Ask a Therapist backman spoon breastfeeding dysphagia e-z spoon endoscopy Feeding feeding issues feeding therapy front spoon feeding Lori Overland oral motor skills oral sensitivity oral stimulation pre-feeding program reflux side spoon feeding spoon feeding swallowing swallowing issues videofluroscopy

Ask a Therapist: Sensory Feeding For An Infant With Medical Issue

Dear Lori,

I attended the Sensory Feeding Course in England in June, and would like to thank you for a full two days of professional input.  Before I left Manchester, I had already thought of how I was going to utilize some of the techniques in my therapy sessions.

You had mentioned that you would not mind answering questions, so I hope you do not mind me taking advantage of the very generous offer.

I have my first appointment to see a 4 month old boy with feeding problems next week.  Mom reports that he breast fed nicely (after an initial period of latching difficulty, and the need to suck using a nipple shield). After 1 week, baby got floppy, stopped feeding, and was taken to hospital, where he stayed for a few weeks. He is currently being fed through a nasal feed tube.  Although he is reported to have a strong suck, he does not suck on breast for long. Bottle feeding has the same results.  This child has had extensive genetic testing, endoscopy (up to larynx), videofluroscopy, and EMG--all without any abnormal findings. He is scheduled for an endoscopy to investigate the esophagus.  He has reflux, and I was told that milk came through the nose.  The ENT did not find any sub-cutaneous cleft, nor velo-pharyngeal insufficiency.  He will also have an MRI.  The current medical opinion seems to indicate problems with swallowing.   All this information was received by phone. I have not seen any reports, as yet.

My goal for the session (aside from meeting and assessing the child), is to show mom the oral and sensory-motor stimulation techniques and massages (as well as hand, foot and body massages).  I also would like to introduce some pre-feeding activities, to try to prevent, or, at least minimize oral sensitivity and aversion to food taken orally.

Question: With a dry spoon (Beckman E-Z feeder), shall I introduce spoon feeding with a front feed, or side feed technique? I am inclined to do both, as they involve different oral motor movements.  However, I do not want to instill incorrect feeding behaviors.  (This is the first time that I am working with an infant).

I would like to thank you in advance for your input.

Best regards,

You are absolutely welcome to ask questions! I am so glad you have been able to use the techniques in your therapy.  I am wondering if this baby was tested for food allergies. Does he have reflux? What are his bowels like? Was he scoped? Do you know if they explored inflammation of the intestines or colon?  Does he have infantile spasms? There sounds like there is an underlying medical issue which has not been identified yet. I agree that your best course of action is to address his underlying oral sensory motor skills to support feeding. At 4 months of age and with so many unanswered medical questions I would not want to start spoon feeding just yet. 

When you do get ready to address spoon feeding if he has low tone, I would recommend side spoon feeding with either the small maroon spoon or the EZ spoon. Good luck with this little one!

Lori Overland, MS, CCC-SLP, C/NDT

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