM, Beauregard N, Slattery J, Kennedy G. Identification of neonates at risk of developing feeding problems in infancy. Dev Med Child Neurol. 2000;42(4):235–9.CrossRefGoogle Scholar
  17. 17.
    Van der Meer A, Holden G, Van der Weel R. Coordination of sucking, swallowing, and breathing in healthy newborns. J Pediatr Neonatol. 2005;1(2):69–72.Google Scholar
  18. 18.
    Bamford O, Taciak V, Gewolb IH. The relationship between rhythmic swallowing and breathing during suckle feeding in term neonates. Pediatr Res. 1992;31(6):619–24.CrossRefGoogle Scholar
  19. 19.
    Thoyre SM, Holditch-Davis D, Schwartz TA, Roman CR, Nix W. Coregulated approach to feeding preterm infants with lung disease: effects during feeding. Nurs Res. 2012;61(4):242–51; Thurlbeck WM. Postnatal human lung growth. Thorax. 1982;37(8):564–71CrossRefGoogle Scholar
  20. 20.
    Law-Morstatt L, Judd DM, Snyder P, Baier RJ, Dhanireddy R. Pacing as a treatment technique for transitional sucking patterns. J Perinatol. 2003;23(6):483–8.CrossRefGoogle Scholar
  21. 21.
    Clark L, Kennedy G, Pring T, Hird M. Improving bottle feeding in preterm infants: investigating the elevated side-lying position. Infant. 2007;3(4):154–8.Google Scholar
  22. 22.
    Park J, Thoyre S, Knafl GJ, Hodges EA, Nix WB. Efficacy of semielevated side-lying positioning during bottle-feeding of very preterm infants: a pilot study. J Perinat Neonatal Nurs. 2014;28(1):69–79.CrossRefGoogle Scholar
  23. 23.
    Dawson JA, Myers LR, Moorhead A, Jacobs SE, Ong K, Salo F, Murray S, Donath S, Davis PG. A randomised trial of two techniques for bottle feeding preterm infants. J Paediatr Child Health. 2013;49(6):462–6.CrossRefGoogle Scholar
  24. 24.
    Lau C. Is there an advantage for preterm infants to feed orally in an upright or sidelying position? J Neonatal Nurs. 2013;19(1):28–32.CrossRefGoogle Scholar
  25. 25.
    Thach BT, Stark AR. Spontaneous neck flexion and airway obstruction during apneic spells in preterm infants. J Pediatr. 1979;94(2):275–81.CrossRefGoogle Scholar
  26. 26.
    Kummer A. Cleft palate & craniofacial anomalies: effects on speech and resonance. Nelson Educ. 2013:149.Google Scholar
  27. 27.
    Tobin JM, McCloud P, Cameron DJ. Posture and gastro-oesophageal reflux: a case for left lateral positioning. Arch Dis Child. 1997;76(3):254–8.CrossRefGoogle Scholar
  28. 28.
    Elser HE. Positioning after feedings: what is the evidence to reduce feeding intolerances? Adv Neonatal Care. 2012;12(3):172–5.CrossRefGoogle Scholar
  29. 29.
    van Wijk MP, Benninga MA, Dent J, Lontis R, Goodchild L, McCall LM, Haslam R, Davidson GP, Omari T. Effect of body position changes on postprandial gastroesophageal reflux and gastric emptying in the healthy premature neonate. J Pediatr. 2007;151(6):585–90.CrossRefGoogle Scholar
  30. 30.
    Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: updated 2016 recommendations for a safe infant sleeping environment. Pediatrics. 2016;138:e20162938.CrossRefGoogle Scholar
  31. 31.
    Chang YJ, Lin CP, Lin YJ, Lin CH. Effects of single-hole and cross-cut nipple units on feeding efficiency and physiological parameters in premature infants. J Nurs Res. 2007;15(3):215–23.CrossRefGoogle Scholar
  32. 32.
    Hwang YS, Lin CH, Coster WJ, Bigsby R, Vergara E. Effectiveness of cheek and jaw support to improve feeding performance of preterm infants. Am J Occup Ther. 2010;64(6):886–94.CrossRefGoogle Scholar
  33. 33.
    Foster JP, Psaila K, Patterson T. Non-nutritive sucking for increasing physiologic stability and nutrition in preterm infants. Cochrane Database Syst Rev. 2016;10:CD001071.PubMedGoogle Scholar
  34. 34.
    Zhang Y, Lyu T, Hu X, Shi P, Cao Y, Latour JM. Effect of nonnutritive sucking and oral stimulation on feeding performance in preterm infants: a randomized controlled trial. Pediatr Crit Care Med. 2014;15(7):608–14.CrossRefGoogle Scholar
  35. 35.
