Ask a Feeding Specialist

Cindy Dobbelsteyn, M. Sc, SLP (c) is the Assistant Professor, School of Human Communication Disorders at Dalhousie University and is the feeding specialist at  IWK Health Center in Halifax.  Her research will be coming out in late May or early June in "Dysphagia, Vol. 20 and is titled:  "Early Oral Sensory Experiences and Feeding Development in children with CHARGE Syndrome:  A report of five cases."

Question:  I have a 5 year old child that takes nothing by mouth and has some verbal skills. Oral motor stimulation is being done by SLT and OT.  Should we continue? Is there a critical window to move to oral feeding, ie. tests should be done?

Answer:  This is not an unusual situation that you are in.  Children with CHARGE have a real problem getting onto oral feeding.  We still are not sure why.  Although some studies suggest there is a crital period, about 18 months for introduction (Lister), many children with CHARGE Syndrome are well beyond this stage of development before it is safe to introduce solid feeds.  It appears that these children are introduced to oral feeds at a later point in life, and there does not appear to be a critical window of opportunity for the introduction of oral feeding.  A child will only be ready to try a variety of foods in larger amounts when a variety of conditions are met. These include:  resolution of the precipitating problems (ie. tracheosophagial fistula; cardiac problems; or presence of aspiration); an extended period of good health status; swallowing safety; adequate oral motor skills; ability to comfortably take sufficient bolus feeds and develop a sense of hunger; and demonstration of interest/readiness on the part of the child and parent. (Suzanne Evans Morris) These conditions should be assessed routinely by a multi-diciplinary feeding team involving the parent, and with the use of videofluoroscopic swallowing studies to demonstrate  swallowing safely when this is an area of concern. Helping the children transition from gastrostomy tube feeds is a challenge and requires a coordinated, multi-diciplinary approach.  If a child is not ready to begin transitioning to oral feeds, oral motor and particularily sensory stimulation should be continued to be provided.