Dysphagia In Children

Dysphagia is a condition in which a person has difficulty with swallowing which in turn makes eating and drinking significantly problematic.  When a child has trouble with eating or swallowing, it causes issues not only in terms of getting the proper nutrition, but it can also pose risks with things like choking and chronic irritation. There are a number of causes as to why this happens, and the severity as well as treatment outcomes can vary greatly depending on the age, underlying conditions, and at what stage of the swallowing process the dysphagia is occurring.

Dysphagia is quite common in children and as many as 25% to 45%  of children can suffer from some form of the condition throughout childhood. It can come on suddenly or be a long-term issue that requires an evolution in treatment as the needs of the child change with growth. Either way, during treatment, a team of specialists will work with the child to help address any and all issues that come with dysphagia and to prioritize the child’s comfort and safety.

Symptoms of Dysphagia

Some symptoms of dysphagia can be easy to associate with a feeding issue, but there are other characteristics that may not be as obvious as a sign of dysphagia. Because of this, it is important to take note of any and all issues even if they seem unrelated to discuss with the doctor. Some of the main symptoms to look out for are:

-Eating more slowly than what one may consider a normal pace

-Drooling that occurs during feeding

-Difficulty with successfully swallowing food, even if soft or in small pieces

-A feeling of something being stuck in the throat

-Problems with gagging wile trying to eat

-Trouble with involuntary sucking and swallowing

-Unexplained weight loss

-Frequent issues with vomiting and/or spitting up food

-Irritability during feedings

-Issues with respiratory infections

-Frequent coughing or choking when eating

-Exaggerated arching or stiffening of the back during feeding times

-Voice sounding raspy after eating

Causes of Dysphagia

In order to better understand what causes dysphagia, it is important to note that there are 4 main stages that occur during the act of swallowing and any problem or inconsistency throughout these stages can cause dysphagia to occur. The main stages are:

Oral Preparation Stage

This is the preliminary stage where food is broken down by chewing and saliva.

Oral Stage

During this stage, the tongue will be used to force any food and liquids to go toward the throat. This is a voluntary stage where one has to actively begin the process of swallowing.

Pharyngeal Stage

After the food enters the throat it will encounter a flap known as the epiglottis. This flap functions to close off access to the windpipe so food cannot travel to the lungs. During this time, the muscles in the throat begin to ease and relax which allows food and liquids to slide down the throat or pharynx and into the esophagus. Once it has gone down the pharynx, the esophagus will open again so breathing can resume. This phase starts off as a voluntary action but will transition to involuntary which can make it a bit more difficult to address issues that occur during this stage.

Esophageal Stage

In this final stage, any liquids will naturally go down the esophagus and then the muscles in the esophagus will begin to push the remaining food toward the stomach in a wave-like pattern known as peristalsis. When the food hits the end of the esophagus it will go through a band of muscle at the entrance of the stomach known as the lower esophageal sphincter. This muscle will begin to relax which allows the food and liquids to enter the stomach for digestion. This final phase is completely involuntary.

All these stages whether voluntary or involuntary are controlled and activated by nerves that connect signals from the digestive tract to the brain in order to complete the action. If the child has a sudden issue with dysphagia when no other issues had been found previously, it may be an acute problem where the child simply has some material that is stuck in the esophagus that occurred in one of the earlier voluntary stages. However, if the child has had persistent challenges with swallowing and also suffers from other ailments such as fever or GI issues, the problem could be occurring in one of the later stages or could even be a symptom of another underlying health concern.

Health Issues Leading to Dysphagia in Children

While dysphagia can occur for any number of reasons, there are some health problems that can make a child more predisposed to dealing with dysphagia such as:

-Premature birth

-Having a cleft lip or palate

-Compression issues with the esophagus

-Having larger than normal tongue or tonsils

-Any type of obstruction such as a foreign object in the esophagus

-Masses such as tumors in or on the throat

-Long term use of a ventilator

-Oral sensitivity that causes irritation

-Issues with the formation of the digestive tract

-Any type of paralysis of the vocal cords

-Developmental delays that impact the way that the nerves and muscles function

–GERD (gastroesophageal reflux disease)

–Certain craniofacial anomalies that can impact the way the mouth and throat work

These are just some examples of issues that can lead to dysphagia, but the severity and related symptoms can look different for each individual. As stated above, this is why it is important to discuss any and all symptoms in detail with a healthcare provider.

