Swallowing and feeding therapy for children and adults

What it is

Dysphagia means difficulty swallowing. Swallowing is a fast, complex sequence: chewing, forming food into a ball, moving it to the back of the mouth, and passing it safely into the esophagus while the airway closes. When any part of this sequence is affected, eating and drinking can become slow, uncomfortable or unsafe.

The main safety concern is aspiration, when food or liquid goes into the airway instead of the esophagus. This can lead to chest infections. Not everyone who aspirates coughs, which is one reason swallowing concerns deserve a careful look. Dysphagia can also affect nutrition, hydration and the pleasure and social side of meals.

Feeding in children, swallowing in adults

In children, the concern is often feeding: difficulty accepting textures, chewing, moving from purées to solid foods, or a very limited diet. Feeding difficulties can be linked to medical, oral-motor or sensory factors, and often to a mix of them.

In adults, dysphagia often follows a stroke, a neurological condition such as Parkinson’s disease, MS or ALS, a brain injury, or treatment for head and neck cancer. It can also appear gradually with ageing.

Urgent signs. Call 911 if someone is choking and cannot breathe, cough or speak. See a physician promptly for frequent coughing or choking during meals, a chest infection or pneumonia, unexplained weight loss, signs of dehydration, or swallowing difficulty that starts suddenly, especially with other new symptoms such as slurred speech or weakness.

Who we see

• Adults with swallowing changes after a stroke or brain injury, often after hospital discharge.
• Adults with neurological or progressive conditions, such as Parkinson’s disease or MS.
• Adults after head and neck cancer treatment, in collaboration with their oncology team.
• Older adults whose eating and drinking have become harder or slower.
• Children with feeding difficulties, including trouble with textures, chewing or a very limited range of foods.

Infants with breastfeeding or bottle-feeding difficulties, and anyone whose swallowing is acutely unsafe, should first be assessed through their physician or a hospital team. We are glad to support afterward when appropriate. For questions about how a baby’s lips, tongue and jaw work during feeding, including tongue tie, see orofacial myofunctional disorders. For the typical steps of the first year, from purées to lumps and the open cup, read our guide to baby feeding milestones from 0 to 12 months.

How we assess it

A clinical swallowing assessment begins with your history: medical conditions, medications, what has changed, and how meals are going. We look at the strength and movement of the lips, tongue, jaw and throat, and, when it is safe, watch you or your child eat and drink different textures.

A clinical assessment has limits. Some problems, including silent aspiration, can only be seen with instrumental assessment, such as a videofluoroscopic swallow study or a fiberoptic endoscopic evaluation. These are done in hospital settings. When one is needed, we will explain why and ask your physician to arrange it.

For children, we also look at growth, mealtime routines and sensory responses, and may suggest that your pediatrician review medical factors. Learn more about our assessment process.

How therapy works at VoxLingue

All recommendations are made with safety first and are shared with your physician when you agree to it.

Adults

Depending on what the assessment shows, therapy may include:

• Exercises to improve the strength, range and coordination of the muscles used for swallowing.
• Swallowing strategies, such as specific postures, smaller sips and bites, or a slower pace.
• Diet and texture recommendations, often using the IDDSI framework widely used in Canada, so that foods and drinks are prepared consistently.
• Mealtime routines that reduce fatigue and keep meals as enjoyable and social as possible.

Children

Feeding therapy is gradual and respectful of the child. Sessions may build oral sensory awareness and chewing skills, and help your child explore new foods through play, at their own pace and without pressure. We coach parents on mealtime routines and on how to offer new foods calmly.

Working as a team

Swallowing involves health, nutrition and medical care. We collaborate with physicians, dietitians, occupational therapists and hospital teams as needed, and refer when a concern is outside our scope.

Your role at home

Strategies only work if they are used at every meal. Your clinician will make sure you and the people who prepare meals know exactly which textures, postures and strategies are recommended, and what to watch for. For children, parents keep mealtimes calm and predictable, offer new foods without pressure and practise the activities from therapy. Tell your clinician and physician right away if you notice new coughing, choking, fever or weight loss.

Bilingual and multilingual families

Food is closely tied to family and culture. We want recommendations to fit the dishes your family actually cooks and eats, not a generic list.

Our team works in English and French, and clinicians on the team speak many other languages. Explaining strategies clearly in the language spoken at the table helps everyone who prepares or shares meals follow them safely. Availability of specific languages varies, and we will match you as closely as we can.

In person or by telepractice

Swallowing and feeding assessments usually start in person, at our Marché Central clinic in Montréal. Telepractice can work well for some follow-up sessions, for example to coach a caregiver during a real meal at home, when your clinician judges it safe and an adult is present. If you live in Ontario or far from Montréal, we will discuss with you what can safely be done online.

Getting started

You do not need a physician referral to book with us, but we encourage you to keep your physician informed. If you have urgent signs, please seek medical care first.

Call our Marché Central clinic at 514-467-9132, or request an appointment through our contact form. We will talk through your concerns and match you with a clinician experienced in swallowing or pediatric feeding.