By: Nancy B. Swigert, M.A.,CCC-SLP,BRS-S
You’re worried about your child’s feeding and swallowing skills. Maybe your child is still taking the bottle when her peers are drinking from a cup. Perhaps your child is choking and gagging when eating certain foods. Or maybe your child, who used to take the bottle with no problems, screams every time he sees the bottle and refuses to drink. Or maybe your child has taken the term “picky eater” to new heights; picky doesn’t begin to describe the limited list of foods your child will eat. Perhaps you’ve had to stop taking your child out to eat at restaurants because his tantrums during meal times draw too much attention. Or your child tries new foods, but spits them out and refuses to swallow.
Feeding and swallowing disorders present in a variety of ways. Dealing with a feeding and swallowing disorder can be very frustrating. You worry that perhaps you’ve done something wrong and you’re concerned your child isn’t getting enough nutrition, or is too small for her age. But more frustrating than that is finding the right professional to help your child.
The place to start is to discuss your concerns with your child’s pediatrician, the medical professional who knows the most about your child. However, not all pediatricians are trained to recognize feeding and swallowing problems. There are medical specialists who may need to see your child. For example, if a child is having trouble swallowing because she can’t breathe well due to congestion and difficulty breathing through her nose, an otolaryngologist (ENT) might be the most appropriate professional to see. Sometimes the pediatrician knows exactly which medical professional to recommend. However, many times the pediatrician is uncertain what the cause of the feeding and swallowing problem is, and may send you to several different medical specialists. After consulting with these specialists, you still might not have the answers you seek: why is your child having trouble eating/drinking? What can you do to help your child?
Unless your child’s pediatrician is confident in referring you to another physician specialist, after discussing your concerns with your child’s pediatrician, the next visit should be to a speech-language pathologist who specializes in evaluation and treatment of children with feeding and swallowing problems. After evaluating your child, the speech-language pathologist can help determine if other medical professionals need to see your child. They can help you locate those professionals in your community. Your pediatrician may be able to refer you to the right speech-language pathologist.
Speech-language pathologists hold a master’s or doctoral degree and evaluate and treat children and adults with communication, learning, and feeding/swallowing disorders. Speech-language pathologists work in schools, hospitals, clinics, and private practices. They are certified by the American Speech-Language-Hearing Association (ASHA). That certification indicates they have reached a basic level of competence to work independently.
However, not all speech-language pathologists are experts in evaluation and treatment of swallowing disorders, and even fewer specialize in the evaluation and treatment of infants and children with swallowing problems. You can find speech-language pathologists who specialize in the treatment of children with feeding and swallowing disorders at children’s hospitals, but you will also find them in general medical hospitals, clinics and private practice. The easiest way to know if the speech-language pathologist you have identified really specializes in swallowing is to ask if they are a Board-Certified Specialist in Swallowing and Swallowing Disorders (BCS-S). This designation is awarded by the American Board of Swallowing and Swallowing Disorders (www.swallowingdisorders.org). On this web site you can search to find a board-recognized specialist near you.
If there is not a speech-language pathologist who is a board-recognized specialist near you, you can contact a facility near you by finding one on ASHA’s web page: http://www.asha.org/public/speech/swallowing/. When you contact the facility/practice, ask to speak with the speech-language pathologist who treats children with swallowing disorders. Here are some questions you can ask to help you determine if this SLP has the experience you seek.
- How long have you been a certified speech-language pathologist (SLP)?
- What percent of your time is spent working with children with feeding/swallowing disorders?
- What types of feeding/swallowing problems have you treated?
- After describing your child’s particular challenges, ask the SLP what the first steps would be in evaluating your child.
The answers to these questions will help you decide if you are comfortable taking your child to this SLP for an assessment.