Diagnosing Dysphagia

When a parent first starts to notice any feeding irregularities it can be helpful to take note and observe the child’s behavior to see where they are having difficulties. At this point, a good starting place would be to discuss concerns with the child’s primary care doctor. Depending on how advanced the issues are, the doctor may recommend that the child see a specialist such as a speech therapist, dietician, or occupational therapist who could further evaluate the child and discuss the next steps with the parents.  During a specialist visit, it is quite common for the therapist to initially perform a clinical oral-motor and feeding evaluation. This preliminary step is done to see is what if any treatment might be needed and what further evaluation may be useful in finding a proper diagnosis. Some tests that may be recommended for your child to diagnose dysphagia include:

Video fluoroscopic swallowing study

This study which is also known as a VSS, is performed by both a speech-language pathologist (SLP) and a radiologist. During this exam, the radiologist will take an x-ray of the child’s throat while they are seated upright and they attempt to eat or drink. This exam can help to identify any aspirations or problems seen on the x-ray that could be contributing to the dysphagia. In addition to this, the SLP may also work with the child to play with different techniques to see if they are able to make any improvements to the swallowing function while viewing the x-ray.

Barium Swallow

Much like the video fluoroscopic swallowing study, the main point of a barium swallow is to gauge swallowing behavior through an x-ray. Barium is a substance known as a contrast medium, which means that it is able to see this substance clearly through an x-ray as it moves through the body. With a barium swallow, the child will be asked to lie down and drink small amounts of a barium drink to see if there are any difficulties present not only in the throat itself but also in moving its way down the esophagus and into the stomach.

Fiberoptic Endoscopic Evaluation of the Swallow (FEES)

This is a study that is performed by an Ear, Nose and Throat (ENT) specialist and a speech-language pathologist (SLP).  A small tube or scope will be put through the child’s nose and placed down the back of the throat to observe the strength of the muscles used when swallowing. The main goal of this procedure is to see if the child’s way of swallowing is successfully protecting their airways from various secretions and foods from entering the lungs.

Esophageal Manometry

While under sedation, the child’s doctor will lead a pressure-gauged tube down the throat and into the esophagus of the child. This is done to evaluate the amount of pressure in the esophagus to better understand how well food and liquids are able to navigate down.

Endoscopy

During this procedure, the child will be put under anesthesia and a doctor will lead a small flexible tube that contains a light and a camera down the child’s throat and through the digestive tract. This is done so pictures can be taken to look for any anomalies that could be contributing to the dysphagia. It is also common for biopsies of tissue to be collected from the throat, esophagus, and stomach for further testing in a lab.

Treatment of Dysphagia

After a full evaluation and the proper tests have been completed, a specialist will make recommendations based on the findings and what they think will be the most beneficial form of action to help the child improve eating and swallowing functions. Most often, this will include some type of feeding therapy that will be done with a speech therapist, occupational therapist, or both. In these sessions, the therapist will work with the child on various exercises to make swallowing more effortless, as well as coming up with strategies for both the child and parents to not only improve function but also address problems as they arise. The type of treatment will depend solely on the needs of the individual child, but things like changing the consistency of foods that cause problems, finding ways to avoid nutritional deficiencies, and creating routines to avoid unpleasant side effects of dysphagia such as GERD remain a top priority.

Solace Pediatrics & Feeding Therapy

Solace Home healthcare offers an alternative to the normal model of in-office therapy where a child must be taken to and from appointments at doctors’ and therapists’ offices.  This process can involve time off from work or school, time spent getting ready, travel to and from the appointment, and all of the stress and anxiety that can come with it, both for the child and their parents.  With Solace, our therapists can come to your home or your child’s school at a time that works for your family.  While the obvious benefit is the reduction in travel time, there are a wide variety of secondary benefits too.  Being in the comfort of their own home, children will experience less anxiety than when they are in an unfamiliar medical office, and can be more relaxed and focused on their therapy sessions and work on the skills to improve dysphagia. This allows them to make greater progress than if they have to deal with stress going to and from in-office visits. Additionally, having speech and occupational visits in the home also allows the rest of the family to participate or minimally be aware of what the treatment goals are, and how all family members can help to further them with new strategies or feeding techniques.  Having everyone on board can help with integration and good compliance.  Solace can help not only with treatment but also with evaluation and diagnosis in some instances.  If you feel that your child may be suffering from dysphagia and would like to know how Solace can help, please feel free to reach out so we can talk about the next steps.