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The Source® for Pediatric Dysphagia Second Edition
Ages: Birth-18   Grades: Birth-Adult         

Use best-practice to evaluate and treat dysphagia in children with motor-based, experientially-based, and sensory-based disorders.  This second edition contains significant updates in the treatment of pediatric dysphagia, with new information on the evaluation and treatment of behavioral feeding disorders and school-based dysphagia services.


  • Effectively evaluate and treat dysphagia in children with motor-based, experientially-based, and sensory-based disorders
  • Understand your role in the management of dysphagia in a school setting
  • Manage dysphagia documentation efficiently
  • Treat behavior-based disorders, such as selective eating or refusal to eat
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** This is a Cloud E-Book that is accessible from any device with Internet access. .

Updated and expanded evaluation tools and goals help organize your treatment.  Whether you are new to the subject area or a veteran, you'll find information you need to practice effectively.  Here's a sampling of the content:

  • anatomy and physiology—nutritive vs. non-nutritive suckling, reflexes and what they mean, normal development of feeding and self-feeding skills, and more
  • clinical evaluation—differential diagnosis of feeding disorders, completing a case history, example evaluations, and more
  • instrumentation—administration and analyses of FEES and MBS, radiation safety, monitoring of the infant's/child's response, and more
  • treatment—treatment of problems associated with abnormal tone, sensation, and motor learning; behavior-based dysphagia; children who are NPO; and more
  • managing dysphagia in the school setting—establishing a dysphagia team, reimbursement, developing IEPs and individual health services plans, and more
  • treatment of infants—facilitating infant response, understanding distress signals and state of alertness, breastfeeding, and more

The book comes with a FREE CD of an additional 51 printable pages (in PDF format) of therapy tools:

  • case history form
  • evaluation forms individualized by these age groups:  0-4months, 4 months-5 years, and 5-18 years
  • in-service guide on dysphagia in school-age children
  • educational handouts
  • observation forms
  • questionnaire for children with severe drooling
  • tips for developing good mealtime behaviors

Copyright © 1998, 2010

177-page book plus a CD of an additional 51 printable pages in PDF format (printable evaluation tools and educational handouts)

Without a doubt, Nancy Swigert's The Source for Pediatric Dysphagia Second Edition, is one of the most used tools.  I have memorized and worn out my copy!  I use the forms, the charts, and many of her techniques in my therapy with the birth to three population.  The evaluation forms are very helpful in making sure I note all of the important areas in my reports.  It makes my work much more accurate and professional, as well as easier.  The exercise illustrations are very helpful for parents and families.

Lura J Fauber, SLP
Lewisburg, WV

  • ASHA's Scope of Practice in Speech-Language Pathology includes assessment and management of swallowing disorders and the use of instrumentation for the diagnosis of swallowing and feeding disorders (ASHA, 2001).
  • Infants have been shown to improve efficiency of feeding and reduce duration of nipple feedings with a self-pacing system and vacuum-free bottles (Lau & Schanler, 2000). 
  • Children who are tube-fed may have difficulty transitioning to oral feeding and may become orally defensive.  Preventing oral defensiveness in tube-fed children should be one of the goals in swallowing therapy (Senez, Guys, Mancini, Paz Paredes, Lena, & Choux, 1996). 
  • Oral sensorimotor treatment strategies have been reported to be successful when used with children with cerebral palsy (Gisel, 1994, 1996; Gisel, Applegate-Ferrante, Benson, & Bosma, 1995, 1996).
  • A systematic procedure for provision of dysphagia services to children in a school district ensures that students with dysphagia are fed safely and effectively, and may protect employees and the school system in the event of litigation (Homer, 2003, 2004; Homer, Bickerton, Hill, Parham, & Taylor, 2000). 
  • From 25% to 80% of individuals with cerebral palsy have additional impairments, with about half showing gastrointestinal and feeding problems (Odding, Roebroeck, & Stam, 2006). 
  • In order to establish and stabilize behavior, factors such as practice time, environment supports, and task repetitions must be appropriate (Piek, 2006; Thelen & Smith, 1994). 
  • The child's developmental level should be considered when determining if a skill is emerging, in the middle stage of motor awareness, or in the advanced stage of automaticity (Sheppard, 2008).

The Source for Pediatric Dysphagia Second Edition incorporates these principles and is also based on expert professional practice.


American Speech-Language-Hearing Association (ASHA). (2001). Scope of practice in speech-language pathology. Retrieved September 25, 2009, from

Gisel, E.G. (1994). Oral-motor skills following sensorimotor intervention in the moderately eating-impaired child with cerebral palsy. Dysphagia, 9, 180-192.

Gisel, E.G. (1996). Effect of oral sensorimotor treatment on measures of growth and efficiency of eating in the moderately eating-impaired child with cerebral palsy. Dysphagia, 11, 48-58.

Gisel, E.G., Applegate-Ferrante, T., Benson, J., & Bosma, J. (1995). Effect of oral sensorimotor treatment on measures of growth, eating efficiency and aspiration in the dysphagic child with cerebral palsy. Developmental Medicine and Child Neurology, 37, 528-543.

Gisel, E.G., Applegate-Ferrante, T., Benson, J., & Bosma, J. (1996). Oral-motor skills following sensorimotor therapy in two groups of moderately dysphagic children with cerebral palsy: Aspiration vs. nonaspiration. Dysphagia, 11, 59-71.

Homer, E. (2003). An interdisciplinary team approach to providing dysphagia treatment in the schools. Seminars in Speech and Language, 24, 215-227.

Homer, E. (2004). Dysphagia in the schools: One school district's proactive approach to providing services to children. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 13(1), 1, 7-9.

