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Pediatric Dysphagia (Swallowing Disorder)

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What is dysphagia?

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

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. 

What are the phases of dysphagia?

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. 

What causes dysphagia?

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. 

What are the signs and symptoms of dysphagia?

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)

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.

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.

 

 

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.

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