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As speech-language pathologists have broadened their clinical practice to include infants and children who rely on a feeding tube for nutrition, they have emphasized predominantly the mechanics of eating and drinking. The development and expansion of these skills in the typically developing child is immersed in a foundation and context of mealtimes. Mealtimes provide the physical and emotional connection with others. They create a multiplicity of opportunities to provide a solid foundation upon which the expansion and mastery of feeding skills is based. This article focuses on deepening the understanding and contrast between the meals of children who are orally fed and children who are tube fed It takes the position that children who are tube fed and their families benefit when feeding therapists give priority to building the mealtime skills that emphasize comfort, confidence, and competence.

The mealtime setting can be creatively used by the speech-language pathologist to increase the positive interactions between the child and caregiver and to establish the basic prerequisites for the development of communication. Specific program suggestions are provided to enable the speech-language pathologist to utilize the mealtime setting to integrate both vocal and nonvocal communicative objectives. The roots of interaction and communication which underly both vocal and nonvocal systems are described.

Treatment of children with swallowing dysfunction requires a holistic approach based on a global view of their problems and needs. The connection of the swallowing mechanism with the sensorimotor organization of postural tone and movement throughout the body is a critical factor in the evaluation and treatment of children whose dysphagia is rooted in a neurologic disorder. An appropriate program includes work with the development of movement skills, sensory processing, learning, social skills, and communication. The initial focus is placed on oral-motor treatment, rather than direct work on oral feeding. The primary goal of the program is to develop the appropriate use of the mouth, respiratory, and phonatory systems in exploration, sound play, and as much oral feeding as possible. Oral feeding is the by-product of a total program, not its major goal.