Feeding difficulties are common in children and adults with SAS. As mentioned above, a cleft palate may lead to feeding problems in babies. Later, there may be problems with chewing, overstuffing the mouth with solids, swallowing problems (dysphagia, 61%) and drooling. These feeding difficulties can be seen in individuals with or without cleft palate.
It is thought that palatal and dental abnormalities and low muscle tone play an important role in the high frequency of feeding issues. Also, sensory issues (low oral sensitivity) and problems with attention may contribute.
Dysphagia or swallowing problems can present as coughing or choking, or a gurgly, wet-sounding voice when eating or drinking. It may lead to aversion to eating or drinking, and contribute to weight loss. When food accidentally enters the wind pipe, respiratory track infections may ensue.
When feeding problems are severe, it may lead to a person being underweight.
Management:
In the case of feeding difficulties due to a (yet unrepared) cleft palate, the cleft team will provide feeding advice and support. With other feeding problems, a speech and language therapist is usually the first professional to turn to for assessment, advice and therapy.
When there are signs of dysphagia, several professionals may be involved to assess feeding skills, swallowing/ aspiration risk and nutritional status, such as a speech and language therapist, ENT specialist, pediatrician and dietitian. When indicated, a videofluoroscopic swallowing study can be done. Depending on the severity of the swallowing problems and aspiration risk, various approaches can be chosen:
- therapy by a speech and language therapist
- advice regarding the conditions surrounding eating and drinking, for instance sitting position, feeding technique and pace, fostering attention and other behavioural strategies (physiotherapist, speech and language therapist, behavioural therapist)
- adjustment of food and drinks, for instance softer foods and thickener in drinks (dietitian)
- the use of special cutlery, plates and cups (occupational therapist)
- gastrostomy tube in the case of threatened nutritional status and/or severe aspiration risks (gastroenterologist)
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