Any difficulty or inability to introduce the food/Liquids in to the mouth, chewing and sending the food down to the throat, food pipe and finally to Stomach.

Symptoms differ according to the cause and site of lesion, but in general

• Taking long time to finish meals

• Eating is no longer automatic process, Struggles to eat, need to concentrate while eating.

• Not eating/ avoiding specific textures of foods like solids/ Liquids

• Complaint of Food getting stuck in mouth, throat or chest area

• Recent history of weight loss/ dehydration/ malnutrition

• Recent history of Aspiration Pneumonia/Chest Infection

• Food comes back to the mouth or goes in to the nose while eating

• Cough/ choking/ throat clearing while eating / drinking

• Food/liquids come out of the mouth.

Normal Muscle Movements and neuronal control from brain to these structures (Mouth, throat and food pipe) are crucial, any medical or developmental conditions effecting these functions will lead to swallowing problems, ageing may also contribute to these problems. Some of the common causes are brain strokes, Head and Neck Injuries, presence of head and neck cancer, children with developmental delays, Autism, Cerebral palsy, genetic syndromes, Healthy developing children may also have Feeding issues.

These problems can occur across the life span from new born to geriatric population. As mentioned earlier they are many medical conditions which will affect swallowing function, some medical conditions are more seen in geriatrics and some in children.

Geriatric population are at greater risk to develop swallowing disorders due to ageing process. In the same line children with delayed development milestones are also at high risk to have feeding and swallowing issues.

Feeding and swallowing skills develop from reflex pattern at birth to the complex Voluntary mechanism. Children with Feeding and swallowing issues may struggle to achieve & progress in age appropriate feeding development pattern and it can also be acquired due to a medical condition. Where as in adults it is majorly acquired due to medical conditions affecting the functions of feeding and Swallowing which can be aggravated in elderly population.

Children are more at risk to develop aversion/avoidance to food or may prefer only few varieties (picky eater) which will significantly affects the parent and child interaction.

There are many possible causes for feeding and swallowing problems in children, including:

• Nervous system disorders, like cerebral palsy or meningitis

• Reflux or other stomach problems

• Being premature or having a low birth weight

• Heart disease

• Cleft lip or palate

• Breathing problems, like asthma or other diseases

• Autism Spectrum Disorders

• Head and neck problems

• Muscle weakness in the face and neck

• Medicines that make child sleepy or not hungry

• Sensory issues

• Behaviour problems

Dysphagia may develop secondary to damage to the central nervous system (CNS) and/or cranial nerves, and to unilateral or bilateral cortical and subcortical lesions, such as

• stroke;

• traumatic brain injury;

• spinal cord injury;

• dementia;

• Parkinson’s disease;

• multiple sclerosis (De Pauw et al., 2002);

• amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease; e.g., Ruoppolo et al., 2013);

• muscular dystrophy (e.g., Tabor et al., 2018);

• developmental disabilities in an adult population (e.g., intellectual disability; Chadwick & Jolliffe, 2009);

• post-polio syndrome (e.g., Sonies & Dalakas, 1991);

• myasthenia gravis (e.g., Llabrés et al., 2005; Romo González et al., 2010); and

• polymyositis and dermatomyositis (González-Fernández & Daniels, 2008).

Dysphagia may also occur from problems affecting the head and neck, including

• cancer in the oral cavity, pharynx, nasopharynx, or esophagus;

• radiation and/or chemoradiation for head and neck cancer treatment;

• trauma or surgery involving the head and neck;

• decayed or missing teeth; and

• critical care that may have included oral intubation and/or tracheostomy.

Dysphagia may be associated with other factors, such as

• side effects of some medications (e.g., Balzer, 2000);

• metabolic disturbances (e.g., hyperthyroidism);

• infectious diseases (e.g., COVID-19, sepsis, acquired immune deficiency syndrome [AIDS]); Meux & Wall, 2003);

• pulmonary diseases (e.g., chronic obstructive pulmonary disease [COPD]);

• gastroesophageal reflux disease (GERD);

• following cardiothoracic surgery;

• decompensation; and

• frailty (Bahat et al., 2019).

Feeding and Swallowing disorders required Multidisciplinary team for detailed Assessment and Intervention, team consist of Speech Language Pathologist, ENT Specialist, Gastroenterologist, dietician, Neurologist, Head and neck surgeon, pulmonologist, physician etc

Speech Language pathologist (Speech therapist) is a Health care/Rehabilitation Specialist deals with Speech Language, Communication and Swallowing difficulties in children and Adults. Speech Language pathologist with minimum Bachelors degree in “Audiology, Speech Language Pathology”(BASLP) & registered with Rehabilitation Council of India are qualified to practice individually in India.

Speech Language pathologist have knowledge of the anatomy, physiology, and functional aspects of the upper aerodigestive tract as they relate to swallowing and speech, also have expertise in communication disorders that may affect the diagnosis and management of swallowing disorders.

Speech Language pathologist/ Speech & swallowing specialist/Speech &Swallowing therapist play a vital role in the assessment and management of individuals with Feeding and swallowing disorders and work collaboratively with other professionals, individuals, families, and caregivers.

It’s not mandatory that all Speech Language Pathologist should practice feeding and swallowing disorders, so contacted Specialist may refer to other Speech Language pathologist who has clinical experience in Feeding and Swallowing disorders.

No, Speech Language Pathologist doesn’t prescribe any medications.

As discussed earlier, Feeding and Swallowing issues are the symptoms due to underlying various medical/surgical conditions, so as these medical/ Surgical condition improves then the feeding and swallowing function may also improve but may not become normal due to the residual muscle weakness of tongue, lips, throat or reduced neuronal control to this structures, patient may also develop maladaptive (wrong) feeding and Swallowing pattern behaviours, so Speech Language Pathologist plays Important role in understanding swallowing function and improving it by strengthening the muscles or/and improving coordination by modifying maladaptive feeding pattern to typical swallowing function.

This special intervention by Speech Language Pathologist doesn’t have any side effects in general, however few swallowing interventions are not advisable for some specific conditions.

Early intervention is almost important, any signs and symptoms mentioned above should not be ignored, consulting any of the Multidisciplinary member is very crucial to diagnose the underlying cause and intervention by an appropriate team member.

The duration of treatment varies depending upon underlying cause and overall health condition of the patient. It varies from few days to months, in some conditions person with Dysphagia may have to depend on Tube feeding for longer duration.