Dysphagia | Diagnosis & Treatments
How is dysphagia diagnosed in children?
The physician will obtain a medical history and examine your child. You will be asked questions about how your child eats and any problems you notice during feeding. Imaging tests may also be done to evaluate your child’s mouth, throat, and esophagus. These tests can include:
- Videofluoroscopic swallow study (also called a modified barium swallow study). Your child is given small amounts of a liquid that contains barium (a chalky liquid used to coat the inside of organs so that they will show up on an x-ray) to drink with a bottle, spoon, or cup, or spoon-fed a solid food containing barium. They are seated upright or in the position that you feed them in at home. A series of moving picture x-rays are taken to evaluate what happens as your child swallows the liquid.
- Barium swallow/upper GI series. Your child is given a liquid containing barium to drink and a series of x-rays are taken. They will be lying down on their back for this test. The physician can watch what happens as your child swallows the fluid, and note any problems that may occur in the throat, esophagus, or stomach.
- Endoscopy. This test uses a small, rigid, or flexible tube with a light and a camera lens at the end (endoscope) to examine the inside of part of your child’s airway and digestive tract. An endoscopy is performed under anesthesia. Pictures are taken of the inside of the throat, airway, esophagus, and the stomach to look for abnormalities. Small tissue samples, called biopsies, can also be taken to look for problems.
- Esophageal manometry. In this procedure a small flexible tube is placed into the nose and passed into the esophagus. It can determine how well your child’s esophagus is working by measuring the pressure and coordination of the esophageal muscles.
- Flexible laryngoscopy is an examination done in the office to assess the upper airway and status of vocal cord, which are essential part of evaluation of children with swallowing discoordination.
- Fiberoptic endoscopic evaluation of swallowing (FEES). In this test, a flexible camera is passed through your child’s nose and is used to see parts of the throat as they swallow to assess the status of swallowing and any indication for aspiration.
How is dysphagia treated in children?
Feeding therapy can be helpful for some children. These therapists can educate and work with families to help make swallowing more effective, or suggest techniques or modifications to your child’s diet that may help improve swallowing problems. However, it is critical to be sure there are no anatomical issues in the oral cavity, upper airway, esophagus, and stomach that may require surgical intervention.
Infants and children with dysphagia are often able to swallow thick fluids and soft foods (such as baby foods or pureed or blended foods) easier than thin liquids. The speech language pathologist may recommend that you thicken your child’s liquids and will work with you to create the correct recipe. They may also change the type of cup or bottle your child is drinking from that can help slow the flow of liquids. Some infants who had trouble swallowing formula will do better when they are old enough to eat baby foods from a spoon. Your child’s speech language pathologist may be able to recommend other commercial products that help thicken liquids and make them easier to swallow. The use of thickeners has to be approved by your child’s doctor.
If your child also has symptoms of reflux along with dysphagia, treating this condition may produce improvements in your child’s ability to swallow. As the esophagus and throat are less irritated by acid reflux, their function may improve. Treatment of dysphagia include:
- remaining upright for at least an hour after eating
- thickening your child’s liquid
- medications to decrease stomach acid production
- medications to treat inflammation
- medications to help food move through the digestive tract faster
- surgery of the upper airway and larynx to repair anatomical issues
- surgery to help repair the esophagus or stomach
How we care for dysphagia in children
The skilled clinicians in the Aerodigestive Center, Center for Airway Disorders, Motility and Functional Gastrointestinal Disorders Center, and Feeding and Swallowing Program at Boston Children’s Hospital are experienced in diagnosing and treating children with dysphagia.
Your child may also receive care through our Speech-Language Pathology Program affiliated with these centers. Boston Children’s Hospital also offers a unique Feeding and Swallowing Program, which diagnoses and treats infants, toddlers, and school-aged children with a variety of feeding and swallowing problems. Our interdisciplinary staff includes gastroenterologists, pulmonary specialists, otolaryngologists, speech and language pathologists, and radiologists. Our team thoroughly evaluates your child’s oral motor skills, swallowing and feeding skills, and nutritional intake.
