Swallowing Difficulties in Babies and Children
Specialist assessment and therapy for children with swallowing difficulties (paediatric dysphagia)
Watching your child struggle to eat or drink can be frightening. Whether your baby coughs during feeds, your toddler frequently chokes on food, or your child has already been diagnosed with swallowing difficulties, it's natural to feel worried about their safety and wellbeing.
Swallowing difficulties, also known as paediatric dysphagia, can affect babies and children of all ages. They may make eating and drinking unsafe, increase the risk of chest infections, affect nutrition and growth, or turn mealtimes into a source of stress for the whole family.
As a specialist paediatric Speech and Language Therapist with extensive experience assessing and treating swallowing difficulties, I work with families to understand why feeding is difficult and develop practical, evidence-based strategies to help children eat and drink as safely as possible.
Whether you're looking for reassurance, a comprehensive swallowing assessment, or specialist therapy, I'm here to support you every step of the way.
Are you worried about your child's swallowing?
Many parents contact me because they know something doesn't feel right during mealtimes, even if they're not sure exactly why.
Your child may benefit from a specialist swallowing assessment if they:
Cough or splutter during breastfeeds, bottle feeds or meals
Frequently choke while eating or drinking
Seem to struggle swallowing certain textures
Hold food in their mouth for long periods
Gag excessively during meals
Need meals to be cut into extremely small pieces
Refuse foods that require chewing
Sound wet or gurgly after eating or drinking
Experience recurrent chest infections or chesty coughs
Take a very long time to finish meals
Lose food or drink from their mouth while eating
Appear uncomfortable or distressed during meals
Become breathless whilst eating or drinking
Have experienced poor weight gain linked to feeding difficulties
Have been advised that they may need a swallowing assessment
If several of these sound familiar, a specialist assessment can help identify what's happening and determine the safest way forward.
What is paediatric dysphagia?
Paediatric dysphagia simply means difficulty swallowing.
Swallowing is something most of us rarely think about, yet it is an incredibly complex process involving the brain, nerves and dozens of muscles working together with remarkable precision. A problem at any stage of this process can make eating and drinking more difficult or, in some cases, unsafe.
Swallowing difficulties can occur in babies, toddlers and older children. Some children are born with conditions that affect swallowing, while others develop difficulties following illness, surgery or changes in their medical condition.
For some children, swallowing problems are mild and only affect certain food textures. For others, they can increase the risk of food or drink entering the airway instead of the stomach (known as aspiration), which may increase the likelihood of respiratory complications.
Every child is different, which is why an individual assessment is so important.
Why do swallowing difficulties happen?
Swallowing difficulties can occur for many different reasons.
Some children have difficulties because of developmental differences, while others have an underlying medical condition that affects the muscles or coordination needed for safe swallowing.
Children I commonly work with include those with:
Cerebral palsy
Genetic syndromes
Neurological conditions
Prematurity
Developmental delay
Congenital abnormalities affecting the mouth or airway
Respiratory conditions
Children recovering from surgery or serious illness
Complex medical needs
Feeding tubes transitioning towards oral feeding
Some children have no obvious diagnosis but continue to experience coughing, choking or difficulty managing certain foods. These children also benefit from specialist assessment.
How I assess swallowing difficulties
Every child is different, which is why I don't believe in a one-size-fits-all approach. Before making any recommendations, I take the time to understand your child's medical history, feeding journey and the specific concerns that have led you to seek support.
A swallowing assessment is about much more than watching a child eat. It's about understanding why they are finding eating or drinking difficult and identifying the factors that may be affecting their swallowing safety.
During your assessment, I may explore:
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Understanding your child's wider medical history helps build a complete picture. Depending on your child's needs, we may discuss:
Pregnancy and birth history
Early feeding experiences
Growth and nutrition
Medical diagnoses
Previous hospital admissions
Current medications
Respiratory health
Previous assessments or investigations
Developmental milestones
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Watching your child eat provides valuable information that simply can't be gathered through conversation alone.
Where appropriate, I'll observe your child eating and drinking foods and drinks that they would normally have at home. I'll be looking at many aspects of feeding, including:
How they manage different food textures
Lip closure and tongue movements
Chewing skills
Swallowing coordination
Signs of coughing, choking or aspiration
Fatigue during meals
Breathing whilst eating
Positioning
Self-feeding skills
Mealtime interactions
These observations help me understand both your child's strengths and the areas where they may need additional support.
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You know your child better than anyone.
Your observations are an essential part of the assessment. I'll ask about the difficulties you've noticed, when they occur and how feeding impacts everyday family life.
Together, we'll build a complete picture of what's happening and agree on the most appropriate next steps.
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Following your assessment, you'll receive a detailed written report explaining my findings in straightforward language.
