Esophageal atresia

You may have heard that esophageal atresia can be challenging to treat. Unfortunately, that’s true. But the dedicated, compassionate staff at Children’s is incredibly well-qualified to care for your child. We’re known for our science-driven approach—we’re home to the most extensive research enterprise located in a pediatric hospital in the world, and we partner with a number of top biotech and health care organizations—but we never forget that your child is a child, and not just a patient.

The best treatment for esophageal atresia is usually surgery to connect the ends of the esophagus together. But in long-gap esophageal atresia, the ends are often too far apart to be easily connected.

Traditionally, babies with this type of long-type atresia are treated in ways that require life-long care and monitoring, such as pulling up the stomach to connect directly to the end of the esophagus (gastric pull-ups), or creating more “esophagus” from a piece of the child’s large intestine (colonic transposition). We are proud to offer an alternative to this through a one-time solution known as the Foker Process.

The Foker Process

Here’s what happens during the Foker Process:

1. The surgeon places around four or five sutures on the upper and lower ends of your child’s esophagus. These are tiny stitches that connect the two ends.

2. The tension on the sutures is increased bit by bit, causing each end of the esophagus to grow about one to two millimeters each day—just like a muscle grows when you exercise it. The surgeon applies the proper amount of tension to the ends of the esophagus to create just enough growth for it to be attached.

Depending on how much your baby’s esophagus needs to grow, this may take between two and five weeks. During this time, your baby is on respiratory and nutritional supportive devices and closely monitored by her health care team.

3. Then, during a second operation, the sutures are removed, and the ends of the esophagus are sewn together.

Other treatments

Some babies with milder cases of esophageal atresia may not need the Foker process. Our doctors are experts in choosing the best treatment for each child. For children who don’t have long-gap esophageal atresia, treatment options include:

• Colonic interposition: Surgeons move a section of colon from its place in the gut to the space left by the esophageal gap, in effect creating a replacement esophagus.  
• Jejunum interposition: Rather than a piece of colon, surgeons use a section of the jejunum (the middle part of the small intestine) as a replacement esophagus. 

Learn more about other treatments for esophageal atresia.

How will you follow up with my child?

Each child is different, but often they’re seen every year or two throughout childhood to make sure that there are no problems or complications.

What’s the long-term outlook for babies with esophageal atresia?

If caught early and treated properly, most babies with esophageal atresia can eat normally within two to three months. They may need to be monitored for strictures (places of narrowing) in their esophagus, but these are treatable and in general, the outlook is quite good. In fact, the Foker process most often results in an esophagus that’s indistinguishable from one that has developed normally.

Coping and support

No parent wants her child to be ill, and it’s important to remember that you and your family aren’t alone. There's a lot of support available here at Boston Children's Hospital for you and your family, and here are some of the ways we can help:

Patient education: From the office visit to pre-op to the recovery room, our nurses will be on hand to walk you through your child’s treatment and help answer any questions you may have — How long will I be separated from my child during surgery? What will the operating room be like? They will also reach out to you by phone, continuing the care and support you received while at Children’s.

Parent to parent: Want to talk with someone whose child has been treated for esophageal atresia? We can often put you in touch with other families who have been through similar experiences and can share with you their experience at Children’s.

Faith-based support: If you are in need of spiritual support, we will help connect you with the Children’s chaplaincy. Our program includes nearly a dozen clergy representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian and United Church of Christ traditions who will listen to you, pray with you and help you observe your own faith practices during your hospital experience.

Social work: Our clinical social workers have helped many other families in your situation. Your social worker can offer counseling and assistance with issues such as coping with your child’s diagnosis, stresses relating to coping with illness and dealing with financial difficulties. 

Visit our For Patients and Families page for all you need to know about:

• getting to Children’s
• accommodations
• navigating the hospital experience
• resources that are available for your family

  Children’s Esophageal Atresia Treatment Program’s Facebook page
  Join our Facebook page and connect with other families with children who have been diagnosed with esophageal atresia.