Homer, E., Bickerton, C., Hill, S., Parham, L., & Taylor, D. (2000). Development of an interdisciplinary dysphagia team in the public schools. Language, Speech, and Hearing Services in Schools, 31, 62-75.

Lau, C., & Schanler, R.J. (2000). Oral feeding in premature infants: Advantage of a self-paced milk flow. Acta Paediatrica, 89, 393-398.

Odding, E., Roebroeck, M.E., & Stam, H.J. (2006). The epidemiology of cerebral palsy: Incidence, impairments and risk factors. Disabilities Rehabilitation, 28(4), 183-191.

Piek, J.P. (2006). Infant motor development. Champaign, IL: Human Kinetics.

Senez, C., Guys, J.M., Mancini, J., Paz Paredes, A., Lena, G., & Choux, M. (1996). Weaning children from tube to oral feeding. Child Nervous System, 12(10), 590-594.

Sheppard, J.J. (2008). Using motor learning approaches for treating swallowing and feeding disorders: A review. Language, Speech, and Hearing Services in Schools, 39, 227-236.

Thelen, E., & Smith, L.B. (1994). A dynamic systems approach to the development of cognition and action. Cambridge, MA: MIT Press.


Nancy B. Swigert


Nancy B. Swigert, M.A., CCC-SLP, received her master's degree from the University of Tennessee, Knoxville.  She is a Board Recognized Specialist in Swallowing and Swallowing Disorders.  She is the director of Speech-Language Pathology and Respiratory Care at Central Baptist Hospital in Lexington, KY.  Prior to that, for twenty-six years, she was owner of Swigert & Associates, Inc., a private practice.

Nancy evaluates and treats infants, children, and adults with dysphagia and with neurological communication disorders.  She lectures extensively at the state, regional, and national levels on dysphagia, dysarthria, and reimbursement and coding.  She is also the author of five other publications for LinguiSystems: The Early Intervention Kit, The Source for Dysphagia Third Edition, The Source for Children's Voice Disorders, The Source for Dysarthria Second Edition, and The Source for Reading Fluency.

Nancy is a former president of the Kentucky Speech-Language-Hearing Association and the Council of State Association Presidents.  She is very active in the American Speech-Language-Hearing Association, having served as president in 1998.  She has also chaired the Health Care Economics Committee; the American Speech-Language-Hearing Foundation; and the Steering Committee for Special Interest Division 13, Swallowing and Swallowing Disorders.  She is currently serving on the Specialty Board for Swallowing and Swallowing Disorders.


The Source for Pediatric Dysphagia was first published in 1998.  I wrote the original book after writing The Source for Dysphagia because of my interest in dysphagia with patients of all ages, but also because I thought it would be relatively easy to pull together having already written the book on adults.  However, writing this book served daily to remind me that treating infants and children with dysphagia is an entirely different task than treating adults.  As clinicians, we would benefit (as would both our pediatric and adult patients) from remembering that lesson.

Over the last 12 years, I have often lectured around the country on pediatric dysphagia to clinicians working in a variety of settings, including home health, early intervention, clinics, hospitals, and schools.  These clinicians have shared many challenges they face in providing services to infants and children.  Their requests for more information on certain topics (e.g., autism, behavioral feeding) and the need to provide updated information spurred the writing of this new edition.  This Second Edition provides current information in evaluation and treatment, with particular attention to updating information on evaluation and on treatment for behavioral feeding.

Most chapters contain significant revisions, such as:

  • updated understanding of the physiology of the swallow
  • Total revamping of the evaluation tools to make them more comprehensive and yet easier to use. There are three distinct tools divided by age range.
  • information on FEES as an instrumental assessment tool
  • more comprehensive description of the types of pediatric dysphagia
  • information on motor learning and how it impacts treatment
  • basic information on nutrition (how much and what infants and children should eat)
  • additional treatment techniques for treating behaviorally-based disorders, with a delineation of food refusal and selectivity
  • additional goals and treatment objectives, particularly for stability and mobility and for food refusal and selectivity
  • expanded and updated reference list

I've also added a chapter on providing dysphagia services in school settings.  I was lucky that my colleague and friend, Lisa Rai Mabry-Price, who for the last seven years has worked at the ASHA national office as associate director, School Services, agreed to write the chapter.

The Source for Pediatric Dysphagia Second Edition is designed to make your work more efficient.  The reference material is presented in an easy-to-read format so you can quickly look up information about the child's problem.  The forms facilitate your recording observations of the child in a quick and easy way, reducing the amount of time you spend on paperwork.  The long- and short-term goals and treatment objectives are organized by the type of oral-motor or behavioral problem you are addressing.  These goals will keep you from reinventing the wheel for each child you see, yet will allow you to customize the goals to meet a specific child's needs.

Due to the expanded information in this edition, many of the pages previously included within the book (primarily reproducible pages) have been transferred to the enclosed CD (inside back cover).  

Speech-language pathologists are the preferred providers of services to children with dysphagia.  To remain in this position, we must continually update our knowledge and skills.  I hope The Source for Pediatric Dysphagia Second Edition is one of the ways you will keep your skills on the cutting edge of dysphagia services.  I also hope you'll take advantage of ASHA's Special Interest Division 13, Swallowing and Swallowing Disorders.  It is a great value and an easy way to stay current in our area of practice.  If you're an experienced clinician, perhaps it's time for you to seek recognition as a specialist from the Board for Specialty Recognition in Swallowing and Swallowing Disorders.

There are so many things to remember and consider when working with infants and children with dysphagia.  I hope The Source for Pediatric Dysphagia Second Edition helps you refine your skills and organize your approach to treatment.