Feeding and Swallowing Disorder (Dysphagia)

Dysphagia is a medical condition where a child has a difficult time swallowing. The problem is found in the tube that carries food or liquid (esophagus) from the mouth to the stomach.

The normal process of swallowing involves a series of muscle movements (contractions) that happen in three phases:

  • Oral – chewing, getting the food ready to swallow.
  • Pharyngeal – the tongue pushes the food down the throat.
  • Esophageal – food is pushed from the esophagus into the stomach.

In dysphagia, one of these three phases is disrupted. Chocking or having the liquid go into the lungs (aspiration) is most likely to happen. When the liquid goes into the lungs, it can cause pneumonia.

Some of the causes include:

  • Problem in sucking, chewing, or moving the solid food or liquid into the throat.
  • The airway is closed off to prevent the food from going to the stomach.
  • Physical conditions like cerebral palsy or muscular dystrophy.
  • Poor nutrition and child doesn’t gain weight.
  • Eosinophilic Esophagitis –solid foods (particularly solid meats) have difficulty passing through the esophagus. When solid food sticks in the esophagus, it causes an uncomfortable sensation in the chest.
  • Gastroesophagel reflux – causes chocking and difficulty with both liquid and solid foods.
  • Achalasia- a ring of muscle between the lower part of the esophagus and the stomach won’t relax and open to let food pass into the stomach which causes problems with swallowing food.
  • Esophageal foreign bodies – an object that should not be swallowed becomes stuck in the esophagus. Any object, especially a sharp object seen in an infant or child, is a medical emergency and should be seen in the emergency room.

Symptoms

Infants and children may refuse food and show a lack of alertness during breastfeeding or feeding. Some signs and symptoms include:

  • Arching or stiffening of the body during feeding.
  • Difficulty breastfeeding.
  • Irritability or alertness during feeding.
  • Refusing food or liquid.
  • Long feeding time (more than 30 minutes)
  • Failure to accept different textures of food.
  • Difficulty chewing.
  • Coughing or gagging during meals.
  • Excessive drooling or food/liquid coming out of the mouth.
  • Difficulty coordinating breathing while eating and drinking.
  • Gurgly, hoarse, or breathy voice quality.
  • Frequent spitting up or vomiting.
  • Less than normal weight gain or growth.
  • Frequent pneumonia or respiratory infections.

Treatment

Treatment depends on the cause of the problem. The doctor needs to get a medical history on how the child is developing and eating.

Swallowing therapy for infants and children often involves:

  • Changing the body and head position to allow better airway protection.
  • Modifying the food or liquid textures.
  • Changing the temperature, volume, and consistency of the food and liquids.
  • Oral stimulation to help the muscles become stronger and work correctly.
  • Changing the shape of the nipple size, shape and rate the food is given.
  • Changing the feeding equipment like spoon size.
  • Exercises that help strengthen the muscles in the mouth and tongue.
  • Behavior management or speech therapy.

Various tests may be done to determine the swallowing problem:

  • Videofluoroscopic swallow study – determines how well the infant or child can tolerate amounts and types of liquids and soft foods.
  • Upper endoscopy
  • Esophageal manometry – a thin flexible tube with sensors is passed thru the nose and down the esophagus to the stomach. The patient is asked to dry swallow and then swallow water while the sensors record how well the muscles are working.

Often, a team of professionals can help in treating the child with feeding or swallowing problems. GIforKids has a team of dietitians and behavioral psychologists available. Please contact the office at (865) 546-3998 to schedule an appointment.