Babies are born hungry, but some infants need help to successfully breast or bottle feed. When a baby isn’t eating well, it can be stressful for the whole family. There are many reasons why an infant may be having difficulties with feeding. Here are some possible causes of feeding problems in infants and how feeding therapy can help families find success with feeding.
Prematurity: Babies born prematurely may not have a fully developed neurological system. This means they are not yet able to coordinate the suck/swallow pattern needed for oral feeding. Most children are not ready to develop these skills until 34-37 weeks post-gestation, but others will continue to have difficulties even after this age.
Another result of prematurity that impacts feeding is that the cheek pads are not fully developed, which impacts the stability of the oral structure for feeding. The fat pads within the cheek develop at the end of pregnancy and do not develop after birth. Pre-term and near-term babies may not have thin or missing cheek pads. Infants and parents may need support from an SLP if the infant is unable to breast/bottle feed. SLPs will provide compensatory strategies for cheek support until the infant develops more mature feeding processes.
Cleft lip/palate: The palate and lips are essential for creating a strong suction for feeding. When an infant is born with a cleft lip and/or palate, it can cause difficulties with feeding. An SLP can help determine if the infant will be able to breastfeed and what kind of feeding system will be needed for bottle feeding. Most infants with a cleft/lip or palate can feed successfully with the right intervention.
Tongue tie and lip restriction: Babies’ tongues need to be able to move freely in order to use the back and forth wave-like motion required for suckling and sucking. This can cause difficulties with breastfeeding and sometimes with bottle feeding. If not corrected, can lead to difficulties:
Placing and collecting food while chewing and swallowing
Clearing the mouth of food
Developing a mature swallow pattern
Making speech sounds in a typical manner
Tongue ties may require surgery or through hands on treatments depending on the severity. It is important to have an SLP assess a child before and after surgery. Prior to surgery, an SLP will inspect the impact of the tongue tie and determine if any pre-operative exercises are needed. Following surgery, facilitation techniques taught by an SLP may be needed to teach the infant how to move the tongue appropriately.
Children with tongue ties may also have lip restrictions. The frenums, the membranes that connect the gums to the upper and lower lips, may be too thick or stuff. This can limit a baby’s lip movements required for an effective latch during breast and bottle feeding. As the child grows, lip restrictions can also lead to difficulties effectively removing food from a spoon, drinking from a cup or straw, and producing speech sounds involving the lips accurately. As with tongue ties, lip restrictions may require surgery or hands on techniques to correct depending on the severity of the restriction.
Neurological conditions: Children with neurological conditions such as Cerebral Palsy or Down syndrome may have poor muscle tone. This can make it difficult for these children to get a good lip seal around the nipple or have enough strength for sucking milk. SLPs can work with families to help develop compensatory strategies for effective feeding.
Jaw Weakness: Jaw weakness results in difficulty with jaw control, which is needed for sucking, taking bites of food, chewing, cup and straw drinking, babbling and speaking. Feeding therapy can help to correct jaw weakness which is essential to so many aspects of a child’s development.
Gastrointestinal (GI) Issues: Sometimes when a child is having difficulty with feeding, it can be a sign of an underlying gastrointestinal problem. Signs of GI problems in infants include: limiting milk intake, gagging or vomiting, poor appetite or inconsistent intake, or crying and irritability with meals. Children with feeding difficulties often have sensitive GI tracks. It is important to address problems with the GI tract in order for children to be more successful in feeding therapy. If a child feels better, they will respond to therapy better. Two common concerns in the GI tracts for young children are constipation and reflux. If you have concerns about GI problems, it is important that you talk to your pediatrician.
Constipation can impact feeding by:
Creating a feeling of fullness
Causing nausea and vomiting
Causing abdominal pain, gas, and distention
Slow the motility of the GI tract, including gastric emptying
Lead to an inability to attend to to other activities
Reflux can impact feeding by:
Causing choking or gagging
Lead to oral defensiveness or oral hypersensitivity
Causing recurrent vomiting during and after meals
Heartburn and pain in the esophagus
Bleeding and inflammation of the esophagus
Feeding difficulties can be stressful for children and the entire family. We want to assure you that there are many successful treatment options for these children! If you are concerned about your child’s feeding skills, please contact us if you have any questions or to see if your child may benefit from a feeding evaluation. Feeding therapy can help to improve comfort with eating, improved latch, desire to eat, the oral motor and sensory skills required for eating, and efficiency of eating.
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