Dysphagia

What is dysphagia?

Dysphagia means trouble swallowing. This condition happens when food or liquids can’t pass easily from your child’s mouth, into the throat, down the esophagus, and into the stomach when swallowing.

What causes dysphagia?

Swallowing happens in 4 stages. Swallowing problems happen when something goes wrong in one or more of these stages. Dysphagia can be long-term (chronic). Or it may come on suddenly.

If your child’s swallowing issues start suddenly and your child is normally healthy, your child may have something stuck in his or her esophagus. If your child has trouble swallowing and a fever, it may be because of an infection. Chronic swallowing problems are often caused by another health problem.

Who is at risk for dysphagia?

The following health problems make it more likely for a child to have problems swallowing:

• Cleft lip or cleft palate
• Dental problems. These can include teeth that don’t meet properly, such as with an overbite.
• Large tongue
• Diseases that affect the nerves and muscles. These can include a stroke, tumor, nerve or brain injury, or muscular dystrophy. This can cause paralysis. Or it may cause your child’s tongue, throat, or esophagus muscles to not work as they should.
• Large tonsils
• Tumors or masses in the throat
• Problems with how the bones of the skull and the structures in the mouth and throat form (craniofacial anomalies)
• Problems with how the digestive tract forms. This can cause an esophageal atresia or tracheoesophageal fistula.
• Oral sensitivity or vocal cord irritation. This can happen in ill children who have been on a breathing machine (ventilator) for a long time.
• Paralysis of the vocal cords
• Having a tracheostomy. This is an artificial opening in the throat for breathing.
• Gastroesophageal reflux disease (GERD). This condition can scar or irritate the esophagus or vocal cords.
• Compression of the esophagus by other body parts. This may be from an enlarged heart, thyroid gland, blood vessels, or lymph nodes.
• Having a foreign object stuck in the esophagus, such as a coin
• Developmental delays
• Being born premature

What are the symptoms of dysphagia?

Symptoms can occur a bit differently in each child. They can include:

• Eating slowly
• Trying to swallow one mouthful of food several times
• Trouble sucking and swallowing
• Gagging during feeding
• Drooling
• Feeling like food or liquids are sticking in the throat or esophagus. Or your child may feel like there’s a lump in his or her throat.  
• Arching or stiffening of the body during feedings 
• Chest congestion after eating or drinking
• Coughing or choking when eating or drinking or right after
• Wet or raspy sounding voice during or after eating
• Getting respiratory infections often
• Spitting up or vomiting often
• Having food or liquids come out of the nose during or after a feeding
• Irritability or not being alert during feedings 
• Weight loss

The symptoms of this condition may look like symptoms of other health problems. Make sure your child sees his or her healthcare provider for a diagnosis.

How is dysphagia diagnosed?

Your child’s healthcare provider will ask about his or her health history. Then, he or she will give your child an exam. The healthcare provider will also ask about how your child eats and if you notice any problems during feedings.

Your child may need a blood test if his or her doctor thinks there’s an infection. Your child may also need an imaging test or other tests.

Barium swallow and upper GI series

Your child is given small amounts of barium to drink. This is a metallic, chemical, and chalky liquid that coats the inside of organs. This helps them show up on X-rays better. Your child’s healthcare provider will take a series of X-rays to see what happens as your child swallows the liquid.

Endoscopy

In this test, a small, flexible tube (endoscope) is used to look at the inside of your child’s digestive tract. This tube has a light and a camera lens at the end of it. During the test, your child may have tissue samples removed from his or her throat, esophagus, and stomach. Your child’s healthcare provider will test these samples.

Esophageal manometry

Your child’s healthcare provider will guide a small tube with a pressure gauge through your child’s mouth and into the esophagus. The pressure gauge checks the pressure in your child’s esophagus. This can tell how well food moves through your child’s esophagus. Your child will get medicine to help relax and prevent pain (sedation) for this test.

Laryngoscopy

Your child’s healthcare provider will place a tube into your child’s throat. This is done to check if your child’s throat is narrowed or has any other problems. Your child will be under anesthesia for this test.

How is dysphagia treated?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is and what’s causing your child’s dysphagia.

Infection or an object in the esophagus

If your child’s swallowing issues start suddenly, your child may have something stuck in his or her esophagus. If your child has trouble swallowing and a fever, it may be from an infection. These can both be emergencies. Your child will need medical help right away.  

Chronic dysphagia

If your child has chronic dysphagia or dysphagia caused by a health condition, speech or occupational therapy may help. Your child will learn exercises and feeding techniques to swallow better.

Your baby may be able to swallow thick fluids and soft foods better than thin liquids. Your child’s healthcare provider may suggest giving baby foods or pureed foods. Some babies who had trouble swallowing formula or breastmilk do better when they’re old enough to eat baby foods.

Dysphagia with GERD

If your child also has GERD, treatment for GERD may help your child swallow better. When your child’s esophagus and throat aren’t as irritated by acid reflux, they may work better. GERD may be treated with feeding changes or medicine.

Esophageal stricture

Children who have scarring or narrowing of the esophagus may need a test. In this procedure, your child’s healthcare provider may widen (dilate) his or her esophagus. Your child will need to be under anesthesia for this. Your child may need to have this procedure repeated.  

What are the complications of dysphagia?

This condition can cause aspiration. This happens when food or liquids go into your child’s windpipe and lungs. This can lead to pneumonia and other serious lung problems.

Children with dysphagia often have trouble eating enough. This can cause poor nutrition. They may not gain enough wait to grow properly.

Some children with dysphagia will have long-term problems. Some children’s ability to swallow may not improve much. This is more likely in children who also have other health problems, such as nerve or muscle issues. Other children may learn to eat and drink better. Ask your child's healthcare provider about your child’s outlook.

Your child may need to see a team of healthcare providers who specialize in feeding and swallowing. Your child’s team may include a nutritionist, occupational therapist, speech therapist, psychologist, and primary care provider.

When should I call my child's healthcare provider?

Call your child’s healthcare provider if your child has trouble swallowing or feeding.

If your child suddenly has trouble swallowing, seek medical help right away. If your child has dysphagia and develops new symptoms, such as trouble breathing, get help right away.

Key points about dysphagia

• Dysphagia means trouble swallowing. This condition can be long-term or it can come on suddenly.
• If your child suddenly has trouble swallowing, seek medical help right away.
• Chronic dysphagia may be caused by an underlying health condition.
• Treatment for dysphagia depends on the cause of the condition.
• Your child’s care team may include a nutritionist, occupational therapist, speech therapist, psychologist, and primary care provider.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.