The clinical neurology of problems with oral feeding

Abstract

Oral feeding comprises a number of composite functions, all of which have to be coordinated to ensure adequate nutrition and hydration. Voluntary swallowing is central to the process, but without preserved pulmonary function, including cough, the airway is vulnerable. Medical and surgical problems, and the environment in which the patient is nursed, also determine the success of attempted oral feeding. Using this framework of thinking may help structure the clinical approach to oral feeding failure and facilitate discussion of issues other than just swallowing and dysphagia when forming opinions about the diagnosis and prognosis of the underlying disease, the mechanism of the feeding problem, and the most appropriate therapy. The goals of any intervention should be informed by a detailed appreciation of clinical issues and a working knowledge of the relevant ethical and legal issues. The MEALTIME approach is suggested as an aide memoire to help ensure that the relevant issues are addressed.