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Dysphagia

Childhood Dysphagia

Oral Preparatory and Oral Phase refers to before the swallow. This is the beginning phase when the food or liquid is chewed or manipulated in the mouth to form a cohesive bolus and begins the propulsion of food towards the back of the mouth.  This includes sucking, chewing, sealing lips, moving food back toward throat, holding food in cheeks, etc.   

Dysphagia is difficulty with the swallow function that may involve the mouth, throat, and/or esophagus.  

Swallowing dysfunction may occur in the oral preparatory/oral phase, pharyngeal phase, or esophageal phase.  It can also include a combination of these phases and may result in aspiration. 

Pharyngeal Phase refers to when the food is in the process of being swallowed.  The bolus is moved through the pharynx (throat) by muscle contractions while the body closes off the airway.  This phase includes function of muscles that trigger the upper esophageal sphincter to open, ability to protect the airway, ability to sense food in the wrong part of the throat and clear it by coughing or clearing throat, and the ability for our muscles to squeeze the food down into the esophagus.  

Esophageal Phase refers to when the food has been swallowed and enters the esophagus on its way to our stomach/digestive system.  This would include reflux and sensation of food sticking (globus).

Dysphagia phases

Malnutrition and dehydration, aspiration pneumonia, compromised general health, chronic lung disease, choking, and even death may be a consequence of dysphagia.

Childhood Dysphagia

Feeding is the process involving any aspect of eating or drinking including gathering and preparing foods.  Feeding disorders may not always include problems with swallowing. 

Feeding disorders can be characterized by:

  • Avoiding or restricting food intake​

  • Exhibiting disruptive/inappropriate behaviors prior to mealtime

  • Not self-feeding at the appropriate age or developmental level

  • Not using age appropriate utensils

  • Decreased weight, height, and growth

Swallowing is the process during when saliva, liquids, and foods are transported from the mouth into the stomach while keeping the airway protected. Swallowing is commonly divided into the following four phases as described earlier

Swallowing disorders in children may be characterized by:​​​​​​​​​​​​​​​​​​​​

Coughing and/or choking during or after swallowing

Decreased responsiveness during feeding

Back arching

Pocketing foods

Breathing difficulties when feeding (increased respiratory rate, changes in normal heart rate, turning blue around the lips, nose and fingers/toes, temporary cessation of breathing, frequent stopping due to uncoordinated suck-swallow-breathe pattern, and decreasing oxygen saturation levels)

Frequent respiratory illnesses

Difficulty initiating swallowing

Head turning away from food source

Difficulty managing secretions like drooling

Overpacking the mouth

Facial flushing

Finger splaying

Refusing foods specific foods

Frequent congestion, particularly after meals

Taking longer to finish meals or snacks (longer than 30 minutes)

Crying during mealtimes

Gagging

Taking only small amounts of food

Vomiting (more than typical “spit-up” for infants)

Noisy or wet vocal quality during and after eating

Difficulty chewing foods that are appropriate for age (may spit out or swallow partially chewed food)

Facial grimacing

Loss of food/liquid from the mouth when eating

Children with Cerebral Palsy,  genetic syndromes (e.g., Down's Syndrome, Rett Syndrome, Treacher Collins Syndrome, etc.), cognitive impairment, decreased gross motor skills, Autism, meningitis, encephalopathy, pervasive developmental disorders, traumatic brain injury, muscle weakness in face, neckcraniofacial disorders (e.g., cleft lip, cleft palate, laryngomalacia, tracheoesophageal fistula, esophageal atresia, choanal atresia) are at a higher risk for dysphagia.

Feeding and Swallowing disorders can lead to:​

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​food aversion

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oral aversion

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aspiration pneumonia

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compromised pulmonary status

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undernutrition or malnutrition

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dehydration

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gastrointestinal complications (motility disorders, constipation, and diarrhea)​

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rumination disorder (unintentional and reflexive regurgitation of undigested food that may involve re-chewing and re-swallowing of the food)

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ongoing need for enteral (gastrointestinal) or parenteral (intravenous) nutrition

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psychosocial effects on the child and his or her family

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feeding and swallowing problems that persist into adulthood, including the risk for choking, malnutrition, or undernutrition.  

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poor weight gain 

“Feeding and Swallowing Disorders in Children.” American Speech-Language-Hearing Association, ASHA, www.asha.org/public/speech/swallowing/Feeding-and-Swallowing-Disorders-in-Children/.

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