By: Maggie Fitzgerald, CCC/SLP
Dysphagia is the medical term for difficulty swallowing. Swallowing is a complex process where liquids and foods are transported from the mouth into the stomach. Children with dysphagia have difficulty protecting their airway either before or during a swallow. In many children, this can be due to premature birth, developmental delays, cleft lip or palate, nerve or muscle impairments, and more. The long-term consequences of swallowing disorders can include food aversion, aspiration pneumonia and/or compromise of respiration system, undernutrition or malnutrition, dehydration, and poor weight gain.
Signs of dysphagia
Signs and symptoms vary based on the impairment and the child’s age and developmental level. They may include back-arching, breathing difficulties (such as increased respiratory rate; changes in normal heart rate, skin color change such as turning blue around the lips, nose, and fingers/toes, temporary stoppage of breathing, and frequent stopping due to uncoordinated suck-swallow-breathe pattern), coughing and/or choking during or after swallowing, crying during mealtimes, decreased responsiveness during feeding, difficulty initiating swallowing, difficulty managing secretions (including non-teething-related drooling of saliva), disengagement/refusal shown by facial grimacing, facial flushing, finger splaying, or head turning away from the food source, frequent congestion, particularly after meals, frequent respiratory illnesses, noisy or wet vocal quality during and after eating, taking longer to finish bottles (longer than 30 minutes), refusing foods of certain textures or types, and vomiting (more than typical “spit-up” for infants).
How is it diagnosed?
Your child will participate in a swallow study. The swallow study is a procedure used to see how a child is swallowing and the pathway food and liquids take to the stomach. It is performed by a speech-language pathologist and a radiologist with special equipment that provides a “moving x-ray” of a child’s swallow. They will mix contrast into your child’s liquids and foods to consume from a variety of utensils (bottles, nipples with different flow rates, cups, spoons, and more).
How is dysphagia managed?
Depending on what is observed on the swallow study, the evaluator may recommend ongoing treatment with a Speech-Language Pathologist in a clinic. The therapist will work with families to decide the right ongoing care for the child which will include diet modifications, postural and position techniques, sensory stimulation, and more.
The primary goals of swallowing intervention for children are to support safe and adequate nutrition and hydration, share feeding methods and techniques with caregivers to maximize swallowing safety and feeding efficiency, and minimize the risk of illness.