Dysphagia in Children
Dysphagia is a term that means “difficulty swallowing.” It is the inability of food or liquids to pass easily from your child’s mouth, into the throat, and through the esophagus to the stomach during the process of swallowing.
What causes dysphagia in children?
Swallowing involves three stages, which are controlled by nerves that connect your child’s digestive tract to their brain.
- Oral preparation stage: Food is chewed and moistened by saliva. Liquids are taken in by bottle, cup, or straw. The tongue pushes food and liquids to the back of the mouth toward the throat. (This phase is voluntary: We have control over chewing and beginning to swallow.)
- Pharyngeal stage: Food enters the pharynx (throat). A flap called the epiglottis closes off the passage to the windpipe so food cannot get into the lungs. The muscles in the throat relax. Food and liquid are quickly passed down the pharynx (throat) into the esophagus. The epiglottis opens again so we can breathe. (This phase starts under voluntary control, but then becomes an involuntary phase that we cannot consciously control.)
- Esophageal stage: Liquids fall through the esophagus into the stomach by gravity. Muscles in the esophagus push food toward the stomach in wave-like movements known as peristalsis. A muscular band between the end of the esophagus and the upper portion of the esophagus (known as the lower esophageal sphincter) relaxes in response to swallowing, allowing food and liquids to enter the stomach. (The events in this phase are involuntary.)
Swallowing disorders occur when one or more of these stages fail to take place properly.
Certain health problems can affect swallowing in children include:
- prematurity
- developmental delays
- cleft lip and palate or other craniofacial anomalies
- large tongue or tonsils
- diseases that affect the nerves and muscles, such as a stroke, tumor, nerve injury, brain injury, or muscular dystrophy, and can cause paralysis or poor function of the tongue or the muscles in the throat and esophagus
- prenatal malformations of the digestive tract, such as esophageal atresia or tracheoesophageal fistula
- irritation from being on a ventilator for a prolonged period of time
- having a tracheostomy (artificial opening in the throat for breathing)
- gastroesophageal reflux disease (GERD)
- compression of the esophagus by other body parts, such as the heart, thyroid gland, blood vessels, or lymph nodes
- foreign bodies in the esophagus, such as a swallowed coin
How we care for dysphagia in children
The skilled clinicians in the Aerodigestive Center at Boston Children’s Hospital are experienced in diagnosing and treating children with a range of aerodigestive concerns, including dysphagia.
Your child may also receive care through our Speech-Language Pathology Program or within the Division of Gastroenterology, Hepatology and Nutrition. Boston Children’s 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, speech language pathologists, radiologists, and otolaryngologists. Our team thoroughly evaluates your child’s oral motor skills, swallowing and feeding skills, and nutritional intake.
