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Mechanical dysphagia has many possible etiologies, though all commonly share the process of narrowing the lumen of the esophagus with subsequent delay in passage of solid foods. Benign strictures, webs, and rings are among the most common causes of mechanical obstruction of the esophagus.

The normal oropharyngeal swallow involves rapid neuromuscular actions to move food or liquid through the mouth and pharynx and into the esophagus in two seconds or less. Evaluation of the normal or abnormal swallow is most often completed using a radiographic videofluoroscopic procedure known as the modified barium swallow (MBS) procedure described in detail in this chapter. The MBS has 3 purposes: 1) To identify the presence and the cause of any aspiration; 2) To identify the presence and cause of any oral or oropharyngeal residue after the swallow; 3) To identify treatment strategies that can improve the patient’s swallow. During the MBS various volumes of thin liquids from 1 ml to cup drinking, measured viscosities from thin liquid to nectar, puree, and solid food, voluntary controls including timing and effort of airway closure, increasing muscular effort, etc. and sensory stimulation techniques including boluses of various tastes and carbonation can be introduced as described in the chapter. These procedures are assessed for their effectiveness in improving the oropharyngeal swallow and returning the patient to full oral intake as quickly and safely as possible.

Adequate nutrition is crucial for the proper development of infants and children. Nutritional supplementation has shown clear benefits on the Development Quotient (DQ), which includes practical reasoning, eye and hand coordination, hearing and speech, and performance [1]. As seen in Fig. 5.1, stunted children who received a supplemented nutrition showed a significant increase in their DQ after 12 months compared to stunted children who were fed as usual for age [1]. This chapter outlines feeding guidelines in the developing infant and child as well as some special diets which may be indicated in certain conditions. In addition, developmental milestones pertaining to feeding will be addressed briefly.

The Demographic and Health Survey (DHS) data provide a strong base for evaluating guidelines for child feeding across multiple countries. Based on DHS data, breastfeeding was widely practiced and a high percentage of mothers continued to breastfeed through the first year of life in 20 countries that were identified by the World Bank as among the poorest economically. However, many mothers in these 20 countries began feeding sweetened liquids and solid food to their babies earlier than recommended by the World Health Organization (WHO). In one of these countries – Cambodia – we compared DHS infant feeding data collected in 2000 to date from 2005 and assessed the WHO core feeding indicators recommended for healthy growth. In Cambodia, fewer children exhibited underweight in most age categories in 2005 than in 2000; however, the prevalence of stunting among 18- to 23-month-old children was not less in 2005 and remained above 50%. In this Cambodian study, prevalence of compliance with all age-based breastfeeding and complementary feeding WHO indicators increased significantly between surveys in 2000 and 2005, except percent of mothers currently breastfeeding at 12–15 months which remained relatively constant (2000: 87.1%; 2005: 89.6%). In particular, among Cambodian 0- to 5-month-old infants, prevalence of exclusive breastfeeding increased fivefold and prevalence of early breastfeeding initiation increased threefold between 2000 and 2005. While prevalence of meeting the WHO complementary feeding indicator for feeding diversity increased between 2000 and 2005, the prevalence remained very low for the WHO indicators of feeding diversity and minimal acceptable diet among various age groups. However, multivariate regression models demonstrated no overall general association of the WHO feeding indicators with undernutrition measures of underweight and stunting. There were some age-specific associations: 0- to 5-month-old infants, whose mothers were in compliance with both exclusive breastfeeding and breastfeeding initiation guidance and were at significantly lower risk of underweight; and 6- to 11-month-old infants, whose mothers were in compliance with the overall solid food guidance and were at significantly reduced risk of stunting but not underweight. Our primary finding from models of the WHO feeding indicators in Cambodia was a consistent positive association of reduction in risk of stunting and underweight with increases in relative wealth. In conclusion, many mothers in developing countries continue to breastfeed their babies through the first 12 months as recommended by the WHO. Among the WHO feeding indicators, focus on complementary feeding, particularly increased diversity of foods among children over 6 months of age, is indicated as a potential approach to reduce the high prevalence of stunting among children over 18 months of age in poor countries.

Food processes are designed to create final products with specific properties (composition, structure and functionality, with reproducibility), with respect to quality, security and environment along the production chain. Food powders are dried or semi-dried products with different shapes and composition (Bimbenet et al, 2002). They are used from manufacturer to consumer as additives, ingredients or solid food. Powders are usually characterized at two levels, individual particles and powder in bulk, which is different from liquid or gas products. The physical characteristics of the individual particles are mainly determined by the materials from which they are made and the process by which they are formed (Peleg, 1983).

The words “cell” and “cellular” came to English (via French) from the Latin cella, a store room or chamber. In modern usage, they have several very different meanings. The two that are pertinent to food structure and texture have to do with the cells in edible tissues of plants, fungi and animals or with the open spaces, filled with air or another gas, enclosed by a liquid or solid matrix that forms the cell walls. Rheologically speaking, “solid” is a term that needs to be used with caution. An albumen foam and whipped cream, under most circumstances, do not flow under their own weight and are therefore solid in a certain sense. Yet, upon disintegration, they leave behind a liquid. This is in contrast with puffed cereals and snacks, pieces of freeze-dried vegetables or chicken, and agglomerated, spray dried or instant coffee particles. These, if ground, would leave a powder made of solid particles. But what about fresh bread, cakes, marshmallows and popcorn? We will consider them solids despite the fact that their cell wall material is plasticized. There are different ways to classify cellular solid foods. Here are some

Human milk is recommended as the exclusive nutrient source for feeding full-term infants during the first 6 months after birth and should be continued, with the addition of solid foods, at least through the first 12 months.1,2 The recommendation for human milk feeding arises because of its acknowledged benefits with respect to infant nutrition, gastrointestinal function, host defense, and psychological well-being. The recognition of beneficial effects in premature infants is emerging to support the feeding of human milk.3 Favorable outcomes of breast-feeding are reported for both infants and mothers.