Dysphagia (Child) 

Dysphagia is a condition in which your child has trouble swallowing. Your child may gag, cough or choke when eating or drinking. This problem can be short term, due to a throat infection or other problem in the throat. Other problems can cause it to go on for a longer time. In this case, dysphagia can make it hard for your child to get enough nutrients to grow. Your child also may experience food or liquid going “down the wrong way,” towards the airway and lungs when swallowing instead of to the esophagus and stomach (aspiration). This can cause serious lung infections such as pneumonia.

What are the symptoms of dysphagia?

A child with dysphagia may have symptoms that include:

• Arching or stiffening of the body during feedings 
• A wet or raspy voice during or after eating
• “Rattling” or congestion in the chest during or after eating
• Trouble breathing during or after eating
• Color changes  during or after eating or drinking
• Choking or coughing during or right after eating or drinking
• Drooling, spitting, or food and liquid spilling out of the mouth when eating
• Food or liquids coming out of the nose during or after eating
• Gagging
• Repeated refusal, crying irritability or lack of alertness during feedings
• Slow eating (taking longer than 30 minutes for a feeding)
• Swallowing a single mouthful of food several times
• Trouble coordinating sucking and swallowing
• Vomiting after eating or drinking 
• Difficulty chewing solid foods

Some symptoms of dysphagia  may occur in babies or children who are just learning to eat new foods. Some of these issues may go away with time and practice. However, if these issues continue, tests may be done to find whether there is another cause, such as problems with the mouth, tongue, or throat. The tube that carries food from the mouth to the stomach (esophagus) may be examined for problems. Certain problems with the muscles of the mouth, throat or nerves can also cause swallowing issues. Your child’s healthcare provider can discuss the cause of the dysphagia with you.

What causes dysphagia?

Dysphagia can be caused by any of the following:

• Nerve or brain problems that affect control of muscles in the mouth, tongue, throat, or stomach
• Other health problems that exist at the same time. These include prematurity, GI disorders, and congenital heart disease. 
• Problems with the shape of your child’s mouth, tongue, or throat
• Thickening or narrowing of the esophagus (stricture)

How is dysphagia diagnosed?

To find out if your child has dysphagia, your healthcare provider may order some tests. He or she may refer you to a specialist who will help develop swallowing skills. One such test might be a swallow study. This test can help the healthcare provider learn more about your child's swallowing problem. The swallow test allows the healthcare provider to watch your child swallow a barium solution while this action is X-rayed. Occasionally, endoscopy is used to visualize your child's swallowing habits. 

How is dysphagia treated?

Dysphagia can be treated in various ways depending on the cause. There are a number of medical providers that can help you figure out the cause of the problem. If there is a structural problem with the mouth, throat, or esophagus, your child’s healthcare provider can outline treatment options. In some cases, a speech  pathologist can help your child learn to control muscles in the mouth, tongue, and throat. The speech pathologist may recommend a different feeding position, various utensils, bottles/cups or a different way of giving food to your child. 

Home care

To help reduce or relieve your child’s symptoms of dysphagia:

• Give your child any medicines exactly as directed. Ask the healthcare provider for advice if your child has a hard time swallowing the medicine.
• If coughing, choking, or gagging is occurring frequently, it is important to seek advice from your healthcare provider and/or speech pathologist. They will recommend specific food and liquid consistencies that are safe to eat and drink. For example, some children might need to drink a liquid that is thick like a smoothie. Some children may need to puree or mashed  food. Specific recipes and instructions will be provided by your healthcare team and speech pathologist.  Follow all instructions for modifying foods and liquids as recommended by our child’s healthcare providers.
• Try feeding thick liquids instead of thin liquids. A small amount of rice cereal can be added to infant formula to thicken it. Your child will be given a specific recipe of how much rice cereal to add to the formula to ensure it is the right thickness. Blend the mixture before putting in a baby bottle. (Do not cut holes in nipples, since this can increase the risk of choking and aspiration, and interfere with oral development. Future feeding and speech skills may be affected.)
• Make sure your child stays upright for at least an hour after eating.

When your child begins trying new foods:

• Begin offering pureed food on a spoon at 6 months of age. Talk to your pediatrician about what foods to try.
• Vary the taste, texture and temperature of purees and soft solids for older infants and toddlers. It can take up to 10 times before for your child  will eat something new.
• Do not force your child to eat.
• Offer safe teething toys for your toddler to chew on.

Follow-up care

Follow up with your child’s healthcare provider as advised. He or she can give you information about tests your child may need.