This will include:
A summary of the assessment
My clinical opinion
Practical recommendations you can begin implementing
Advice about feeding safety where appropriate
Recommendations for onward referrals if required
A therapy plan where ongoing input would be beneficial
My aim is that you leave the assessment with a much clearer understanding of your child's swallowing and a practical plan you feel confident putting into practice.
How therapy can help
Every child's therapy programme is different because every child has different strengths, challenges and goals.
Depending on your child's needs, therapy may focus on:
Improving oral motor skills where appropriate
Developing chewing skills
Introducing new food textures safely
Supporting progression through texture stages
Positioning and postural advice
Making mealtimes safer and less stressful
Supporting parents with practical feeding strategies
Working alongside dietitians, paediatricians and other professionals involved in your child's care
Reviewing progress and adapting recommendations as your child develops
Where appropriate, I also work closely with NHS teams and other professionals to ensure everyone involved in your child's care is working towards the same goals.
Why choose Emma Fitzgerald?
Choosing the right therapist for your child is an important decision. Feeding and swallowing difficulties can feel overwhelming, and you want to know your child is being assessed by someone with specialist knowledge and extensive clinical experience.
I have dedicated my career to helping babies and children with feeding and swallowing difficulties. Before establishing my independent practice, I spent over 13 years working within the NHS, including as a Band 7 Clinical Lead Speech and Language Therapist specialising in paediatric feeding and dysphagia.
During my NHS career, I worked with children presenting with a wide range of feeding and swallowing difficulties, from babies struggling with their first feeds through to children with complex neurological and medical conditions requiring highly specialist assessment and management.
My approach is always evidence-based, compassionate and tailored to your child. I understand that every family is different, and I believe parents should leave every appointment feeling listened to, informed and confident about the next steps.
When you work with me, you're not just receiving an assessment—you're gaining a therapist who genuinely wants to understand your child's unique challenges and help your family move forward.
My approach
I believe the best outcomes happen when families feel supported, informed and involved.
Rather than giving parents a long list of instructions, I take time to explain what I'm seeing, why it matters and how each recommendation will help your child.
My aim is to provide practical, realistic advice that fits into everyday family life. Feeding can already feel stressful enough without adding unrealistic expectations.
Every recommendation I make is based on your child's individual needs, current evidence and clinical reasoning.
What happens after you get in touch?
Getting specialist support shouldn't feel complicated.
Step 1 – Discussion
We'll have a brief conversation about your concerns, your child's history and whether my service is the right fit for your family.
Step 2 – Comprehensive assessment
I'll complete a detailed feeding and swallowing assessment, taking time to understand both your child's feeding skills and the wider factors influencing mealtimes.
Step 3 – Personalised report
You'll receive a comprehensive written report explaining my findings, recommendations and practical strategies tailored specifically to your child.
Step 4 – Ongoing support
Some families feel reassured after a single assessment, while others benefit from follow-up sessions as their child progresses. Together, we'll decide what level of support feels right for your family.
Frequently Asked Questions
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Not necessarily. Many children cough occasionally while eating or drinking. However, frequent coughing, choking, wet-sounding breathing or repeated chest infections may indicate an underlying swallowing difficulty that should be assessed by a specialist.
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No. Gagging and choking are different protective responses.
Some gagging can be a normal part of learning to eat, particularly in babies and toddlers. However, persistent gagging, particularly if it limits your child's diet or causes significant distress, may benefit from further assessment.
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Yes. Many children make significant progress with the right assessment, advice and intervention. Every child is different, so the most appropriate approach will depend on the underlying cause of their swallowing difficulties.
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Not every child requires an instrumental swallowing assessment.
Following a clinical assessment, I will discuss whether further investigations such as a Videofluoroscopic Swallow Study (VFSS) or Fibreoptic Endoscopic Evaluation of Swallowing (FEES) may be appropriate and will liaise with your medical team where necessary.
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Yes.
Where appropriate and with your consent, I can work collaboratively with your child's NHS Speech and Language Therapy team, paediatrician, dietitian, school or nursery to help ensure everyone is working towards the same goals.
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Some swallowing assessments can be completed successfully via secure video consultation. However, this depends on your child's age, medical history and the nature of their swallowing difficulties.
If I feel your child requires an in-person assessment or medical review, I will discuss this with you before arranging an appointment.
Take the first step towards safer, less stressful mealtimes
If you're worried about your child's swallowing, you don't have to work through it alone.
Whether you're looking for reassurance, a specialist assessment or ongoing therapy, I'm here to help you understand what's happening and support your child to eat and drink as safely and confidently as possible.
get in touch to discuss your concerns and find out whether specialist Speech and Language Therapy is the right next step for your family.