Ask! A surprising symptom of a feeding problem

Q. At my son’s recent well check, my pediatrician said she suspects that my son has a feeding disorder. How can that be? He is in the 90th percentile for weight.


A. The weight of a child in isolation cannot rule in or out a feeding/swallowing disorder. While being underweight is more often a complication of a feeding disorder, children in the higher weight percentiles can also present with feeding disorders. For children with this type of feeding disorder, growth and developmental milestones are met from consuming a diet consisting of high-calorie foods that are nutritionally deficient.


Often these children have never developed the skills to adequately and thoroughly chew more advanced foods. Because they are uncomfortable swallowing these foods, they start to avoid these advanced foods with a strong preference for easy to eat foods. These advanced foods (meats, vegetables and fruits) are the foods with the most nutrition. The easy to eat foods tend to be the high-calorie foods that are nutritionally deficient (junk foods).


Children who are not skilled chewers prefer junk food because these foods are more forgiving. Even if not chewed adequately, most junk foods are swallowed quite easily because they dissolve so quickly when mixed with saliva. A Cheeto is a great example of this. Most children don’t choose preformed dinosaur shaped chicken nuggets because they taste better than the chicken that comes right off the grill. They choose it because it is easier

to swallow.


Unfortunately, nutritionally dense foods tend to require more advanced levels of chewing. Foods like fruits and vegetables tend to have multiple textures, which make them more challenging to manage. These foods, if not managed correctly, can be harder to transit from the mouth to the throat, can become stuck in the throat and are more likely to scatter throughout the mouth. Children will avoid these foods because they are too difficult.


So based on the information explained above, I would strongly suggest that you bring your child in for a feeding evaluation. The evaluation will indicate whether your child is lacking in the skills required to manage the healthy, more challenging to eat foods. For many children, just learning the skills to successfully chew and swallow more challenging foods helps increase their willingness to try these healthy foods. Healthy eating impacts a child’s

health and well-being now and as he grows and matures into adulthood.


-- Joan Comrie, Carolina Pediatric Dysphagia


Joan Dietrich Comrie has dedicated her entire career to studying, teaching and practicing in the area of dysphagia, specifically pediatric dysphagia.  She received her bachelor of science degree and then her master of science degree in the area of speech pathology at the University of Wisconsin-Madison in 1986.  Before starting Carolina Pediatric Dysphagia in 1996, she worked at several hospitals (Cardinal Hill Rehabilitation Hospital, Lexington Ky., Vanderbilt Medical Center, Nashville, Tn. and WakeMed, Raleigh, NC) where she developed or reorganized the hospital's pediatric dysphagia program.


Joan has spoken on the topic of pediatric dysphagia nationally and internationally.  She has published in a professional journal.  She co-taught the first dysphagia course offered at UNC and continues to guest lecture to several university graduate level speech pathology programs and to the UNC Medical Students who complete their rotation at WakeMed.  She has served as chairman and member of a subcommittee of the Special Interest Division  #13 of the American Speech Language Hearing Association (ASHA).  She has received her certificate of clinical competence (CCC)  through ASHA and is Licensed in the state of NC.


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