Feeding and Swallowing Problems (Dysphagia)
Dysphagia refers to feeding or swallowing problems. These problems can occur in infants and in children of all ages. Children may have difficulty with the movement and coordination of the jaws, lips, tongue, or soft palate during feeding. They can also have trouble with muscle strength and the timing of movements during the pharyngeal or esophageal swallowing phase. Difficulty with oral sensation may affect the movements necessary for feeding. Dysphagia can result in a refusal to eat, or frequent gagging and vomiting.
Symptoms of Dysphagia
The following signs and symptoms may indicate the need for an assessment of feeding and swallowing:
- Difficulty latching onto the nipple or trouble maintaining a seal on the nipple during breast or bottle feeding
- Problems maintaining a coordinated breathing pattern or rhythmical suck-swallow pattern during breast or bottle feeding
- Problems achieving age-appropriate feeding skills, such as spoon-feeding, accepting table food and drinking from a cup
- Avoidance of certain textures, such as pureed food or crunchy food
- Coughing, choking, gagging, or skin color changes with feedings
- Wet, gurgly voice quality during or after feedings
- Difficulty swallowing secretions or abnormal drooling
- If the patient has a tracheotomy tube, evidence of food or liquid when suctioning through the tracheotomy tube
Causes of Dysphagia
Any structural problem of the oral cavity (mouth), pharynx (throat), larynx (voice box), or esophagus (tube to the stomach) has the potential to create a feeding problem. Cleft palate is an example of a structural problem that can cause feeding problems because the opening in the palate makes sucking difficult. Neurological disorders (such as those caused by prematurity, cerebral palsy, anoxic brain injury, or brain dysfunction) may affect the strength and motor coordination of the muscles that are important for feeding. Certain respiratory problems may make coordination of breathing and sucking difficult. Some children without a known medical condition have feeding difficulties.
When to Call the Doctor
Talk to your pediatrician or family doctor if your child has any signs or symptoms of feeding / swallowing problems. Your doctor may suggest further evaluation by a speech pathologist.
Evaluation
To evaluate dysphagia, a speech-language pathologist will observe the range and strength of oral-motor movements during play, speech (if present) and feeding. Clinical signs of swallowing dysfunction that may suggest aspiration are carefully noted. If aspiration is suspected, further tests may be done. This may including a special X-ray called a VSS (videofluoroscopic swallowing study), or an endoscopy procedure, requiring placement of a very small tube in the nose.
Treatment
Following the evaluation, the speech pathologist may recommend oral-motor / feeding therapy. The goals of therapy may include:
- Coordinating the suck-swallow patterns during bottle or breast feeding
- Developing appropriate oral movements for feeding
- Improving chewing patterns
- Increasing tolerance for texture
Why Cincinnati Children's?
As a national leader in pediatric speech pathology, Cincinnati Children's has a program for the treatment of dysphagia. This program is staffed by speech-language pathologists who have undergone specific specialty training. We welcome referrals from primary care providers and specialty physicians.
Contact Us
For additional information on this or any Health Topic, please call the Family Resource Center, 513-636-7606, or your pediatrician.
Rev. 10/07
