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Feeding includes food acquisition, ingestion, digestion, and absorption. This activity relieves hunger and provides multisensory stimulation, resulting in a pleasant, rewarding experience for both the child and the caretaker. Successful feeding experiences create positive reciprocal interactions that reinforce the bonding relationship between child and caretaker. Feeding disorders prevent the infant from ingesting adequate nutrients for continued health, growth, and development.

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Feeding and swallowing are complex processes that can be divided functionally into 4 phases, as shown in Figures 31-1 and 31-2. The preoral phase is initiated when the child senses and communicates hunger. The oral phase is a food-processing step wherein the ingested material is formed into a bolus that can safely pass through the pharynx; the remainder of the swallowing process is involuntary and reflexive. The pharyngeal phase is quite rapid. It is initiated by bolus contact with the tonsillar pillars and pharyngeal wall with subsequent elevation of the larynx, vocal cord closure, and relaxation of the upper esophageal sphincter. A peristaltic wave of contraction of the pharynx propels the bolus into the esophagus.

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Figure 31-1.
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Model of the normal phases of feeding in infants and children. Complex interactions between phases often obscure diagnosis of the primary cause of a feeding disorder.

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Figure 31-2.
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A: The infant oropharynx. The larynx is elevated with the epiglottis touching the soft palate, creating a functional separation between the air passages (white arrow) and the food passages (black/gray arrow) in the pharynx. Food courses around the epiglottis, into the pharyngeal recess, and then to the esophagus. B: The toddler (2–3 years old) oropharynx. C: The adult oropharynx: (1) oral preparatory phase, (2) oral phase, (3) pharyngeal phase, (4) esophageal phase. Note that the infant oral cavity is much smaller than the child or adult oral cavity, providing little space for manipulation of the food bolus. The larynx is elevated so that the epiglottis almost touches the soft palate, and the larynx is at the level of the first to third cervical vertebrae. The tongue is entirely within the oral cavity, with no oral region of the pharynx. In the toddler, the larynx descends to the fifth cervical vertebra, and by adulthood it descends to the sixth to seventh cervical vertebra.

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During passage of the bolus through the pharynx, excellent coordination between breathing and swallowing is essential to prevent aspiration. In the esophageal phase, the bolus is transported into the stomach. Finally, the bolus is broken down and absorbed during the digestive phase. Developmental and maturational changes in the phases of swallowing occurring from infancy to childhood can have a significant impact on ...

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