Feeding A Child With Dysphagia (Difficulty Swallowing)
Advice on feeding a child who has difficulty swallowing.
By Barb Wagner
First off, give your child a big table spoon with a big old scoop of French Vanilla Icing on it. (Just buy those ready to spread icing tins at the store.) You'll have him eating out of a spoon before you know it.
We made eating a game and when we'd be cooking we'd let them just "play" with whatever. (I can hear people cringing as I type but it works.) Cooked Noodles are great (such as, elbow noodles, small and medium shell noodles, small tubes etc.) and they are slippery enough that it helps to use a spoon.
Lar used to play "Highchair Hockey" with both kids and they thought it was just hillarious...
"He skates up the ice with the noodle (shifting the noodle-puck from one side of the spoon to the other)....
He scoops it up...
He shoots....the crowd roars (whaaaaaaaa)
HE SCORES! (and into the mouth it goes)"
Just throw 2 or 3 cooked noodles onto the tray of his highchair and give him a spoon to experiment with how to pick them up. Show him that the spoon is a "tool" in the kitchen and that it makes things much yummier and "fun" to use. Let him paint with chocolate pudding on his highchair tray. Allow him to eat the pudding off of the spoon but act silly and don't let him put the "pudding fingers" in his mouth, just the spoon. Pull his fingers away and direct the pudding spoon in his other hand, toward his mouth to see if he gets the idea...repeat this over an over.
People on dysphagia diets need to have the kinds of foods that are not too runny, or not too sticky which leaves very little in the middle to chose from. The reason for the 'not too runny and not too sticky' diet is that they have limited control of the muscles of the lips, cheeks, mouth, tongue and throat and/or limited sensation. They have difficulty in:
- creating a bolus (ball) of food,
- moving the bolus of food around in the mouth and keeping it moving toward the rear of the mouth, and
- coordinating swallowing without choking or feeling like they are going to choke
Children often choose to eat things like Fritos, which doesn't seem so odd when you think of what it's like to eat them. They are solid but when chewed the cornmeal stays quite coarse and so it is easy for him to form a bolus of food. You may find that if you have your child him tested that he has better use of his rear portion of his mouth than the front, hence chewing crisp chips is more appropriate for him. And lastly the cornmeal is firm but not sticky. Thus it is good for swallowing and the coarseness of it makes it easier for him to identify the location of the food for proper swallowing pattern if he has any kind of loss of sensation. Let's not forget the salt, the salt taste receptors are very strong, particularly in children.
You will eventually want to be giving him more quality calories as he enters greater growth spurts. There are products you can buy at the drugstore that you can add to foods that you are calling "sticky" (ie. mashed potatoes, sweet potatoes etc...) that makes it more of a consistency for swallowing. The only thing is the consistency is nice but it makes the foods more bland as you are adding (usually) yet another starch to the mix. Your local hospital/dietician can set you up with recipes and little tricks to deal with making "normal" food into a consistency that he can deal with much better.
If you suspect your child need a dysphagia diet, your best bet is to have him tested and to get a proper diet and recipes from a qualified dietician. If you have a major medical facility in your area, the might even have a pediatric dietician who will know very detailed recipes especially for children. In the meantime, experiment.
Try feeding him different things, make it a game and if he spits stuff out, just shove it aside. Try a whole tray of fruit first and see what fruit best suits his chewing needs. Try letting him/ or putting the fruit in the rear of his mouth between the cheek and the molars and see how he manages as opposed to "him" putting something in the front of his mouth. Then if he can't handle a "chunk" of fruit, take a fork and lightly squish it, but not break the piece of fruit (canned papaya, pears, or peaches work best) and put it the same way into the back of his mouth between the cheek and molars.Watch how he manipulates the food with his tongue and how he coordinates his tongue and chewing movements, then if he does swallow, watch how he does it. It is easiest to buy those little snack pack fruits to do this experiment, they are already cut up nice and tiny and you don't have to waste food if he doesn't like it. Try different textured cheeses (cottage cheese to a medium to a hard cheese) and see what he handles best. Meat is a tricky one but you might find a meatball with a gravy or tomato sauce is best if the meatball is made with some ground vegies and lots of cracker and eggs to hold it together. The texture will be softer than whole meat and much moister for making a bolus and moving it about. If he "is" having trouble moving his food from the front to back of the mouth, just teach him how to "put it" in the back, he can learn with his fingers first and later work on utensils (kids never eat with untensils in front of each other anyways, so you won't have to worry about his little friends bothering him about his dexterity when he's in mixed company as he gets older).