Swallowing and Feeding in the School Setting: What Should a District Do?

“We don’t address swallowing and feeding in our district but…we have a medically fragile student in our district that is currently tube fed and from what we can tell, is very compromised in the area of swallowing. The parents would like for us to feed their child orally at school and are very persistent. They will not give us a release to communicate with the physician. We don’t want to, but we think we have to feed the child.”

This is a common scenario that triggers a school district to confront the issue of addressing swallowing and feeding. Unfortunately, they often begin asking questions only when they have a high profile, contentious case and they have nothing in place to either dispute the parent’s request or support their own decisions!

Is This Something a District Must Address?

Many school districts are apprehensive about addressing swallowing and feeding and frequently take a “hands off” approach. Their rationale is that it is too risky, a medical issue, and not educationally relevant. But let’s take a closer look at those concerns:

Two Supreme Court cases, Irving Independent School District vs. Tatro, 468 U.S. 883 (1984) and Cedar Rapids Community School District vs. Garret F., 526 U. S. 66 (1999) ruled that if the services are supportive services that the student needs to attend school and benefit from his education, and that they do not need to be performed by a licensed physician, then the school division must provide them.³ As a result, health services provided by a nurse or other qualified professional are considered a related service under the Individual with Disabilities Education Act (IDEA, 2004). Swallowing and feeding services would fall under health as a related service. In addition, several state court cases have set precedent by ruling in favor of school districts providing modified diets, etc.

But is it Educationally Relevant?

Yes, in order for a student to benefit from his/her curriculum they must have adequate nutrition in order to:

• Be healthy enough to attend school
• Have the stamina participate in their curriculum at school
• Eat their school meals within the allotted time
• Socialize with peers

Who Should Be Addressing Swallowing and Feeding in the School Setting?

Are you an SLP that has been asked to manage a student’s swallowing and feeding disorder on your own? Many speech language pathologists (SLPs) have the training to evaluate and treat swallowing concerns; however, these complex disorders require the expertise of a team of professionals, each looking at the disorder using their own training and profession.

The core team of the SLP, occupational therapist (OT) and the school nurse, along with parents, physical therapists (PT), classroom teachers, paraprofessionals, school administration and others, make up the school-based team. The team effort needs total and complete district backing which includes a system-support procedure.¹

A procedure for addressing swallowing and feeding in the school setting must include the following:

• Comprehensive process for identifying swallowing and feeding disorders and establishing safe feeding plans
• A protocol for training classroom staff on the safe plan and a system of ongoing monitoring of the implementation of the plan
• A procedure for working with parents and school cafeteria programs to ensure that the food presented to students meets the requirements of the safe feeding plan.
• The checks and balances necessary to ensure that children are safe during mealtimes and when eating at school.
• Intervention for oral sensory motor skills to improve functional swallowing and feeding skills when appropriate.

What Should You Do if Your District is Not Addressing Swallowing and Feeding?

Gather your colleagues and form a committee to begin the process of educating your district on swallowing and feeding disorders, include answers to the following:

• What is a swallowing (dysphagia) and feeding disorder?
• What are the complications related to swallowing and feeding disorders?
• What students are at risk for a swallowing and feeding disorder?
• What are the signs and symptoms?
• What can a district do to provide a safe eating environment for students with swallowing and feeding disorders?
• What professionals have the training and experience to address this disorder? (See District Information Sheet Below)

The committee, usually SLPs, OTs and nurses, can present to their district a suggested procedure that will offer the checks and balances necessary to safely address swallowing and feeding disorders in the school setting. These should include:

• A system-wide procedure
• A team approach
• Commitment to FAPE (free and appropriate public education) by recognizing the educational relevance of addressing swallowing and feeding
• Implementation of the procedure with fidelity

Forming a system-supported swallowing and feeding procedure establishes a safe eating environment for students at school; educates classroom staff on the student’s swallowing and feeding issues so that they are knowledgeable and confident; and establishes a process for utilizing a district’s professional staff to monitor and adjust the student’s swallowing and feeding plan when necessary.