What does this service provide?

We are a group of speech and language therapists who have specialised in eating, drinking and swallowing difficulties in babies, children and young people (aged 0-19 years). The medical term for these difficulties is dysphagia.

Difficulties experienced by children who have dysphagia can include:  

  • change in alertness around feed/meal-time, for example, becoming sleepy, anxious/distressed 
  • coughing or choking before, during or after food or drink 
  • changes in colour, for example, going red or pale, blue tinges on the upper lip 
  • changes in breathing – faster or slower than usual 
  • sounds of breathing difficulty, for example, wheezing, gurgling or “wet” breathing/wet cough 
  • eye watering or widening, passive tears or crying, excessive blinking or grimacing 
  • recurrent chest infections and/or pneumonia, repeated episodes of bronchiolitis 
  • difficulty with eating or swallowing age-appropriate food/liquid consistencies 

Additional signs: 

  • becoming tired during a meal/lengthy mealtimes 
  • severe food refusal 
  • difficulty in maintaining/achieving a safe position for eating and drinking 
  • deteriorating physical health 
  • deteriorating condition of teeth and mouth 
  • weight loss 

We are based across the county usually in child development centres or special and complex needs schools. 

Our aim is to assess eating, drinking and swallowing difficulties and reduce the risk of harm by providing targeted advice and intervention.  We aim to ensure that the children are supported to eat and/or drink orally as safely as possible to facilitate prevention of significant health issues associated with dysphagia. 

We work alongside the families and other health services including dieticians, occupational therapists, health visitors, doctors and community nurses.  We frequently liaise with medical teams in specialist hospitals where children have complex conditions. We can provide training on aspects of dysphagia management to parent/carer groups, education staff and other professional groups. 

The following services are offered: 

  • assessment of child’s eating, drinking and swallowing within a mealtime environment 
  • advice on how to develop these skills, for example, by modifying food or drink textures or feeding strategies 
  • training to groups of professionals/carers around the development of and functional eating, drinking and swallowing 

We often work in conjunction with a dietician if there are concerns about growth and an occupational therapist or physiotherapist for support with seating and postural stability. 

We do not support children with behavioural and solely sensory feeding difficulties. 

If a child has suspected sensory or behavioural feeding difficulties (the child can eat, has good oral-motor skills and no swallowing concerns but has a restricted range of accepted foods) they would only be seen for assessment if any oral motor and pharyngeal concerns are indicated. We do not offer longer-term support or management for children whose feeding difficulties do not have an oral-motor or pharyngeal swallowing cause. 

Should I be worried?

You may be concerned about one or more of the following issues: 

  • your child’s eating and or drinking skills are not developing in line with their age 
  • your child is coughing when eating or drinking 
  • your child is regularly retching/gagging on food 
  • they cough and choke on some foods regularly 
  • your child has repeated chest health issues e.g., chest infections 
  • with a school aged child, your child’s teacher may have expressed concerns about their eating and drinking in school 
What do I do?

If you are concerned about your child’s eating and drinking in the first instance you should talk to your health visitor. If this is not possible then speak to your GP about your concerns. 

If your child is seeing a hospital paediatrician or a paediatrician in a child development centre or special school, you can discuss your concerns with that doctor. 

If your child is at school, you can discuss with their teacher and ask whether have they noticed anything of concern when the child is eating and drinking at school? 

If your child is over 5 years old and has never been referred for a specialist feeding assessment by a speech and language therapist, you will need to go to your GP, explain your concerns and request a referral to a specialist dysphagia speech and language therapist for a feeding assessment. 

If your child has been assessed by the dysphagia service in the past then any professional (health visitor, school nurse, speech and language therapist, physiotherapist or occupational therapist) can refer to our team for an assessment of eating, drinking and swallowing. They will ask for your consent to make this referral and will ask you to complete a questionnaire. This will help us in our assessment of your child’s difficulties with feeding. 

What happens next?

Once we have received a written referral, if more information is needed, or if the referral is not appropriate, we will contact the referrer to let them know. Referrals are then triaged and given a priority rating. You will then receive a letter which will give information on how long your child will have to wait for an appointment. 

We do not provide an urgent or same day service in the community. In the case of new or sudden onset swallowing difficulties in a child who is otherwise well and has no history of feeding difficulties, please seek urgent medical advice via your GP or local Accident and Emergency services. 

What happens at the dysphagia assessment?

The assessment may take place either at home or your child’s educational setting or you may be asked to attend a clinic setting. The assessment will last approximately 1-2 hours.  

During the appointment, a therapist will take a case history and observe your child eating and/or drinking and may listen to their swallow using a stethoscope. You may be asked to offer a range of tastes and textures during the appointment. 

Following the assessment, the therapist will discuss any recommendations and strategies that may help with your child’s difficulties. You may also receive a written mealtime plan or management plan. This will describe your child’s feeding recommendations in detail, for example, positioning, textures to be offered/avoided. 

The therapist will sometimes recommend modifications to thicken drinks/specific foods and occasionally these require a prescription which the therapist will request from your child’s GP. Very occasionally, the therapist will recommend further investigations are carried out and will write to your child’s GP (or paediatrician) to request this. 

What happens during and after your appointment?

An assessment may take place either at home or in your child's educational setting or you may be asked to attend a clinic setting. The assessment will last approximately one to two hours.  

During the appointment, a therapist will take a case history and observe your child eating and/or drinking and may listen to their swallow using a stethoscope. You may be asked to offer a range of tastes and textures during the appointment. 

Following the assessment, the therapist will discuss any recommendations and strategies that may help with your child's difficulties. You may also receive a written mealtime plan or management plan. This will describe your child's feeding recommendations in detail, for example, positioning, textures to be offered/avoided. 

The therapist will sometimes recommend modifications to thicken drinks/specific foods and occasionally these require a prescription which the therapist will request from your child's GP. Very occasionally, the therapist will recommend further investigations are carried out and will write to your child's GP (or Paediatrician) to request this.

If your child requires additional assessment (it can be difficult to assess all aspects of the mealtime on one session) further appointments may be offered to complete this process. 

Referrals may be made to other services in relation to the management of any dysphagia concerns. Your therapist may need to liaise with a range of health/education/other relevant professionals and where relevant a report may be written.  

Depending on your child's needs, they may be offered a review appointment to monitor progress with the recommendations or they may be discharged with the option to re-refer if required. 

What happens after assessment?

If your child requires additional assessment (it can be difficult to assess all aspects of the mealtime on one session) further appointments may be offered to complete this process. 

Referrals may be made to other services in relation to management of any dysphagia concerns. Your therapist may need to liaise with a range of health, education or other relevant professionals and where relevant a report may be written. 

Depending on your child’s needs, they may be offered a review appointment to monitor progress with the recommendations or they may be discharged with the option to re-refer if required. 

How can I access this service?

This service can be accessed through the Children's Speech and Language Therapy Service.

Where can I find resources for this service?

Start for life – NHS website with lots of videos and tips about your child’s feeding development 

Child feeding guide – strategies and tools for fussy eating and creating happy mealtimes 

Toddler and Infant Nutrition Advice - Infant and Toddler Forum (infantandtoddlerforum.org) 

Feeding matters – an American website which has lots of information and resources for children with feeding difficulties 

IDDSI International Dysphagia Diet Standardisation Initiative – contains information on levels of food and drink texture and consistency and how to test levels accurately 

The food chain – why can’t my child swallow? – an informative podcast on BBC sounds about swallowing difficulties in children with information from the perspective of parents and families 

What happens during a videofluoroscopy study video – this is an investigation that may be requested for your child to help clarify specific swallowing difficulties

Picky eaters video

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