Nurturing Children with Feeding and Swallowing Problems

• By:  Paul Stefko
• Posted:  July 19, 2017
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Speech language pathologist C. Renèe Gwin has spent nearly 20 years helping children with speech issues, and with something that most of us take for granted: eating. Gwin’s company, NURTURE Feeding and Communication Support, provides the specialized therapy these children need — in the comfort of the family home.

Gwin discovered her calling to therapy during her undergraduate education at Geneva College and her masters work at Clarion University. “I found I had a passion for helping people communicate,” she says. “It’s such an important part of our life: that we can express ourselves and really share who we are.”

Much of her early career involved working in clinics. She says she noticed that “although I was able to help kids in that setting, it was sometimes difficult for them to transfer what they were doing in the clinic to their home environment.”

She founded her company to address this challenge. “We start right in the home, and we work through all of the issues around feeding and swallowing in their home,” she explains. “The family is there with us and can participate — so we don’t have that extra step where what is learned in a therapeutic setting has to be transferred to the home environment.”

Common Feeding Problems and Warning Signs

Gwin says that feeding and swallowing problems may be related to a number of conditions, including anatomical issues, negative or traumatic experiences, or autism spectrum disorders (see sidebar), and they can occur at different ages or stages of development.

“We could see a newborn that is having difficulty latching onto a bottle or with nursing,” she says. “As children transition from formulas or breast milk to more solid foods, sometimes they have difficulty with those textures. Or kids may not have the appropriate oral motor skills to move foods in their mouths and chew. Most people don’t think about this, but there is a lot that goes into moving food from side to side within the mouth and creating what we call a bolus, which is the food that is actually swallowed.”

Gwin says there are some basic signs that should alert parents to feeding problems: “With a baby or newborn, the most visible thing is seeing them struggle when they go to feed, turning their head or refusing food. Even if there’s nothing obvious like that, another warning sign would be that the baby’s not gaining weight.”

Similarly, older children may present a clear sign like frequent gagging or vomiting. But Gwin says feeding and swallowing problems may also manifest in other behaviors. “Children may become very anxious around food. Or as soon as food comes out they run away, or they refuse to come to the table,” she explains.

She emphasizes that not every undesirable behavior is a sign of a bigger problem, and an occasional bad reaction to food isn’t necessarily cause for worry. “In typical feeders, you may see a little gagging when a baby first tries foods, and then that decreases as they adjust to it,” she says. “And some kids are just picky eaters, especially early on — they may react badly to certain foods or say they don’t like them, but then come back and try again when they are older.”

Treatments and Therapies

Gwin’s in-home services for children and families touch on several areas: feeding and swallowing therapy; occupational therapy; speech therapy and language therapy; and pediatric massage therapy. The first step in every case is a thorough evaluation. “My evaluations are usually about two hours,” she says. “I want to get a full view of everything that’s going on with the child before we talk about how to proceed.”

Both feeding therapy and occupational therapy are used to address issues around food. Gwin notes that there are many variables in teaching a child how to interact better with food. “It may be working with the child to develop oral motor skills, but that’s just part of the whole experience,” she says. “A lot of older kids say they’re afraid of the food, so we may be working on building self-esteem and confidence. Trust may be an issue. Some kids have had a lot of medical procedures, and maybe someone told them, ‘it’s not going to hurt,’ and then it did hurt. Or parents may have been hiding one food inside another to try to get a child to eat something. When trust breaks down, it has a real impact, so we need to take steps to rebuild that trust.”

Another technique Gwin uses is “chaining.” She explains that a common problem is that a child will only eat a specific food, and isn’t getting enough nutrition. “We’ll look at the food that the child eats — its color, texture, shape — then find foods that are appropriate for nutrition and share at least some of the same qualities,” she says. “We move through the process that way, gradually expanding what they’re comfortable with by tying in the qualities of foods they already eat.”

With speech and language therapy, some of the same issues may be involved, but here the focus is on overcoming difficulty communicating. “Some kids we work with have expressive language disorder, which means they have a difficult time putting words together to express their needs,” Gwin says. “Other children may be diagnosed with apraxia — that’s a motor planning problem. And some kids may need assistive technology devices — we can work with the family to find the most effective device to help their child communicate.”

Pediatric massage therapy is a more recent addition to Gwin’s business. In some cases, this is used to complement efforts to overcome a feeding or swallowing problem. But Gwin says pediatric massage is proving valuable in a wide range of areas, from “dealing with stress and anxiety, to injuries from sports or dancing, to pain issues such as arthritis.”

The Message to Families: There Is Help and Hope

The issues that Gwin deals with are hard on families as well as the child involved. When a child has a feeding problem, for example, it can make meals very stressful for the whole family. Or a family may eat the same foods all of the time because of what a child is willing to eat — and end up compromising their nutrition. For some families, a child’s struggles may mean that going out to eat isn’t an option.

Gwin says it’s important for families to know that help is available — and can make a real difference in health and quality of life for the child and the family. She adds that there is a longer-term payoff to doing therapeutic work as well. “We are social beings, and a lot of our events and interactions involve food,” she points out. “When kids struggle with food, it will create more and more stressful situations as they get older. If we can build the skills and address the issues around food, we remove those challenges from their future.”

She says she has seen children make great progress even in difficult, complex cases. As one example, she talked about a child that was adopted who had cleft palate and cleft lip issues and was on the autism spectrum.

“When I started seeing her, she would only eat two foods — yogurt and pumpkin pie filling — and she would only eat from her nanny,” Gwin says. “On weekends, she wouldn’t eat at all because the nanny wasn’t with the family. She was very averse to touch — I could only touch her toes at first. But we worked together and eventually she let me touch her face and work with her scars — she had pretty dramatic scarring from her cleft lip surgery.

“Now she is able to eat orally, she drinks from a cup, and she eats a very diverse soft diet,” Gwin says. “She had a lot going on, but she’s made amazing progress. It’s been a great journey with her.”

In talking to Gwin, it’s very clear that her career is a true calling. “I love my work,” she says. “I’ve found my passion — I know what I’m to do in life, and it’s this.”