    Lessen BS. Effect of the premature infant oral motor intervention on feeding progression and length of stay in preterm infants. Adv Neonatal Care. 2011;11(2):129–39.CrossRefGoogle Scholar
  36. 36.
    Barlow SM. Oral and respiratory control for preterm feeding. Curr Opin Otolaryngol Head Neck Surg. 2009;17(3):179.CrossRefGoogle Scholar
  37. 37.
    Da Costa SP, van Den Engel-Hoek L, Bos AF. Sucking and swallowing in infants and diagnostic tools. J Perinatol. 2008;28(4):247–57.CrossRefGoogle Scholar
  38. 38.
    Omer IM, Ibrahim NG, Nasr AM. Oxygen therapy in neonatal intensive care units in Khartoum State. Sudan J Paediatr. 2015;15(2):49–51.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Richter GT. Management of oropharyngeal dysphagia in the neurologically intact and developmentally normal child. Curr Opin Otolaryngol Head Neck Surg. 2010;18(6):554–63.CrossRefGoogle Scholar
  40. 40.
    Prasse JE, Kikano GE. An overview of pediatric dysphagia. Clin Pediatr. 2009;48(3):247–51.CrossRefGoogle Scholar
  41. 41.
    Logemann JA. Behavioral management for oropharyngeal dysphagia. Folia Phoniatr Logop. 1999;51(4–5):199–212.CrossRefGoogle Scholar
  42. 42.
    Clark HM. Neuromuscular treatments for speech and swallowing: a tutorial. Am J Speech Lang Pathol. 2003;12(4):400–15.CrossRefGoogle Scholar
  43. 43.
    Sheppard JJ. The role of oral sensorimotor therapy in the treatment of pediatric dysphagia. Dysphagia. 2005;14(2):6–10.Google Scholar
  44. 44.
    Bachmeyer MH. Treatment of selective and inadequate food intake in children: a review and practical guide. Behav Anal Pract. 2009;2(1):43.CrossRefGoogle Scholar
  45. 45.
    Cichero JA. Thickening agents used for dysphagia management: effect on bioavailability of water, medication and feelings of satiety. Nutr J. 2013;12(1):54.CrossRefGoogle Scholar
  46. 46.
    Arvedson JC. Management of pediatric dysphagia. Otolaryngol Clin N Am. 1998;31(3):453–76.CrossRefGoogle Scholar
  47. 47.
    Kumin L, Von Hagel KC, Bahr DC. An effective oral motor intervention protocol for infants and toddlers with low muscle tone. Infant Toddler Intervention. 2001;11(3/4):181–200.Google Scholar
  48. 48.
    Suiter DM, Leder SB, Karas DE. The 3-ounce (90-cc) water swallow challenge: a screening test for children with suspected oropharyngeal dysphagia. Otolaryngol Head Neck Surg. 2009;140(2):187–90.CrossRefGoogle Scholar
  49. 49.
    Bronson-Lowe C, Leising K, Bronson-Lowe D, Lanham S, Hayes S, Ronquillo A, Blake P. Effects of a free water protocol for patients with dysphagia. Dysphagia. 2008;23(4):430.Google Scholar
  50. 50.
    Dantas RO, Kern MK, Massey BT, Dodds WJ, Kahrilas PJ, Brasseur JG, Cook IJ, Lang IM. Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing. Am J Physiol. 1990;258(5):G675–81.PubMedGoogle Scholar
  51. 51.
    Coon ER, Srivastava R, Stoddard GJ, Reilly S, Maloney CG, Bratton SL. Infant videofluoroscopic swallow study testing, swallowing interventions, and future acute respiratory illness. Hosp Pediatr. 2016;6(12):707–13.CrossRefGoogle Scholar
  52. 52.
    Gosa MM, Corkins MR. Necrotizing enterocolitis and the use of thickened liquids for infants with dysphagia. Dysphagia. 2015;24(2):44–9.Google Scholar
  53. 53.
    Garcia JM, Chambers E, Matta Z, Clark M. Viscosity measurements of nectar-and honey-thick liquids: product, liquid, and time comparisons. Dysphagia. 2005;20(4):325–35.CrossRefGoogle Scholar
  54. 54.
    Tutor JD, Gosa MM. Dysphagia and aspiration in children. Pediatr Pulmonol. 2012;47(4):321–37.CrossRefGoogle Scholar
  55. 55.
