From tube feeding to oral feeding (speech and language approach)

Progress in medicine diagnostics enables early detection of feeding problems as is confirmed by the increase in feeding difficulties at an early age. The area of feeding and subsequent difficulties is not an isolated area, but it occurs and facilitated by various factors. To improve ways of feeding and find the optimal way, as well as to support and encourage the child and the family it is important to form an interdisciplinary team of experts (e.g.. paediatrician, psychologist, gastroenterologist, speech and language pathologist). This review gives an outline of features which relate to the basic swallowing process, possible difficulties and reasons to introduce tube feeding. Prolonged tube feeding often brings medical and psychological complications. Worldwide, there are a small number of clinical centers specialized in tube weaning. Different approaches for easier and more efficient transfer to oral feeding are described. All the approaches agree that the continuum to oral feeding is an individual process, often very long and it requires supervision of different profiles and a shift from focus on the act of feeding to the processes that support feeding. What is known as comprehensive oral motor treatment includes integration of all systems included in feeding, support for the child and the family, medical status and development of oral skills.