Pediatric dysphagia (swallowing disorder)

What is pediatric dysphagia?

Children with dysphagia struggle to move food, liquids or saliva from their mouth, into their throat and down their esophagus. Dysphagia makes eating, drinking and swallowing difficult and puts children at significant risk for aspiration (where food or liquid gets into the lungs). Children with dysphagia often have trouble getting enough nutrition.
 
Some children are born with conditions that make it more likely they will have trouble swallowing. Others develop swallowing problems because of medical treatment or a head and neck injury.

What are the different types of pediatric dysphagia?

There are three types of dysphagia: oral, pharyngeal and esophageal.

Oral dysphagia

Oral dysphagia is when a child is unable to intake their food properly. These children have trouble chewing food into the right size, shape and consistency to be swallowed. They often struggle to correctly move their lips and tongue to position food in the back of their mouth when it is time to swallow. They may frequently spit up or choke.

Pharyngeal dysphagia 

Normally, food travels down the throat to the stomach. Pharyngeal dysphagia occurs when there is a problem with this path. It can happen when a flap in the throat, called the epiglottis, doesn’t close properly to stop food from entering the lungs. It can also happen when the throat muscles relax and guide food to the esophagus, causing children to easily choke.  

Esophageal dysphagia 

This type of dysphagia happens when the esophagus is too narrow. This causes food or liquid to stay in the esophagus, instead of traveling to the stomach. Sometimes children with weak esophageal walls develop pockets that can trap food. While lying down or sleeping, the trapped food may come back into the throat and make them choke.  

What are the signs and symptoms of pediatric dysphagia?

• Arching or stiffening the body when eating 

• Breathing faster or slower when eating 

• Coughing, choking or chest congestion when eating or drinking, or right after 

• Drooling 

• Eating unusually slowly 

• Failure to gain weight 

• Weight loss 

• Sensation of food or liquid being stuck in the throat or esophagus  

• Frequent respiratory infections 

• Gagging during eating 

• Having food or liquids come out of the nose during or after eating 

• Spitting up or vomiting often 

• Trying to swallow the same mouthful of food several times 

• Trouble chewing

• Trouble sucking and swallowing during breastfeeding or bottle feeding

• Irritability during feedings

• Wet- or raspy-sounding voice

How is pediatric dysphagia diagnosed?

A speech and language pathologist (SLP) will examine your child’s mouth, cheeks and throat. They will have your baby or child move their mouth in certain ways and make certain sounds. The SLP may have your child eat small pieces of food or sip liquids and watch how they get food to their mouth, chew and try to swallow. They’ll also look at how your child breathes, holds their head and moves their mouth.  

After their exam, the SLP may ask for additional tests, including:  

• Video fluoroscopic swallowing study: During this test, your child will swallow small amounts of barium and the SLP will watch on a video how the liquid moves down their throat.   

• Fiberoptic endoscopic evaluation of the swallow (FEES): A small camera will be put into your child’s nose. The SLP will feed dyed liquids and food through, watching how they swallow and checking if food or liquid is getting into the airway (aspiration). 

• Endoscopy: A small, flexible tube (endoscope) with a camera on the end is used to look at the inside of your child’s digestive tract. The doctor may take tissue samples. This test helps doctors identify where tissue is inflamed and what happens in the narrowing as your child swallows.

What causes pediatric dysphagia? 

Some of the most common reasons a child develops dysphagia include: 

• Cancer or tumors near the head and neck 

• Chemotherapy, radiation or surgery for cancer  

• Cleft lip or cleft palate 

• Compression of the esophagus by an enlarged heart, thyroid gland, blood vessels or lymph nodes 

• Craniofacial abnormalities  

• Dental problems  

• Developmental delays 

• Large tongue or tonsils 

• Neuromuscular diseases like pediatric stroke, muscular dystrophy or cerebral palsy 

• Head, neck and brain injuries  

• Digestive tract malformations 

• Sensitivity in the mouth or irritation of vocal cords that can occur in children who have been on a ventilator for a prolonged period of time 

• Having a tracheostomy (artificial opening in the throat for breathing) 

• Gastroesophageal reflux disease (GERD) 

• Prematurity 

How is pediatric dysphagia treated? 

Children’s Health SLPs are equipped to treat all types of dysphagia. We create individual treatment plans for each child and partner with other experts like physical and occupational therapists and dieticians to be sure that your child gets all the help they need. 

Therapy plan may include:  

• Chewing and swallowing exercises to build coordinated strength between muscles, broaden range of motion and increase your child’s ability to control food and liquid 

• Electric stimulation therapy (Neuromuscular Electrical Stimulation (NMES)) to stimulate muscles involved in the chewing and swallowing process, as well as increase the pressure needed to push food down the esophagus  

• Surgery to help widen the esophagus 

• Posture and positioning techniques to minimize resistance and support muscle movement 

• Feeding therapy to help decrease sensitivity or dislike of foods and liquids 

They may also make recommendations like:   

• Adjusting your child’s diet  

• Changing things like the nipple, bottle, cup or utensils that your child uses to eat in order to decrease the risk for inhaling food or liquid 

• Pacing mealtime, quantity of food and size of bites or drinks 

• Pediatric Feeding and Swallowing, American Speech-Language-Hearing Association

• Feeding and Swallowing Disorders in Children, American Speech-Language-Hearing Association

• Dysphagia, National Institute of Deafness and Other Communication Disorders

• Evaluation and Treatment of Swallowing Disorders, American Family Physician