There are 3 phases to feeding: Oral phase, Pharyngeal phase, and Esophageal phase

Oral phase of feeding includes the intake of food into the mouth, chewing, and moving the bolus to the back of the mouth in preparation for swallowing. This phase requires full voluntary control. Therefore, it is the only phase that can be addressed in therapy. The pharyngeal and esophageal phases are involuntary. 

Factors that influence feeding

There are multiple factors that influence the oral phase of feeding.  These may be medical nutritional, and/or sensorimotor.

Medical influence on feeding 

  • Illness
  • Neurologic: Brainstem and cortical centers, Sensory, Neurochemical
  • Cardiac Disorder
  • Respiratory Disorder
  • Gastrointestinal Disorder
  • Allergies

Nutritional influences on feeding 

  • Allergies
  • Caloric intake
  • Food-drug interaction
  • Transition from tube feeding to oral feeding
  • Sensory food choices

Sensory-Motor Influences on Feeding

  • Tone
  • Structure
  • Sensory Issues: Hyper, Hypo, Mixed
  • Hypersensitivity- an overreaction to tactile input.
  • Hyposensitivity-a under reaction to tactile input.
  • Mixed sensitivity- any combination of normal sensitivity, hypo, or hyper.
  • Fluctuating tactile sensitivity- responses that change over time.

What are feeding Problems?

  • Inadequate caloric intake resulting in failure to thrive
  • Food refusal
  • Bottle dependence
  • Failure to advance in textures
  • Food selectivity 
  • Pharyngeal dysfunction: cough, choke, gag
  • Vomiting

What is a therapeutic feeding program?    

The goal of a therapeutic feeding program is to develop a set of techniques that support safe feeding and maximize a patient’s postural stability, muscle tone, sensory processing, and oral sensory motor skills. 

What is the goal of a feeding program?

  1. To ensure your child gets adequate nutrition
  2. To ensure your child develops the sensory-motor skills required to support safe and effective eating.

Is your child a picky eater? 

Behavioral issues are rarely the cause of feeding issues, but rather the result of underlying factors. Often sensory motor in nature. 

A successful therapeutic feeding program requires the clinician to identify sensory motor factors, refer to a specialist when necessary, and address sensory motor factors.

Oral Motor Intervention

Work on striated muscles which improve range of motion and/or strength via interventions which are graded and controlled to move the muscle group through a full range of activation.

Goals of Oral-Motor/ Feeding therapy are: 

  • To work on normal/typical movement patterns
  • To normalize oral sensitivity
  • To increase awareness of the oral mechanism
  • To improve feeding skills and nutritional intake: chewing, straw drinking, and cup drinking. 

Dina has specialized Oral Motor and Feeding training from leading experts in the field, some of which are:  

Beckman Oral Motor, Lori Overland, Sara Rosenfeld Johnson, Susan Evens Morris, Rona Alexander, Katherine Shaker, and Mary Tarbell of the nationally known Encouragement Feeding program at the University of Virginia.  She has also trained at the Center for Pediatric Feeding and Swallowing at St. Joseph’s Children’s Hospital. 

Dina has extensive experience in feeding therapy. She has been treating infants and toddlers with all types of feeding issues. She is deeply passionate about treating medically complex children due to various genetic syndromes such as CHARGE, Prader Willi, Down, Pierre Robin, Kleefstra, Trisomy 13, and Rett.