Prevention & Risk Treatment
What causes dysphagia?
To understand dysphagia, it helps to first understand how swallowing occurs.
Swallowing involves four stages. These stage are controlled by nerves that connect the digestive tract to the brain:
- Oral preparation stage. Food is chewed and moistened by saliva.
- Oral stage. The tongue pushes food and liquids to the back of the mouth toward the throat. (This phase is voluntary: people have control over chewing and beginning to swallow.)
- Pharyngeal stage. Food enters the pharynx (throat). 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 pharynx (throat) into the esophagus. The epiglottis opens again to allow for breathing. (This phase starts under voluntary control, but then becomes an involuntary phase that cannot be consciously controlled.)
- Esophageal stage. Liquids fall through the esophagus into the stomach by gravity. Muscles in the esophagus push food 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. (The events in this phase are involuntary.)
Swallowing disorders occur when one or more of these stages fails to take place properly.
Children's health problems that can affect swallowing include:
- Cleft lip or cleft palate
- Dental problems (teeth that do not meet properly, such as with an overbite)
- Large tongue
- 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
- Large tonsils
- Tumors or masses in the throat
- Problems with the prenatal development of the bones of the skull and the structures in the mouth and throat (known as craniofacial anomalies)
- Prenatal malformations of the digestive tract, such as esophageal atresia or tracheoesophageal fistula
- Oral sensitivity that can occur in very ill children who have been 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
Why is dysphagia a concern?
Dysphagia can result in aspiration which occurs when food or liquids go into the windpipe and lungs. Aspiration of food and liquids may cause pneumonia and/or other serious lung conditions.
Children with dysphagia usually have trouble eating enough, leading to inadequate nutrition and failure to gain weight or grow properly.
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 individual may experience symptoms differently. Symptoms may include:
- 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
- Spitting up or vomiting frequently
- 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 resemble other conditions or medical problems. Please consult your child's health care provider for a diagnosis.