Mount Sinai’s Speech Language Pathology program provides individualized assessment and treatment for children from newborns to 18 years of age who are experiencing complications with feeding, swallowing, and airway management. Our speech language pathology team has extensive expertise and success in evaluating and treating the underlying behavioral and medical conditions that may be impacting your child’s feeding safety or progression. We work together with you to complete a thorough assessment and to develop and implement an evidenced-based treatment plan.

What feeding and swallowing issues do we treat?

The following are some of the issues that we treat:

• Coughing or choking when eating or drinking
• Neurologic impairment
• Neuromuscular disease
• Genetic syndrome with high incidence of dysphagia (e.g., Pierre Robin sequence, Down syndrome, Prader-Willi, CHARGE syndrome)
• Cerebral palsy
• Seizure disorders
• History of aspiration, frequent respiratory infections, or recurrent pneumonias
• Oncology cases, such as vallecular mass, laryngeal mass, and neck mass
• Children with unexplained oxygen requirements
• Vocal cord paralysis or changes in voice (weak/breathy/hoarse)
• Feeding with tracheostomy tube or ventilator dependence
• Low tone
• Cleft lip
• Cleft palate
• Laryngomalacia
• Post-cardiac surgery
• BPD or pulmonary hypertension

What should you expect during the initial assessment?

During the first assessment, you and your child will meet with a Mount Sinai speech language pathologist to discuss what happens during feeding, the symptoms your child is experiencing, and any concerns you have. For this appointment, we suggest you bring some of your child’s favorite food and drinks and any utensils, bottles, or dinnerware they typically use. Whenever possible, it is beneficial to schedule your child’s meals and snacks for them to be hungry at the time of their appointment.  This will enable the speech pathologist to observe your child’s presentation with food and liquid in real time.

During the initial assessment, you will also meet with a Mount Sinai otolaryngologist (ENT physician), whose level of involvement will vary by case.

Depending on your child’s symptoms, the speech language pathologist may recommend an instrumental swallow assessment. There are two different types of assessments they may recommend:

• Modified barium swallow study (MBS): The SLP will complete this test in the radiology department and in conjunction with a radiologist. For this exam,  your child will drink food and liquid mixed with barium while the radiologist takes a video x-ray.  The purpose of this exam is to observe the various phases of the swallow, including the mouth, throat, and esophagus.  On this exam, the SLP can determine if any food or liquid is entering your child’s airway and, if so, can trial various strategies and consistencies of food and liquid to improve airway protection.
• Flexible endoscopic evaluation of the swallow (FEES): This test is completed in the office with an ENT and SLP.  During this test, the provider will place a small camera through the nose to look at your child’s throat.  While the camera is in place, your child will eat and drink real food that contains green food coloring to improve visualization. This exam allows the provider to look at the voice box, including the vocal cords, and to see if any food or liquid is entering the airway during feeding.  The SLP may also trial various strategies or offer different consistencies of food and liquid throughout the exam to improve airway protection.

Both of these assessments are useful in developing a treatment plan for your child.

What does treatment entail?

Treatment is always tailored to your child’s needs, age, and developmental stage. The following are some common treatment activities:

• Learning to suck to initiate bottlefeeding or breastfeeding
• Training in bottlefeeding and breastfeeding techniques, positions, and strategies to maximize airway protection
• Transitioning to cups and straws
• Learning to chew
• Expanding diet texture repertoire
• Weaning from thickener
• Weaning from tube feeding

How long will treatment last?

Length of treatment will depend on many factors, such as the symptoms your child is exhibiting and the severity of these symptoms.  Treatment can span weeks, months, or years. In some cases, treatment will be provided in clusters with breaks between periods of therapy.  The primary goal is always to deliver a treatment plan that meets your needs and the needs of your child.

How to make an appointment

To make an appointment for a speech language pathology assessment, call 833-4EN-TKID.