Pediatric Dysphagia

Dysphagia means trouble swallowing. This condition happens when food or liquids can’t pass easily from your child’s mouth into the throat, down the esophagus, and into the stomach when swallowing.

Swallowing happens in 4 stages. Swallowing problems happen when something goes wrong in 1 or more of these stages. Dysphagia can be long-term (chronic). Or it may come on suddenly.

If your child’s swallowing issues start suddenly and your child is normally healthy, your child may have something stuck in the esophagus. If your child has trouble swallowing and a fever, it may be because of an infection. Chronic swallowing problems are often caused by another health problem.

The following health problems make it more likely for a child to have problems swallowing:

• Being born prematurely
• Cleft lip or cleft palate
• Compression of the esophagus by other body parts
• Dental problems, such as an overbite
• Developmental delays
• Diseases that affect how the nerves and muscles work
• Eosinophilic esophagitis, an allergic condition that affects the esophagus
• Gastroesophageal reflux disease (GERD)
• Having a foreign object stuck in the esophagus, such as a coin
• Having a tracheostomy, which is an artificial opening in the throat for breathing
• Large tongue
• Large tonsils
• Oral sensitivity or vocal cord irritation, which can happen if the child has been on a breathing machine (ventilator) for a long time
• Problems with how the bones of the skull and the structures in the mouth and throat form (craniofacial anomalies)
• Problems with how the digestive tract forms
• Paralysis of the vocal cords
• Tumors or masses in the throat

This condition can cause aspiration. This happens when food or liquids go into your child’s windpipe and lungs. This can lead to pneumonia and other serious lung problems.

Children with dysphagia often have trouble eating enough. This can cause poor nutrition. They may not gain enough weight to grow correctly.

Some children with dysphagia will have long-term problems. Some children’s ability to swallow may not improve much. This is more likely in children who also have other health problems, such as nerve or muscle issues. Other children may learn to eat and drink better. Ask your child's healthcare provider about your child’s outlook.

Your child may need to see a team of healthcare providers who specialize in feeding and swallowing. Your child’s team may include a nutritionist, occupational therapist, speech therapist, psychologist, gastroenterologist, allergist, and an ear, nose, and throat (ENT) specialist.

Call your child’s healthcare provider if your child has trouble swallowing or feeding.

If your child suddenly has trouble swallowing, get medical help right away. If your child has dysphagia and develops new symptoms, such as trouble breathing, get help right away.

Your child’s healthcare provider will ask about your child’s health history and do a physical exam. The healthcare provider will also ask about how your child eats and if you notice any problems during feedings.

Your child may need a blood test if the provider thinks there’s an infection. Your child may also need an imaging test or other tests. These tests may include the following:

Barium swallow and upper GI series

Your child is given small amounts of barium to drink. This is a metallic, chalky liquid that coats the inside of organs. This helps them show up on X-rays better. Your child’s healthcare provider will take a series of X-rays to see what happens as your child swallows the liquid.

Endoscopy

In this test, a small, flexible tube (endoscope) is used to look at the inside of your child’s digestive tract. This tube has a light and a camera lens at the end of it. During the test, your child may have tissue samples removed from the throat, esophagus, and stomach. These tissue samples will be looked at in a lab.

Esophageal manometry

Your child’s healthcare provider will guide a small tube with a pressure gauge through your child’s mouth and into the esophagus. The pressure gauge checks the pressure in your child’s esophagus. This can tell how well food moves through the esophagus. Your child will get medicine (sedation) to help relax and prevent pain for this test.

Laryngoscopy

Your child’s healthcare provider will place a tube into your child’s throat. This is done to check if your child’s throat is narrowed or has any other problems. Your child will be under anesthesia for this test.

Symptoms can occur a bit differently in each child. They can include:

• Arching or stiffening of the body during feedings
• Chest congestion after eating or drinking
• Coughing or choking during or after eating or drinking
• Drooling
• Eating slowly
• Feeling like food or liquids are sticking in the throat or esophagus or feeling like there’s a lump in the throat
• Gagging during feeding
• Getting respiratory infections often
• Having food or liquids come out of the nose during or after a feeding
• Trying to swallow one mouthful of food several times
• Trouble sucking and swallowing
• Spitting up or vomiting often
• Irritability or not being alert during feedings 
• Wet or raspy sounding voice during or after eating
• Weight loss

The symptoms of this condition may look like symptoms of other health problems. Make sure your child sees a healthcare provider for a diagnosis.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is and what’s causing your child’s dysphagia.

Infection or an object in the esophagus

If your child’s swallowing issues start suddenly, your child may have something stuck in their esophagus. If your child has trouble swallowing and a fever, it may be from an infection. These can both be emergencies. They need to be treated right away.

Chronic dysphagia

If your child has chronic dysphagia or dysphagia caused by a health condition, speech or occupational therapy may help. Your child will learn exercises and feeding techniques to swallow better.

Your child may be able to swallow thick fluids and soft foods better than thin liquids. Your child’s healthcare provider may suggest giving baby foods or pureed foods. Some babies who had trouble swallowing formula or breastmilk do better when they’re old enough to eat baby foods.

Dysphagia with GERD

If your child also has GERD (gastroesophageal reflux disease), treatment for this condition may help your child swallow better. When your child’s esophagus and throat aren’t as irritated by acid reflux, they may work better. GERD may be treated with feeding changes or medicine.

Eosinophilic esophagitis

If your child is diagnosed with this allergic inflammatory condition, a particular elimination diet is often advised for treatment. Medicines may also help.

Esophageal stricture

Children who have scarring or narrowing of the esophagus may need a test. In this procedure, your child’s healthcare provider may widen (dilate) their esophagus. Your child will need to be under anesthesia for this. Your child may need to have this procedure repeated.