Role of the Speech and
Language Therapist in
Assessment of Oral
Feeding
Gail Robertson
Specialist Speech and Language Therapist
Terminology
• Dysphagia
• Eating, Drinking and swallowing
Difficulties (EDS)
• Swallowing problem
• Feeding disorder / difficulty
Phases of swallowing
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Oral Preparatory phase
Oral phase
Pharyngeal phase
Oesophageal phase
Stage One and Stage Two
Stage Three and Stage Four
Effective Swallowing
Safe and effective swallowing is a complex act
requiring the coordination of:
• Cranial nerves, the brain stem and cerebral
cortex
• 26 muscles of the mouth, pharynx and
oesophagus
To assess oral motor skills
Assess eating and drinking
Assess safety of swallowing
To share information and
contribute to planning within the
Multidisciplinary Team
(including parents/carers)
•Medical History
Including birth history, diagnosis particularly
neurological conditions, respiratory
problems, reflux etc
•Feeding History
Including tube feeding, development,
behaviour, nutrition, gagging/choking etc
•Parents/carers views, concerns
Assessment of Oral Motor Skills
• Assess oral structures and control of oral
movements for eating , drinking and
swallowing including reflex behaviour
• Oro-Facial Exam/Observation
• Ability to control oral secretions
Assessment of Eating and Drinking
• How is child fed?
Position, who feeds, self-feeding, utensils
• What is child eating and drinking?
Consistency, texture, amount, temperature, taste
Assessment of Eating and Drinking
• How does child deal with food/drink?
Sucking, biting, chewing, drinking, abnormal
movements, spillage, indications of poorly
coordinated or unsafe swallow
• How long does it take and what happens
afterwards?
Coughing, vomiting
Assessing safety of swallow
Swallow may be poorly coordinated, delayed or
absent
Clinical signs indicating an unsafe
swallow/aspiration – cough, choke, colour
change, wet voice, refusal, changes in
breathing, poor weight gain, frequent chest
infections
VFSS – objective assessment (has limitations)
Silent aspiration
Videofluroscopic Swallowing Study
• Visualise the swallowing mechanism
• Objective evaluation
• Present different consistencies
BUT
• Positioning
• Brief
• Variability
Should not be taken in isolation
Evaluation
• Is the child safe
• Does the child have oral skills
required
• Can the child achieve and maintain
nutritional requirements
• Quality of life for child and carers