Dysphagia means difficulty with feeding or swallowing. It is a symptom, not a disease. 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 may lead to aspiration (where food or liquid gets into the lungs).

Dysphagia can affect a person at any age, from infants to the elderly.

Causes of Dysphagia

Many conditions have associated dysphagia. These include structural problems in the mouth, throat or esophagus. These also include conditions that weaken or damage the muscles or nerves used for feeding and swallowing. Some common disorders related to swallowing problems in children are:

• Brain injury
• Birth defects
• Cleft palate
• Cerebral palsy
• Gastroesophageal disorders, including reflux
• Heart or lung conditions
• Head or neck cancer
• Neuromuscular disease
• Prematurity
• Sensory problems
• Stroke

Signs and Symptoms of Feeding and Swallowing Problems (Dysphagia)

• Problems coordinating sucking, swallowing and breathing while bottle-feeding or drinking from a cup or straw
• Coughing
• Choking
• Gagging
• Color change during or after feeding
• Lengthy feeding times (greater than 30 minutes)
• Trouble chewing
• Congestion during or after feeding
• Change of breathing rate with feeding
• History of pneumonia
• Sensation of food being stuck in the throat
• Limited intake of food or liquids
• Refusal of previously accepted food or liquids
• Failure to gain weight
• Evidence of food or liquid in a tracheotomy tube during or after eating

Impact of Dysphagia

Dysphagia may result in inadequate airway protection during swallowing. This can cause food or liquid to get into the lungs (aspiration). Aspiration into the airway can cause upper respiratory infections and pneumonia. The child may not be able to manage food or liquid well or accept an age-appropriate diet. Dehydration and malnutrition may occur if the feeding problem goes untreated. If the dysphagia is severe, another source of nutrition and hydration, such as a feeding tube, may be needed. A child with dysphagia may develop anxiety about eating or drinking.

Treatment for Dysphagia

Treatment for dysphagia is based on the nature and severity of the child's feeding and swallowing problem. The speech-language pathologist will help with the evaluation of the dysphagia. They may suggest or provide therapy to:

• Develop strength, range of motion, and coordination of the lips, tongue, cheek and jaw muscles for efficient eating and drinking
• Help decrease oral sensitivity or oral aversion to foods and liquids
• Decrease behavioral resistance to feeding
• Work on strategies to decrease the risk for aspiration

The speech-language pathologist may also suggest the following after talking with the child’s medical team:

• 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
• Strategies to help with drinking and eating

This information is not intended to replace the need for specialized care.

Diagnosis of Dysphagia

If the child has a feeding or swallowing problem, talk with the primary care doctor. Depending on the severity of the problem, the child may be referred to a doctor that specializes in the evaluation of feeding problems, a speech-language pathologist, an occupational therapist, a registered dietician, and/or a lactation consultant.

A speech-language pathologist can perform a clinical oral-motor and feeding evaluation. This will help identify the problem and see if there is a need for treatment or further assessment first.

A VSS (video fluoroscopic swallowing study), also known as a modified barium swallow, may be suggested. A VSS is done by a speech-language pathologist and a radiologist. An X-ray video is taken of the child’s throat while they are eating and drinking. The examiners evaluate the safety and efficiency of swallow. They can also detect aspiration and other problems with swallowing function. Techniques to modify the way the child swallows can be introduced during the VSS to see what may help with swallowing issues.

A FEES (Fiberoptic Endoscopic Evaluation of the Swallow) study may also be suggested. This study is done with an ear, nose and throat (ENT) doctor and a speech-language pathologist. It involves putting a small tube (scope) through the child’s nose to the back of the throat so that the structures and muscle function can be watched directly during swallowing. This study allows observation of the child’s ability to protect the airway from secretions, liquids and solids during swallowing.

Helping Your Child

• Implement various exercises, activities and recommendations given by the speech pathologist.
• Include the child in family mealtime and keep the experience positive.