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.