Synopsis
Assess complex paediatric feeding across safety, nutrition, skill and experience, recognise aspiration and acute tube complications, use multidisciplinary investigation appropriately and make shared decisions about oral support and gastrostomy feeding.
- Assess feeding in four linked domains: airway safety, nutrition and hydration, developmental skill, and the child's and family's mealtime experience.
- Take a detailed meal history including textures, duration, positioning, fatigue, respiratory signs, stool pattern, discomfort and caregiver strategies.
- Observe an ordinary feed with speech and language therapy when possible; one brief examination cannot reproduce every home difficulty.
- Instrumental swallow assessment answers a defined question about physiology and management; it is not a stand-alone test for every selective eater.
- While awaiting assessment, agree safe positioning, pacing, texture and emergency actions without imposing unnecessary nil-by-mouth restriction.
- Consider enteral feeding when oral intake cannot safely or adequately meet need, after multidisciplinary assessment and shared decision-making.
- Gastrostomy can improve reliable nutrition and medicine delivery but does not abolish aspiration of saliva, reflux or all respiratory risk.
- Every child with a gastrostomy needs a written tube type, size, replacement, feeding, venting and emergency contact plan.
Key red flags
Cough, choking, colour change, wet voice, desaturation or recurrent chest infection associated with feeding suggests oropharyngeal aspiration.
Silent aspiration remains possible when airway sensation and cough are impaired, so absence of choking is not reassuring by itself.
Bilious vomiting, abdominal distension, guarding, severe pain or systemic illness requires urgent gastrointestinal assessment before further feeds.
A gastrostomy inserted recently or replaced with difficulty must not be used until position and tract safety are confirmed by the responsible team.
Weight faltering, prolonged meals, dehydration, micronutrient deficiency or exhausting caregiver workload indicates clinically significant feeding difficulty.
Fearful feeding, unexplained oral injury or withholding of nutrition can signal trauma, coercion or safeguarding harm.
Investigation priorities
Assess positioning, skill, respiratory response, endurance and interaction during a representative meal.
Management branches
Feeding is prolonged, distressing, nutritionally inadequate or associated with respiratory symptoms.
- Take a structured history of food, fluids, symptoms, growth and routines.
- Examine respiratory state, hydration, oral structures, neurology and abdomen.
- Arrange multidisciplinary mealtime observation using familiar methods when safe.
- Create interim feeding and escalation advice with the family.