Information about our eating, drinking and swallowing needs service.

Who do we see?

Who do we see?

Children and young people from birth to 19 years of age with physical and neurological eating, drinking and swallowing problems [this is called “dysphagia”]. This includes children and young people who:

• Were born prematurely
• Have a cleft lip and or palate
• Have a syndrome they were born with (e.g. Down syndrome)
• Have an acquired brain injury
• Have cerebral palsy
• Have developmental feeding difficulties

We do not see children/young people who have:-

• dribbling
• body dysmorphia [anorexia nervosa/bulimia]
• self-restricted feeding/extreme “fussiness”
• pica (eating non-foods)

To ensure a multi-disciplinary approach, we work with a range of other health professionals both in hospital and in the community. These include:-

• The child/young person’s family and carers
• Staff in educational settings
• Health visitors
• Doctors
• Dietitians
• Children’s community nurses
• Psychologists
• Physiotherapists
• Occupational therapists
• Social care workers

Who can refer?

Who can refer?

Inpatient referrals are accepted by telephone from a member of the ward staff, (tel : 01743 45800 option 4).

Outpatient referrals are accepted in writing from the child/young person’s:–

• Paediatrician
• GP
• Other health professionals (but only following discussion with the eating drinking and swallowing therapist and with the consent of the child/young person’s doctor).

Written referrals should be sent to the speech and language therapy admin team based at Coral House, 11 Longbow Close, Harlescott Lane, Shrewsbury, SY1 3GZ.

NB We do not accept direct referrals from families or educational placements.

When do we see people?

We read all new referrals carefully and aim to see high priority cases within 3 working days. Referrals of lower priority will be placed on a waiting list and seen as soon as possible. We aim to see all children within the NHS, 18 week waiting time frame.

Where do we work?

We aim to work in the environment which is most appropriate for the child/young person. This may be:-

• At Princess Royal Hospital (neonatal/children’s ward)
• In community clinics
• In educational/day care settings
• In the child/young person’s home

What do we do?

We will assess the child/young person’s eating, drinking and swallowing skills through:-

• Listening to the concerns of the child/young person, their family/carers, educational/day care setting staff and other professionals as appropriate.
• Observation of the child/young person’s eating, drinking and swallowing skills.

Once the assessment is completed we will:-

• Offer advice and recommendations as appropriate.
• Liaise with the wider professional team.
• Make onward referrals as appropriate.

How do we work?

Our aim is to address the needs of the child/young person and their carers as quickly as we can within the confines of busy caseloads. This may mean that we initially contact people on the telephone and may then offer consultation via an online platform [e.g. Attend Anywhere, MS Teams, What’s app video] or a face to face appointment.

We usually ask to observe a child/young person eating and drinking in order to identify what difficulties they may be having. We will then devise a plan to help families and educational/day care settings support them to improve their feeding skills. This plan may be verbal or written.

A guide to typical development of eating and drinking skills

Children develop at different rates and there may be a reason why your child is not progressing through the typical development.

Credit: NHS Tayside. Children and Young People's Speech and Language Therapy

If you are concerned about the development of your child’s eating and drinking skills, please speak to your health visitor or another medical practitioner. They may be able to offer you advice and support. They can also refer on to Speech and Language Therapy if they feel this is appropriate.

Tips

• Always ensure your child is in an upright position for safe eating and drinking.
• Have fun with food. The messier the better!
• Introduce one new taste per week.
• Introduce a small amount of food at a time.
• Don't make what the child is eating the focus of attention.
• Make neutral comments. That is don't show your feelings if the child tries or doesn't try it.
• Reduce the number of foods the child can choose from.
• Ensure there are minimal distractions at mealtimes.
• Ensure consistency between feeders. That is mum and dad do the same thing.
• If your child likes to have a toy while eating, have specific toys for this time.

• STAY – Stay with children when they’re eating – it’s the biggest thing you can do for them.
• STILL – Get children to sit still – it can be a battle but it’s much safer.

· Cut up foods that are round, hard, chunky, doughy, or stodgy.

• Sausages or hot dogs – cut into short, narrow strips lengthways as thin as possible. Removing the skin makes them easier to swallow.
• Meat – cut into strips and remove any bones, skin, or fat.
• Fruit – check for pips or stones and remove them.
• Round fruit (grapes, blueberries, cherries, strawberries, and cherry tomatoes)– cut lengthways and then into quarters.
• Vegetables and larger fruit (melon, apple, mango, carrot and cucumber) – cut into thin strips, grate or mash, steam, or simmer.
• Legumes (chickpeas and butter beans) – mash or steam to soften them.
• Nuts and seeds – chop or flake (Whole nuts should not be given to under 5’s).
• Cheese – cut into narrow batons or strips.
• Bread - Cut all types of bread into narrow strips. White bread can form a doughy ball, so brown or toasted bread is a good option.
• Remove skin from fruits or vegetables to make them easier to swallow.

· AVOID these foods – for babies and young children

• Popcorn
• Marshmallows
• Round Hard Sweets – including lollipops
• Mini-Eggs
• Jelly cubes
• Peanut butter (but ok to use as a spread
• Whole grapes

Links:

• Safe from choking | How to prevent choking in children
• Why are grapes so dangerous? | Child Accident Prevention Trust
• CAPT fact sheet: Breathe-Easy-Fact-Sheet-2023.pdf
• Child Choking - Paediatric First Aid | St John Ambulance
• You Tube: What to Do When Someone Is Choking First Aid Training St John Ambulance https://youtu.be/3G_0YxMEViE?feature=shared
• You Tube: What to do if Your Baby is Choking - First Aid Training - St John Ambulance https://youtu.be/oswDpwzbAV8?feature=shared

Useful links, leaflets and books

Link to Information regarding allergies

Link to Information regarding reflux

Link to Information regarding weaning

Link to PADS Baby Led Weaning a baby with Down syndrome

Link to Information about aspiration

Information regarding refusal of foods

Links to websites:

ARFID Awareness
Feed Eat Speak - a blog on fussy eating facts and fixes
Fussy and Faddy Eating in Toddlers
Making Sense of Sensory Behaviour
Story Book for Children
Food Refusal - traded service offering families support and further training
Feeding Trust

Free resources regarding self-restricted eating.

Book:

Food Refusal and Avoidant Eating in Children, Including those with Autism Spectrum Conditions: A Practical Guide for Parents and Professionals (2018) by Gillian Harris and Elizabeth Shea

Information sheets

Children With Self-Restricted Diets

Messy Play

Fun with Food

Expanding Sets

Self restricted eating video

Link to Self Restricted Eating video

Link to Friends and Family feedback form

Link to the iThrive document which gives an overview to clinical staff, local authorities, parent & carer groups, third sector and voluntary organisations, schools, nurseries and parent & carers about the current support, signposting, services and treatment available for children and young people who have eating, drinking and swallowing needs across Shropshire, Telford and Wrekin.