What is dysphagia?

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, down the esophagus, and into the stomach during the process of swallowing.

Dysphagia can result in aspiration, which occurs when food or liquids go into the windpipe (trachea) and lungs. Aspiration of food and liquids may cause pneumonia and other serious lung conditions.

Children with dysphagia may have trouble eating enough, leading to inadequate nutrition and failure to gain weight or grow properly.

What causes dysphagia? 

To understand dysphagia, it helps to first understand how swallowing occurs. Swallowing involves four stages. These stages are controlled by nerves that connect the digestive tract to the brain:

• Oral preparation stage: Liquid is taken from the bottle or cup into the mouth. Food is chewed and moistened by saliva.
• Oral stage: The tongue pushes food and liquids to the back of the mouth toward the throat.
• Pharyngeal stage: Liquid and food enter the throat (pharynx). A flap called the epiglottis closes off the passage to the windpipe, so food cannot get into the lungs. Next, the muscles in the throat relax, and food and liquid are quickly passed down the throat into the food pipe (esophagus). The epiglottis opens again to allow for breathing.
• Esophageal stage: Liquid and food fall through the esophagus and into the stomach partially by gravity. Muscles in the esophagus push food and liquid 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 stomach (known as the lower esophageal sphincter) relaxes in response to swallowing, allowing food and liquids to enter the stomach.

Swallowing disorders occur when one or more of these stages fail to take place properly.

Health problems that can affect swallowing include:

• Structural differences in the face or mouth, including cleft lip or cleft palate, severe dental problems, macroglossia (large tongue), and micrognathia (small/retracted chin)
• Structural differences in the throat or esophagus, including large tonsils, tumors or masses, congenital malformations such esophageal atresia or tracheoesophageal fistula
• Diseases that affect the nerves and muscles, such as a stroke, tumor, nerve injury, brain injury, or muscular dystrophy, and can cause paralysis or poor function of the tongue or the muscles in the throat and esophagus
• Oral sensitivity that can occur in children who have been hospitalized and/or on a ventilator for a prolonged period of time
• Irritation of the vocal cords after being on a ventilator for long periods of time (as may occur with premature babies or very ill children)
• Paralysis of the vocal cords
• Having a tracheostomy (artificial opening in the throat for breathing)
• Irritation or scarring of the esophagus or vocal cords by acid in gastroesophageal reflux disease (GERD)
• Compression of the esophagus by other body parts, such as enlargements of the heart, thyroid gland, blood vessels or lymph nodes
• Foreign bodies in the esophagus, such as a swallowed coin
• Developmental delays
• Prematurity or other immaturity in the part of the brain that controls swallowing

What are the symptoms of dysphagia?

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 person may experience symptoms differently: 

• Eating slowly
• Trying to swallow a single mouthful of food several times
• Difficulty coordinating sucking and swallowing
• Gagging during feeding
• A feeling that food or liquids are sticking in the throat or esophagus, or that there is a lump in these areas
• Arching or stiffening of the body during feedings 
• Congestion in the chest after eating or drinking
• Coughing or choking when eating or drinking (or very soon afterward)
• Wet or raspy sounding voice during or after eating
• Frequent respiratory infections
• Unexplained fevers
• Food or liquids coming out of the nose during or after a feeding
• Irritability or lack of alertness during feedings 
• Weight loss

Symptoms of dysphagia may look like other conditions or medical problems. Please consult your child's healthcare provider for a diagnosis.

How is dysphagia diagnosed?

Dysphagia is a complex medical condition that often requires evaluation and intervention from several healthcare professionals. These include physicians, dieticians and speech language pathologists. During an evaluation for dysphagia, a doctor or other healthcare provider will examine your child and get 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:

• Fluoroscopic procedure/barium swallow: During this test, your child is asked to drink barium, a metallic, chalky liquid which shows up well on X-rays. As a series of X-rays are taken, a doctor reviews them to assess what happens as your child swallows the fluid, noting any problems that may occur in the throat, esophagus or stomach.
• Bronchoscopy: This is a test that uses a scope with a lens and camera to investigate the airway (windpipe and bronchial tubes) for anatomic causes or contributors to swallowing problems and to identify if there is active aspiration. A bronchoscopy is done under anesthesia and may be done with rigid or flexible scopes, or both.
• Endoscopy: This is 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. An endoscopy is done under anesthesia. 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.
• CT scan of the chest: Imaging is used to look for any injury to the lungs that may have occurred from aspiration. Specific treatments may be recommended if such an injury is found. This test requires sedation in certain age groups.
• Esophageal manometry: 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 how well food moves through the esophagus.