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.