Feeding a Child With a Cleft

The first and most important factor in feeding children with dysphagia is safety. Your team will gather this information by examining your child, listening to their history, and using different procedures. 

One procedure to assess your child’s swallow is a modified barium swallow study (MBSS). This video x-ray procedure will record your child drinking liquids and (possibly) eating solids of various consistencies. A speech-language pathologist (SLP) and a radiologist will perform this procedure. They will watch to see if any food or drink enters the airway (aspiration) or if it comes close to entering the airway, but is expelled just in time (penetration). 

Sometimes aspiration is really obvious with coughing and choking. Other times it happens without the child reacting (silent aspiration). It is very important to determine if your child is aspirating and which part of the swallow is not functioning properly. This information allows the SLP and your child’s physicians to determine which consistencies of food and liquid are safe to swallow, what therapy strategies may be helpful, and how the laryngeal cleft is impacting your child’s swallowing abilities. 

If the MBSS does not show penetration or aspiration, you will likely follow up with your providers to discuss next steps. This usually means your child can safely swallow food and drinks without extra help. However, the swallow study is only a short snapshot in time, so it may not capture intermittent aspiration that occurs only occasionally. If your child has symptoms, but no aspiration is seen on the MBSS, it is important to speak with your team about how to proceed. 

If the MBSS does show penetration or aspiration, the SLP will tell you which food and drink consistencies are safe or unsafe for your child. Safe means your child can swallow that consistency without the risk of aspiration. Unsafe means your child may develop complications from aspiration. You may hear your child “passed” or “failed” a swallow study. However, it is truly not an either-or procedure. 

Your team is looking to determine how your child’s swallow functions and what consistencies they can eat and drink safely. The team may recommend using compensatory strategies to help improve your child’s safety and efficiency when eating. You may be advised to thicken your child’s liquids, or that no consistency is completely safe and your child needs alternative means to eat and drink. You may be recommended a combination of these interventions to balance meeting your child’s hydration and nutritional needs, feeding development, gastrointestinal factors, and personal wishes. 

Based on your child’s swallowing difficulties and other medical issues, your team will advise you on the safest method to feed your baby.