Clinical Feeding and Swallowing Evaluation for the School-Based Speech-Language Pathologist

Published in the February 2025 issue of the ISHA Voice.

By Elisabeth C. D’Angelo, 2023. Available on ASHA using this link: https://pubs.asha.org/doi/epdf/10.1044/2023_LSHSS-23-00019

Review by: Valerie Heneghan, a member of the ISHA Evidence-based Practices Issues Committee

Why is feeding therapy for school aged children typically reserved “outpatient” speech-language pathologists? School-age children require safe and adequate nutrition and hydration for learning and social participation. Federal law mandates that a child must be educated in the least restrictive environment (Rozalski et al., 2011) and encourage the support of children with dysphagia and feeding disorders (Lau & Schanler, 2000; Power-deFur & Alley,2008). The law also maintains that the school and its staff are responsible for the child while at school (Katsiyannis et al., 2001).

In line with the World Health Organization International Classification of Functioning, Disability and Health, PFDs are defined as impaired oral intake that is inappropriate for age and associated with medical, nutritional, feeding skill, and/or social–emotional dysfunction (Goday et al., 2019). The incidence of PFDs is estimated to be 25%–45% for typically developing children and up to 80% for children with developmental disabilities (Linscheid et al., 2003).

Growth and the ability to learn are supported by adequate nutrition and hydration. Social participation with peers around eating is integral to optimal child development. Limitations to offering support through school-based environment may be attributed that children can only qualify for special education services if they are below a certain point developmentally or compared with the standardized score cutoff levels. They are also required to demonstrate “educational impact” from their disability (Yell & Drasgow, 2000). The educational impact on children with pediatric feeding disorder (PFD) is dependent on their ability to take sufficient nutrition and hydration to support their ability to learn in the academic environment which may be difficult to document.

This article outlines a flow chart and feeding evaluation process for the school-based SLP with resources to support the need for school-based feeding interventions.