Author: Jessica Cerretani

Swallowing problems: 4 things to know about dysphagia

swallowing problems

It seems like second nature to most of us, but swallowing is actually an intricate process with multiple stages, from the moment food or liquid passes through your lips until it enters your stomach. If something goes awry at any point in this journey, dysphagia, or difficulty swallowing, can be the result.

If your child chokes, regurgitates or turns blue while feeding, it may be a sign that they have oropharyngeal dysphagia — but sometimes symptoms of this problem aren’t that obvious. “Symptoms can be more subtle, such as food refusal, arching, a ‘wet’-sounding voice or eye watering during feedings,” says Dr. Rachel Rosen, director of the Aerodigestive Center at Boston Children’s Hospital. “It’s important to have your child evaluated by a specialist who understands the complexities of the swallowing mechanism. Often clinicians are quick to blame gastroesophageal reflux when it is actually a swallowing problem.” To kick off National Dysphagia Awareness Month, she explains four things parents should know about dysphagia in children.


There’s more than one type of dysphagia.

You may have been told that your child has “dysphagia,” but the specific type depends on the part of the digestive tract that’s affected. Esophageal dysphagia occurs when the esophagus doesn’t clear food appropriately because of inflammation, because of a nerve or muscle problem or because of prior surgeries. Some children may just have oral dysphagia, where they have trouble chewing or taking certain textures of food but the ability to swallow is preserved. On the other hand, oropharyngeal dysphagia occurs when your child has difficulty swallowing because of problems with their mouth, tongue, palate, larynx or the muscle at the top of the esophagus. Your care team can help determine what type of dysphagia your child has.


Symptoms can be subtle.


The classic stereotype of dysphagia is a child who has visible gagging or choking or coughing with feeding. While many kids with dysphagia do exhibit such problems, others may have less obvious symptoms. “It’s not unusual for children with dysphagia to have recurrent respiratory infections, wheezing or other breathing difficulties as their major symptom,” says Dr. Rosen. If you suspect dysphagia could be responsible for respiratory problems, a visit to a specialist may be in order.


Simple changes can make a big difference.


A diagnosis of oropharyngeal dysphagia doesn’t necessarily mean that your child will require surgery or a feeding tube. In fact, changing what and how you feed your child may be all the treatment needed. For example, giving your child thickened feedings may make it easier for them to ingest fluids without the risk of aspirating them. Some children may need to be on a softer diet until their chewing skills improve. Similarly, your child may need to eat or drink more slowly or may need to change the position in which they eat and drink, such as feeding with a chin tuck or feeding in an upright position. “Often, we can try a new cup or position for feeding during your child’s clinic visit to assess whether it will be helpful in the home setting,” says Kara Larson, MS, CCC-SLP, lead speech language pathologist in the Aerodigestive Clinic. “Sometimes just small changes can have an impact on making feeding safe and less stressful for the family.”


A team approach is best.


Because swallowing is such a complex process, the best approach to caring for oropharyngeal dysphagia is one that’s comprised of clinicians from a variety of different specialties, including aerodigestive specialists, gastroenterologists, pulmonary specialists, radiologists, otolaryngologists and speech language pathologists that are specially trained in feeding and swallowing disorders. “We have come so far in the diagnosis and treatment of oropharyngeal dysphagia,” says Dr. Rosen. “There is more and more research showing that children with oropharyngeal dysphagia have a great prognosis and that their quality of life is improving greatly.”

Learn about the Aerodigestive Center.


Read Full Story

Esophageal atresia: Sorting fact from fiction

esophageal atresia

Will a diagnosis of esophageal atresia affect my child’s weight? Are recurrent respiratory infections normal? How long should my child stay on proton-pump inhibitors?

As the patient coordinator for the Esophageal and Airway Treatment Center at Boston Children’s Hospital, Dori Gallagher, RN, fields questions like these every day from patients around the world concerned about their children with esophageal atresia. In this condition, a baby is born without part of the esophagus (the tube that connects the mouth to the stomach). Instead of forming a tube between the mouth and the stomach, the esophagus grows in two separate segments that do not connect. Without a working esophagus, it’s impossible to receive enough nutrition by mouth. Babies with esophageal atresia are also more prone to infections like pneumonia and conditions such as acid reflux.

Read Full Story

Gun violence and children: Why it’s a public health issue

pediatric gun deaths
Images by Patrick Bibbins

“There have been more than 52,000 pediatric firearm deaths in the past 18 years,” says Dr. Eric Fleegler, a pediatric emergency physician at Boston Children’s Hospital as he kicks off his talk. It’s May 3, 2018, and he’s sharing the startling statistic with a rapt audience at the hospital’s Special Grand Rounds on Trauma and Gun Violence.

Later that same day, a 10-year-old Ohio boy will be shot in the face while he sleeps in bed, one of 11 bullets to enter his home during a drive-by shooting. Three North Dakota siblings ages 6 to 14 will be murdered by their mother — who will then kill herself — with a handgun. The following day, a 3-year-old South Carolina boy will fatally shoot himself in the head while playing with a gun he finds at a family friend’s home.

Read Full Story

Stroke in kids: What’s different?

pediatric stroke
Illustration: Fawn Gracey

Every May, we recognize National Stroke Awareness Month to honor everyone who has experienced a stroke — and to raise awareness of this disease. That awareness is especially important for pediatric stroke, which is more common than you might imagine. “Stroke occurs throughout childhood, from birth through 18 years of age, and more commonly than people think,” says Dr. Michael Rivkin, co-director of the Stroke and Cerebrovascular Center at Boston Children’s Hospital. “In fact, among newborns, its occurrence is very nearly that of its occurrence in older adults.” Here, he shares four facts parents need to know about pediatric stroke — and how it differs from that in adults.

Kids aren’t immune.

Despite the misconception that stroke is a disease of the elderly, anyone can experience one — including infants and children. Babies can even have strokes while they are still in their mother’s womb. All told, strokes occur in an estimated 1 in 2,500 live births and affect nearly 11 out of 100,000 children under age 18 every year. The risk of having one is highest in a child’s first year of life, particularly during the few weeks before and after birth.

Kids can have different risk factors.

Most of us are familiar with the factors that can raise the risk of stroke in adults, such as cardiovascular disease, an irregular heartbeat, obesity, diabetes and smoking. But children are more likely to experience a stroke for different reasons, says Dr. Rivkin. Common risk factors for pediatric stroke include congenital heart disease, blood vessel abnormalities (such as arterial dissection and moyamoya), disorders that increase the blood’s tendency to clot (such as sickle cell disease), infection or inflammation.

Kids can have different symptoms.

In adults, we’ve been taught to look for the most common warning signs — classic symptoms such as facial drooping, arm weakness or numbness and speech difficulties. Although these signs can also be used to help identify the problem in children, kids can exhibit other symptoms as well. Newborns and young children may be extremely sleepy, use only one side of their body and experience seizures. In children and teenagers, severe headaches, vomiting, dizziness and trouble with balance and coordination, as well as seizures, may signal a stroke.

Kids tend to recover better.

Because children’s brains are still developing, they tend to recover better than many adults. Indeed, the problems that result from the stroke (such as weakness and numbness) can often improve over time with therapy. A team approach to pediatric stroke — including child neurologists, hematologists, neurosurgeons, interventional and neuroradiologists, physical and occupational therapists, speech and language therapists, neuropsychologists, educational specialists, and physical and rehabilitation medicine physicians — is optimal. “We understand that a multidisciplinary and intensive approach to care of children with stroke provides the best route to recovery,” says Dr. Rivkin.

Learn about the Stroke and Cerebrovascular Center.

Read Full Story