Dysphagia is a gastroesophageal reflux disease that impairs the ability to swallow effectively or safely. Swallowing is considered a complex system, including oral, oropharyngeal, and pharyngeal stages.
Swallowing impairments can occur for a variety of reasons! Children may be born with physical or structural issues that increase difficulty swallowing, or they may have developmental disorders that contribute to motor weakness or incoordination that make swallowing difficult. If your infant has trouble swallowing formula, your toddler can only eat baby foods, or your older child has trouble swallowing food of all kinds, resources, and treatments are available to help your child eat normally.
Swallowing disorders occur when a child has structural issues, weakness, incoordination, poor function, etc. Dysphagia can look like coughing, choking, difficulty breathing, or acid reflux after a child swallows food or drink, leaving residue in the mouth or throat and having to clear the throat repeatedly. These are more common, but not the only signs, that a swallowing disorder may affect a child’s ability to eat or drink normally.
The three phases of feeding and swallowing include the oral phase (oral preparatory stage and oral transit stage), pharyngeal, and esophageal stages of swallowing.
Oral prep phase: food entering the mouth, chewing patterns with teeth, rotary chewing with jaw, coordination, and strength of the tongue to move food to the teeth and the back of the child’s mouth for the swallow.
Oral Transit phase: food is thoroughly chewed and pushed together to the back of the mouth for swallowing. The soft palate closes to keep food from going up into the nasal passage for the swallow.
Pharyngeal phase: food is brought to the pharynx (throat) and is swallowed. The epiglottis shuts, preventing food or drink from entering the lungs, and goes down to the esophagus.
Esophageal phase: after the food passes through the upper esophageal sphincter, peristalsis begins and moves the food through the digestive system. While a speech-language pathologist does not treat esophageal phase dysphagia, it can be identified through an instrumental swallowing test (MBSS).
Dysphagia is diagnosed with screenings or tests to evaluate the coordination and strength of the oral structures and the use of instrumental swallow evaluations. Instrumental evaluations are tests performed with medical instruments, such as FEES or MBSS, that allow the clinician to see how food or drink is consumed and swallowed.
With FEES (Fiberoptic Endoscopic Evaluation), a small camera on a tube is inserted into the nasal passage to look down over the vocal folds. From here, the clinician can observe part of the oropharyngeal and the pharyngeal phase of swallowing. This helps the clinician see if clients have a weak swallow, leaving food in the pharynx or allowing food or drink to move toward the lungs. Different consistencies of food and drink are given to ensure that different types of food or drink can be consumed safely.
MBSS (Modified Barium Swallow Study) is a test where a client sits in view of an X-ray machine and is given a drink or solid food containing barium. The clinician can observe all phases of the swallow from a side view as the barium shows up on the machine. This helps the clinician see if clients have a weak swallow, difficulty moving food to the back of the mouth, leaving residue in the pharynx, or if they’re allowing food or drink to move toward the lungs. Different consistencies of food and drink are given to ensure that different types of food or drink can be consumed safely.
Treating dysphagia requires an evaluation before therapy begins, and the evaluation will help determine what needs to be focused on to improve a client’s swallowing patterns. Swallowing is a complex process with many moving parts, and initial tests will help determine which aspects need to be targeted to ensure the best treatment!
Treatment is determined based on the difficulty someone is experiencing with swallowing. For example, if they are having oral difficulties, they may require exercises or strategies to assist in chewing or strengthening the tongue. This may not be recommended for those struggling with the pharyngeal phase of swallowing.
Ultimately, treatment is given by an occupational therapist or a speech therapist, who recommends different exercises or compensatory strategies to improve swallowing and eating skills. Clinicians may also recommend changes in diet while swallowing skills improve to make eating safer!
Not necessarily! Dysphagia is considered physical difficulty with swallowing, and a child avoiding certain foods may indicate some difficulties with swallowing. However, it may just be picky eating!
Picky eating is considered different from dysphagia. Someone who is a picky eater may or may not have dysphagia, but having difficulties eating a variety of foods is more of a behavioral issue we see in children. They may also have oral aversion or sensory difficulties that limit the types of foods they prefer or are willing to try! Consider looking into a feeding and swallowing program if it sounds like your child may have difficulty with picky eating.
Reach out to your primary care physician or your speech therapist! You will likely be referred for a swallowing assessment (such as FEES or MBSS) before your child attends regular therapy sessions.
Once your child attends an instrumental evaluation and a clinician is able to pinpoint which aspects of swallowing are difficult, then a clinician can create a treatment plan for your child and their specific swallowing needs!