    Weir K, McMahon S, Chang AB. Restriction of oral intake of water for aspiration lung disease in children. Cochrane Database Syst Rev. 2005;(4):CD005303.Google Scholar
  56. 56.
    Cichero JA, Nicholson TM, September C. Thickened milk for the management of feeding and swallowing issues in infants: a call for interdisciplinary professional guidelines. J Hum Lact. 2013;29(2):132–5.CrossRefGoogle Scholar
  57. 57.
    Ferrara L, Bidiwala A, Sher I, Pirzada M, Barlev D, Islam S, Rosenfeld W, Crowley CC, Hanna N. Effect of nasal continuous positive airway pressure on the pharyngeal swallow in neonates. J Perinatol. 2017;37:398–403.CrossRefGoogle Scholar
  58. 58.
    Leder SB, Siner JM, Bizzarro MJ, McGinley BM, Lefton-Greif MA. Oral alimentation in neonatal and adult populations requiring high-flow oxygen via nasal cannula. Dysphagia. 2016;31(2):154–9.CrossRefGoogle Scholar
  59. 59.
    Perlman AL, Luschei ES, Du Mond CE. Electrical activity from the superior pharyngeal constrictor during reflexive and nonreflexive tasks. J Speech Lang Hear Res. 1989;32(4):749–54.CrossRefGoogle Scholar
  60. 60.
    Illingworth RS, Lister J. The critical or sensitive period, with special reference to certain feeding problems in infants and children. J Pediatr. 1964;65(6):839–48.CrossRefGoogle Scholar
  61. 61.
    Janahi IA, Elidemir O, Shardonofsky FR, Abu-Hassan MN, Fan LL, Larsen GL, Blackburn MR, Colasurdo GN. Recurrent milk aspiration produces changes in airway mechanics, lung eosinophilia, and goblet cell hyperplasia in a murine model. Pediatr Res. 2000;48(6):776–81.CrossRefGoogle Scholar
  62. 62.
    Simon M, Collins MS. The pediatric lung and aspiration. Dysphagia. 2013;22(4):142–54.Google Scholar
  63. 63.
    Karim RM, Momin IA, Lalani II, Merchant SS, Sewani AA, Hassan BS, Mahmood N. Aspiration pneumonia in pediatric age group: etiology, predisposing factors and clinical outcome. JPMA. 1999;49(4):105–8.Google Scholar
  64. 64.
    Thach BT. Maturation and transformation of reflexes that protect the laryngeal airway from liquid aspiration from fetal to adult life. Am J Med. 2001;111(8):69–77.CrossRefGoogle Scholar
  65. 65.
    Mizuno K, Ueda A, Takeuchi T. Effects of different fluids on the relationship between swallowing and breathing during nutritive sucking in neonates. Neonatology. 2002;81(1):45–50.CrossRefGoogle Scholar
  66. 66.
    Weir K, McMahon S, Barry L, Ware R, Masters IB, Chang AB. Oropharyngeal aspiration and pneumonia in children. Pediatr Pulmonol. 2007;42(11):1024–31.CrossRefGoogle Scholar
  67. 67.
    Taniguchi MH, Moyer RS. Assessment of risk factors for pneumonia in dysphagic children: significance of videofluoroscopic swallowing evaluation. Dev Med Child Neurol. 1994;36(6):495–502.CrossRefGoogle Scholar
  68. 68.
    Nativ-Zeltzer N, Kuhn MA, Imai DM, Traslavina RP, Domer AS, Litts JK, Adams B, Belafsky PC. The effects of aspirated thickened water on survival and pulmonary injury in a rabbit model. Laryngoscope. 2018;128(2):327–31.CrossRefGoogle Scholar
  69. 69.
    Arvedson J, Rogers B, Buck G, Smart P, Msall M. Silent aspiration prominent in children with dysphagia. Int J Pediatr Otorhinolaryngol. 1994;28(2–3):173–81.CrossRefGoogle Scholar
  70. 70.
    Tutor JD. Dysphagia and aspiration in the pediatric patient. Dysphagia. 2001;10(2):6–9.Google Scholar
  71. 71.
    Jadcherla SR, Wang M, Vijayapal AS, Leuthner SR. Impact of prematurity and co-morbidities on feeding milestones in neonates: a retrospective study. J Perinatol. 2010;30(3):201–8.CrossRefGoogle Scholar
  72. 72.
    Park J, Knafl G, Thoyre S, Brandon D. Factors associated with feeding progression in extremely preterm infants. Nurs Res. 2015;64(3):159–67.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Laura Brooks
    • 1
  1. 1.Department of RehabilitationChildren’s Healthcare of AtlantaAtlantaUSA

Personalised recommendations