Oropharyngeal Dysphasia and Aspiration

What is oropharyngeal dysphagia?

Dysphagia means difficulty swallowing. There are two types of dysphagia: oropharyngeal and esophageal. Oropharyngeal dysphagia occurs when your child has difficulty swallowing because of problems with their mouth, tongue, palate, larynx or the muscle at the top of the esophagus. Esophageal dysphagia occurs when the esophagus does not clear food appropriately because of inflammation, because of a nerve or muscle problem or because of prior surgeries. Your care team can help determine what type of dysphagia your child has.

What is aspiration?

Sometimes, dysphagia can result in food or liquid entering your child's lungs, a problem called aspiration.

What are the symptoms of oropharyngeal dysphagia?

In addition to aspiration, your child may experience symptoms including:

  • difficulty feeding
  • coughing during drinking, particularly with thin liquids
  • gagging during meals
  • back arching during feeding
  • cyanosis (blue spells)
  • redness around the eyes during or after feeding
  • vomiting during feeding
  • rattling in the throat or chest
  • frequent breathing difficulties
  • poor growth

What causes oropharyngeal dysphagia?

Oropharyngeal dysphagia can have many different causes, including developmental causes, neurologic causes and anatomic causes. Children with a history of prematurity, neurologic diagnoses, genetic syndromes, developmental delay or a history of cardiothoracic surgery may be at greatest risk for the condition. However, oropharyngeal dysphagia can occur even in children without these risk factors. Your care team will help identify the most likely cause for your child's symptoms.

How is oropharyngeal dysphagia diagnosed?

If your child's physician suspects oropharyngeal dysphagia, they may perform a variety of tests to evaluate swallowing and make a diagnosis:

  • Physical examination and medical history
  • Clinical feeding evaluation (CFE) with a speech language pathologist who specializes in pediatric feeding and swallowing disorders
  • Esophageal manometry
  • Videofluoroscopic swallow study (VFSS), also known as a modified barium swallow study (MBS)
  • Fiberoptic endoscopic evaluation of swallowing (FEES) exam

How is oropharyngeal dysphagia treated?

Your child's method of feeding may need to be altered to reduce the chance that food will inadvertently enter the lungs. For example, you child may need to add thickener to their liquids, may need to eat or drink more slowly or in a different position or, rarely, may need to receive liquids by a tube that goes into the nose or the stomach.

How we care for oropharyngeal dysphagia

The skilled clinicians in the Aerodigestive Center and Center for Airway Disorders at Boston Children's Hospital are experienced in diagnosing and treating children with a range of aerodigestive concerns, including oropharyngeal dysphagia and aspiration. We have a rich understanding of the complexity of the swallowing process, which allows us to consider all aspects of this mechanism when evaluating and treating dysphagia.