What would you say if a graduate student or clinical fellow asked you to explain the difference between a feeding/swallowing disorder and an eating disorder for pediatric patients? As a pediatric feeding and swallowing specialists, I answer this question with, “It’s complicated.”
Often, an overriding medical issue—such as gastrointestinal issues or poor oral strength and coordination due to prematurity—causes feeding and swallowing disorders. As medical issues resolve, feeding and swallowing issues can persist. And, over time, these issues could gradually change from medically based issues to increasingly behaviorally based.
Speech-language pathologists working in pediatric dysphagia constantly assess and reassess the nature of the feeding/swallowing issues and how they change. Was the problem clearly dysphagia at first, for example, but after a few months of treatment became more of a feeding difficulty? For older children, can they now explain an overarching fear with eating?
I ask myself many questions after each outpatient visit with a patient and their family: Are there any new gastrointestinal issues? How did the appointment go? When is the next one? How was the visit to the pulmonologist? Were any tests ordered? How are things going during the school lunch time? How does intake look in this setting?
Advocating for the child by reviewing these issues with parents is an integral part of all my outpatient sessions.
Slowly, as children get older, weekly appointments become monthly and then just annual follow-ups. Perhaps Benji resolved symptoms of his pyloric stenosis (stomach issues in babies causing severe vomiting) or Macy’s bronchopulmonary dysplasia (lung disease prevalent in premature newborns) diagnosis may be less evident as lung function matured.
However, their food repertoire remains limited or they only express thin liquid from a bottle. All the negative experiences with the pain or discomfort associated with meals cause some scars.
To be the best detective in discovering if a feeding/swallowing disorder evolved into an eating disorder, try these strategies:
- Help the caregiver learn what to look for in their child’s medical changes and understand the results of testing.
- Build communication into feeding and swallowing sessions. Understanding the parents’ perspective—and the child’s if possible—should guide treatment approaches.
- Gain an understanding of those root causes and how they shaped the feeding and swallowing issues, no matter how old the child is when you start treatment.
- Be prepared to adjust treatment or make a referral as you learn new information. Parents or caregivers are probably just as—or more concerned—by any new tests or medical details. Answer their questions, share resources, and help them understand and manage their baby’s evolving diagnosis.
- Keep lines of communication open with area professionals involved in feeding and swallowing disorders. Creating an interprofessional network will help you find out the child’s medical issues and treatments, as well as be able to offer referrals you trust to the parents.
In addition to communicating with caregivers and other professionals, learning the signs and symptoms of common eating disorders helps us detect if a feeding and swallowing disorder has begun to evolve into a feeding and swallowing disorder with eating disorder components.
A great tool for this is the Diagnostic and Statistical Manual of Mental Disorders (DSM). A publication of the American Psychiatric Association, the DSM contains sets of symptoms potentially experienced by someone with an eating disorder. Those symptoms are grouped into categories by disorder to help clinicians with effective diagnoses and care of people with eating disorders. Some common examples of eating disorders include anorexia nervosa, bulimia nervosa, binge-eating disorder, pica, rumination disorder, and avoidant/restrictive food intake disorder.
Managing feeding and swallowing disorders in young children can be a complicated journey involving an ongoing recalibration of the disorder we are treating. Keeping the lines of communication open between children, parents/caregivers, and local teams of professionals is our best treatment strategy.
Jennifer Wilson, MA, CCC-SLP, is a clinical instructor at the University of Tennessee Health Science Center. She has more than 20 years’ experience serving clients with pediatric dysphagia in a variety of settings. She is also an affiliate of ASHA Special Interest Group 13, Swallowing and Swallowing Disorders. firstname.lastname@example.org