Difficulties with swallowing and feeding are a growing concern across the pediatric age spectrum worldwide. This complex issue is increasing in prevalence, and solutions are not easy. The increase in prevalence is largely due to improving survival rates amidst technological advances, along with gaps between scientific discoveries and implementation at the point-of-care. Transfer of knowledge is a major issue at several levels; to further complicate, different specialty disciplines have evolved that are related to swallowing and feeding processes. Swallowing and aero-digestive safety go together at every step, and these cross-systems interface mechanisms that favor successful eating; lack thereof may result in chronically tube-fed patients. Swallowing and eating safely is a developmental process in continuum, and aberrations can happen at any time point during childhood development. Precise recognition of problems and, therefore, rehabilitation requires knowledge of the comprehensive factors that contribute to eating difficulties and dysphagia, as well as knowledge of their management.
Feeding problems are never simple, because multiple biologic mechanisms and behaviors are involved.1 Hence, when assessing feeding problems, both patient characteristics and feeding processes need to be examined. A commonly overlooked aspect of feeding is environmental and cultural situations, which may differ globally. Examples may include unique family meal traditions, difference in taste perceptions, and regional difference in individual or institutional experiences.2 Feeding is an extremely complex activity that involves a variety of unique sensory inputs at central and peripheral levels to evoke precise motor and coordinating skills. Clinical, pathological, psychosocial, nutritional, developmental, and environmental factors can be specific to each subject's situation, either those in normal health or those with ailments. For example, each child has different characteristics regarding morbidities, growth and development, hunger/satiety thresholds, taste and texture preferences, and swallowing and airway protection skills, as well as metabolic needs. It is also important to note that differences exist between infants and children regarding feeding disorders and their respective treatment strategies. Anatomically, a fully developed child has 3 pharyngeal regions (velopharynx, oropharynx, and hypopharynx). Healthy children are typically able to self-feed with solid or liquid boluses, while infants require caregiver support to provide liquid feeds. Additionally, an infant's suck-swallow-breathing rhythms with liquid boluses vastly differ from a child's chewing and swallowing rhythm with solid boluses. Regardless of age or experiences with eating, there are a variety of precisely timed steps involved in safely moving a bolus from the oral cavity to the pharynx, through the esophagus, and into the stomach. Therefore, numerous opportunities exist for missteps at any of these stages. If such missteps occur and are not self-corrected or resolved in a timely fashion, major dysfunctions can occur, resulting in short-term or long-term consequences.