Dysphagia is a difficulty swallowing effectively. Oral dysphagia refers to problems with using the mouth, lips and tongue to control food or liquid. Pharyngeal dysphagia refers to problems in the throat during swallowing.
Dysphagia can affect a person at any age — from infants to the elderly.
There are many disorders that may cause dysphagia. Any condition that weakens or damages the muscles or nerves used for swallowing may cause dysphagia. The following are some common disorders related to pediatric swallowing problems:
- Cardiac or respiratory conditions
- Gastroesophageal disorders, including reflux
- Sensory or motor problems
- Prematurity
- Head and/or neck cancer
- Cleft palate
- Cerebral palsy
- Stroke
- Neuromuscular disease
- Brain injury
- Birth defects
Signs and symptoms of dysphagia include:
- Inability to coordinate sucking, swallowing and breathing while bottle-feeding
- Limited intake of food or liquids
- Refusal of previously accepted food or liquids
- Failure to gain weight
- Irritability associated with feeding
- Color change during or after feeding
- Lengthy feeding times (greater than 30 minutes)
- Coughing
- Choking
- Gagging
- Difficulty chewing
- Congestion during or after feeding
- Change of respiratory rate with feeding
- History of pneumonia
- Sensation of food being stuck in the throat
- When there is a tracheotomy tube, evidence of food or liquid in the tube
A child with dysphagia often has anxiety with eating or drinking. The child may not be able to manage food well or accept an age-appropriate diet. Dysphagia may result in inadequate airway protection during swallowing, causing aspiration of food or liquid into the lungs. Aspiration into the airway can cause frequent episodes of upper respiratory infections and pneumonia.
Dehydration and malnutrition may also occur if the feeding problem remains untreated. If the dysphagia is severe, an alternate source of nutrition and hydration, such as a feeding tube, may be necessary.
If the child has a feeding or swallowing problem, this should be discussed with the primary care physician. Depending on the severity of the problem, the child may be referred to a physician that specializes in feeding problems, a speech-language pathologist, an occupational therapist, a registered dietician, or a lactation consultant.
Treatment for dysphagia is individualized based on the nature and severity of the child’s swallowing problem. A speech-language pathologist can perform a clinical oral-motor and feeding evaluation to determine the problem and whether there is a need for treatment or further assessment first. The speech-language pathologist may recommend and provide therapy to:
- Enhance strength, range of motion, and coordination of the lips, tongue, cheek, and jaw muscles
- Decrease oral aversion due to sensory problems
- Decrease behavioral resistance to feeding
- Decrease the risk for aspiration
The speech-language pathologist may also recommend the following:
- A change in food textures or in the thickness of liquids
- A change in the feeding equipment, such as the nipple, bottle, cup or utensils
- Compensatory strategies
Parents can help at home by:
- Implementing various exercises, activities, and recommendations given by the speech pathologist
- Including the child in family mealtime and keep the experience positive