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).
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:​
​
​food aversion
​
oral aversion
​
aspiration pneumonia
​
compromised pulmonary status
​
undernutrition or malnutrition
​
dehydration
​
gastrointestinal complications (motility disorders, constipation, and diarrhea)​
​
rumination disorder (unintentional and reflexive regurgitation of undigested food that may involve re-chewing and re-swallowing of the food)
​
ongoing need for enteral (gastrointestinal) or parenteral (intravenous) nutrition
​
psychosocial effects on the child and his or her family
​
feeding and swallowing problems that persist into adulthood, including the risk for choking, malnutrition, or undernutrition.
​
poor weight gain