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Pediatric Dysphagia (Swallowing Disorder)



Pediatric dysphagia (swallowing disorder) occurs when a child has difficulty swallowing food or liquids. This can occur in any phase of the swallowing process. 

Expanded Overview

A child with dysphagia may have trouble swallowing food or liquids, including saliva. The child may also experience pain while swallowing. It is difficult for a child with a swallowing disorder to get the correct amount of nutrients into their body, which can affect the child’s ability to grow and gain weight. 

It takes about 50 pairs of muscles and 6 cranial nerves working together for human beings to swallow. If anything goes wrong anywhere in the process, it may cause a disorder known as dysphagia. Swallowing and feeding disorders are common in children. It's estimated between 25% and 45% of normally developing children have some form of the condition. 

Phases of Swallowing

Swallowing has four phases. The first two phases are voluntary, while phases three and four occur involuntarily in a child’s body. A child has dysphagia when one or more of these phases fail to occur properly:

  • Oral preparation phase – food and liquid are prepared in the mouth for swallowing (chewing). 
  • Oral phase – the tongue starts the swallowing response by pushing the food and liquid to the back of the mouth. 
  • Pharyngeal phase – food and liquid are passed through the pharynx (throat) and into the esophagus (swallowing tube). 
  • Esophageal phase – food and liquid goes from the esophagus into the stomach. 


There are a variety of illnesses, diseases and congenital (present from birth) defects that can cause dysphagia in a child. A few of the most common include:

  • GERD (gastroesophageal reflux disease) – stomach acid backing up into the esophagus, causing pain and difficulty swallowing. 
  • Cleft lip or cleft palate – birth defects affecting the child’s lip or palate, making it difficult to chew food and prepare for swallowing. 
  • Vocal cord paralysis – when a gap in the vocal cord (vocal fold) can cause the child to choke while eating or drinking. 


While symptoms of dysphagia vary by child, in general, the main symptom is a child’s inability to swallow correctly while eating or drinking. Other accompanying symptoms may include the following. 

Symptoms in infants (birth to 1 year*) and toddlers (1-3 years old**)

  • Arching back 
  • Coughing
  • Choking 
  • Difficulty breathing while eating 
  • Excessive crying 
  • Vomiting (more than spit-up) 
  • Weight loss/lack of weight gain 

Symptoms in children older than 3 years: 

  • Coughing 
  • Choking 
  • Difficulty breathing while eating 
  • Drooling 
  • Eating slowly 
  • Feeling like there is food stuck in throat 
  • Weight loss/lack of weight gain 
  • Voice sounds different 

*Age of infants as defined by the World Health Organization (WHO)
**Age of toddlers as defined by the Centers for Disease Control (CDC)


Occasional swallowing and feeding problems are common in children and usually not a cause for concern. If your child has chronic trouble swallowing, she may have a disorder known as dysphagia. Children are at higher risk for dysphagia if they have cleft lips or palates, or if they have certain nervous system disorders such as meningitis or cerebral palsy.

How can I tell if my child has a swallowing or feeding disorder?

Children with dysphagia sometimes reject certain foods or eat smaller amounts than usual. If your child displays any of the following symptoms during feedings over time, get to your doctor right away.

  • Arching back
  • Breathing difficulties
  • Change in heart rate
  • Choking or coughing while swallowing
  • Crying
  • Dehydration
  • Frequent congestion after meals
  • Frequent pausing
  • Trouble swallowing or managing saliva
  • Turning blue
  • Vomiting
  • Weight loss or insufficient weight gain

Your pediatrician will ask you about any swallowing or feeding problems and give your child a physical exam. He may recommend a speech-language pathologist (SLP) who may

  • Ask you questions about your child's medical history, symptoms and any developmental issues
  • Look at the muscles involved in swallowing to determine their strength and movement
  • Observe your child's behavior during feeding, including her posture and mouth movements
  • If necessary, perform special tests, such as X-rays or endoscopic assessments, to observe the swallowing process from the inside

Depending on the extent of the dysphagia, the SLP may put together a feeding team. Members might include physicians, nutritionists, physical therapists or developmental specialists.

How common are swallowing and feeding disorders in children?

Swallowing and feeding disorders are common in children. Estimates are between 25% and 45% of normally developing kids have some form of dysphagia.

What are the causes of dysphagia in children?

Reflux, nervous system disorders and cleft lips or palates can cause dysphagia in kids. Other causes include low birth weight, muscle weakness or poor mealtime interactions.

What are the symptoms of dysphagia in children?

Kids with dysphagia may reject foods or eat smaller than usual amounts. Other symptoms are choking or coughing during meals, breathing trouble while eating and weight loss or poor weight gain.

How is dysphagia in children diagnosed?

Your pediatrician will perform a physical examination on your child. If she suspects dysphagia, she will refer you to a speech-language pathologist (SLP) to run further tests.

What are the treatments for dysphagia in children?

Treatments can range from behavioral therapy and medications to surgery. Your SLP will work with you and other specialists to determine the treatment plan that is right for your child.

What if my child doesn’t receive treatment for dysphagia?

Left untreated, dysphagia can cause malnutrition or dehydration, aspiration and pneumonia. These can all lead to more serious medical conditions later on.


For more information about swallowing disorders (dysphagia) and feeding disorders, please visit the following sites.

This website offers a complete overview of dysphagia, including support groups and other resources.
American Speech-Language-Hearing Association

For information, support and videos about dysphagia
National Foundation of Swallowing Disorders

For a very detailed overview of dysphagia that includes links to diagnostic videos, and who should be on the team caring for your child
GI Motility Online

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