Feeding a Child With a Laryngeal Cleft

By Caetyn Groner, MS, CCC-SLP

Oral Strategies

The following compensatory strategies have nuanced uses and recommendations and are important to consider trialing during a swallow study for each child. It is vital to work with an SLP who is competent in pediatric feeding and swallowing disorders to guide the use of these techniques. Feeding and swallowing treatment is not one-size-fits-all.

The greatest risk of aspiration comes from drinking thin liquids quickly.

Modify Positioning

Positioning is crucial when feeding a child with a laryngeal cleft. Various positional modifications depend on the child’s age, development, physical needs, etc. Positioning needs to be individualized for each child and can be affected by a variety of factors including reflux, thickener, and flow rate. It’s important to work with a therapist to find the most effective and appropriate position for your child. 

Breast Feeding:

  • Modifying feeding position is often a good starting point when breastfeeding, since modifying flow rate and thickening are not options.

  • Positioning methods that may help include the modified football hold, side lying, and incline supports.

Bottle Feeding:

  • Positioning methods that may help include side lying, elevated side lying, reclined, and pillow supports.

Cup Drinking:

  • Positioning methods that may help include upright (90-90-90) or “chin tuck,” which may allow for greater oral control.

Modify the Vessel

Bottles, straws, and cups come in many shapes and sizes. Part of feeding therapy is determining which vessel is both safe and acceptable to the child. Long term, the goal is for the child to be able to safely drink from any vessel.

Check out LCN’s Drinking Success one-pager for specific vessel recommendations from other parents.

Yellow bottle icon.

Bottle Nipples:

Shape

Choose a nipple shape and flow rate that helps your child achieve an efficient and effective latch. While certain nipples may be marketed to breastfed infants or to facilitate a natural latch, the specific shape should be chosen based on your child’s ability to extract the liquid safely (without symptoms of aspiration) and efficiently (without much effort). Choose a system that works for the child right now, so they can eat well presently. Don’t choose a bottle system that the child can grow into.

Flow

Slowing the flow rate can give the child more time to coordinate their swallow with a smaller amount of liquid. Too slow of a rate can cause the child to exert too much effort or become frustrated. If other modifications are made, such as thickening the liquid, the flow rate will also likely need to be modified.

Straws:

Valve vs. Valveless

Valved straws help make a cup spill resistant. However, they do require a stronger suck to extract the liquid. This is important to consider when using thickened liquids or when working to improve oral dysphagia.

Length and Diameter

The longer the straw and wider the diameter, the bigger the sip/bolus of liquid. The honeybear-style straw cup is often a good starting point for children to learn to use a straw, as the bear is squeezable. The straw on this cup is small in diameter and the length is relatively short. These two factors allow for smaller, more controlled sips.

Cups:

  • Cut-out cups allow for a chin tuck or a neutral head position when drinking from a cup. This can be helpful if those strategies are recommended. 

  • There are also cups that restrict the size of the sip/bolus.

Modify the Liquid

Thicken the Liquid:

Change the Sensory Experience of the Liquid:

  • Cold, tart, bubbly, and flavored liquids can increase sensory input and allow the child better control during swallowing.

  • Plain, room-temperature water is the hardest liquid to swallow, due to the lack of sensory input.