Dysphagia is a term that means "difficulty swallowing." It is the inability of food or liquids to pass easily from the mouth, into the throat and down into the esophagus to the stomach during the process of swallowing.
Dysphagia can result in aspiration which occurs when food or liquids go into the windpipe and lungs. Aspiration of food and liquids may cause pneumonia and/or other serious lung conditions. Children with dysphagia usually have trouble eating enough, leading to inadequate nutrition and failure to gain weight or grow properly.
To understand dysphagia, we must first understand how we swallow. Swallowing involves three stages. These three stages are controlled by nerves that connect the digestive tract to the brain.
Food is chewed and moistened by saliva. The tongue pushes food and liquids to the back of the mouth towards the throat. (This phase is voluntary: we have control over chewing and beginning to swallow.)
Food enters the pharynx (throat). A flap called the epiglottis closes off the passage to the windpipe so food cannot get into the lungs. The muscles in the throat relax. Food and liquid are quickly passed down the pharynx (throat) into the esophagus. The epiglottis opens again so we can breathe. (This phase starts under voluntary control, but then becomes an involuntary phase that we cannot consciously control.)
Liquids fall through the esophagus into the stomach by gravity. Muscles in the esophagus push food toward the stomach in wave-like movements known as peristalsis. A muscular band between the end of the esophagus and the upper portion of the esophagus (known as the lower esophageal sphincter) relaxes in response to swallowing, allowing food and liquids to enter the stomach. (The events in this phase are involuntary.)
Swallowing disorders occur when one or more of these stages fail to take place properly. Children's health problems that can affect swallowing include:
The symptoms that children with dysphagia have may be obvious, or they can be difficult to associate with swallowing trouble. The following are the most common symptoms of dysphagia. However, each individual may experience symptoms differently. Symptoms may include:
Symptoms of dysphagia may resemble other conditions or medical problems. Please consult your child's physician for a diagnosis.
A physician or healthcare provider will examine your child and obtain a medical history. You will be asked questions about how your child eats and any problems you notice during feeding. Imaging tests may also be done to evaluate the mouth, throat, and esophagus. These tests can include:
Your child is given small amounts of a liquid containing barium to drink with a bottle, spoon or cup, or spoon fed a solid food containing barium. Barium shows up well on x-ray. A series of x-rays are taken to evaluate what happens as your child swallows the liquid.
Your child is given a liquid containing barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) to drink, and a series of x-rays are taken. The physician can watch what happens as your child swallows the fluid, and note any problems that may occur in the throat, the esophagus or the stomach.
A test that uses a small, flexible tube with a light and a camera lens at the end (endoscope) to examine the inside of part of the digestive tract. Under anesthesia, an endoscopy is performed. Pictures are taken of the inside of the throat, the esophagus and the stomach to look for abnormalities. Small tissue samples, called biopsies, can also be taken to look for problems.
Other tests that may be performed to evaluate dysphagia include the following:
Under sedation, a small tube containing a pressure gauge is guided through your child's mouth and into the esophagus. The pressure inside the esophagus is then measured to evaluate the esophageal motility.
Under anesthesia, a physician places a tube into your child's throat and looks through it for narrowed areas and other problems.
Specific treatment for dysphagia will be determined by your child's physician based on the following:
Speech or occupational therapy can be helpful for some children. These therapists can give your child exercises to help make swallowing more effective, or suggest techniques for feeding that may help improve swallowing problems.
Infants and children with dysphagia are often able to swallow thick fluids and soft foods (such as baby foods or pureed foods) better than thin liquids. Some infants who had trouble swallowing formula will do better when they are old enough to eat baby foods. The following suggestions should also be considered when caring for a child with dysphagia:
Your child's speech or occupational therapist may be able to recommend other commercial products that help thicken liquids and make them easier to swallow.
Babies who have "oral aversion," which can occur after oral surgery or being on a ventilator for a prolonged period, may benefit from exercises and activities to desensitize them to having objects in their mouths.
When symptoms of gastroesophageal reflux disease (GERD) are also present with dysphagia, treating this condition may produce improvements in your child's ability to swallow. As the esophagus and throat are less irritated by acid reflux, their function may improve.
Treatment of GERD may include:
Children who have scarring or narrowing of the esophagus (esophageal stricture) may be able to be dilated, or widened, under anesthesia. This procedure may have to be repeated periodically.
Some children with dysphagia will have long-term problems. Children who have other health problems, especially those that affect the nerves and muscles (such as muscular dystrophy and brain injury), may not be able to experience much improvement with their swallowing difficulties. Other children may learn to eat and drink successfully. Consult your child's physician regarding the prognosis for your child.
