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Pediatric Feeding and Swallowing Difficulties: Behavioral Aversions and Inadequate Chewing

Updated: Aug 9, 2023

Mother trying to feed a kid with pediatric feeding and swallowing difficulties

This case study focuses on a child, whose identity remains anonymous for privacy reasons, who presented with feeding and swallowing difficulties. The child's parents sought our assistance when the child was 8 years old due to concerns that he consistently swallowed food without chewing it. The mother, initially skeptical about the effectiveness of feeding therapy for a child of this age, had already tried various home remedies to address the issue. The child faced social challenges, including bullying from peers at school during lunchtime, and had developed behavioral aversions towards trying new foods and eating in public settings. The primary goal of the intervention was pediatric swallowing and feeding assessment and management.

Evaluation and Diagnosis

During a comprehensive evaluation, we identified both oromotor and orosensory issues in the child. As a coping mechanism, the child had learned to swallow food without chewing, leading to difficulties with biting and managing food within the oral cavity. Additionally, when forced to eat beyond his comfort, he would vomit. These challenges had significantly impacted the child's social interactions and caused withdrawal from social scenarios.

Treatment approach and progress for pediatric feeding and swallowing difficulties

Our intervention plan focused on a gradual progression of chewing skills and improving orosensory perception while also addressing the child's behavioral aversions. Through periodic counseling sessions, we aimed to boost the child's confidence and reduce anxieties related to feeding. Due to the child's typical development in other areas, such as cognitive skills, he was able to engage in exercises from the first session and readily follow instructions.

Initially, our goal was to stabilize the jaw and disassociate it from the lips and tongue, a milestone achieved after 10 sessions. By sessions 20-22, the child had acquired the ability to bite small pieces of food and engage in the up-down motion of the jaw required for chewing. We gradually introduced finger foods and progressed to include fruits like bananas and papayas for breakfast. By the end of sessions 34-35, the child successfully chewed boiled and cooked vegetables. Notably, a significant milestone was reached when the child eagerly consumed a poori, which brought joy and satisfaction to both the child and his father. Subsequently, we continued therapy for another 10-15 sessions to address behavioral and orosensory challenges related to other vegetables and fruits. Progressing further, we introduced rice and curry, typical South Indian food, as part of the child's diet.

Conclusion of pediatric swallowing and feeding assessment and management

This case study exemplifies the successful intervention for a child with feeding and swallowing difficulties, accompanied by behavioral aversions and inadequate chewing skills. Through a systematic approach targeting oromotor and orosensory issues, as well as the child's emotional well-being, we were able to address the child's feeding challenges. The child's gradual progress in chewing skills, along with reduced behavioral aversions, resulted in an improved feeding experience and increased participation in social scenarios. The collaboration between therapists, parents, and the child played a crucial role in achieving these positive outcomes, allowing the child to enjoy a more diverse and satisfying diet while fostering social integration.

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