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Dysphagia | Overview

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:

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.

Dysphagia | Diagnosis & Treatments

How is dysphagia diagnosed in children?

The physician will examine your child and obtain a medical history. 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:

Video 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, flexible tube with a light and a camera lens at the end (endoscope) to examine the inside of part of your child’s digestive tract. An endoscopy is performed under anesthesia. Pictures are taken of the inside of the throat, the esophagus, and the stomach to look for abnormalities. Small tissue samples, called biopsies, can also be taken to look for problems.

How is dysphagia treated in children?

Feeding therapy can be helpful for some children. These therapists can give your child exercises to help make swallowing more effective, or suggest techniques for feeding that may help improve swallowing problems.

Infants and children with dysphagia are often able to swallow thick fluids and soft foods (such as baby foods or pureed or blended foods) better than thin liquids. The therapist 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 eating or drinking from. Some infants who had trouble swallowing formula will do better when they are old enough to eat baby foods. Your child’s speech or occupational therapist may be able to recommend other commercial products that help thicken liquids and make them easier to swallow.

If your child also has symptoms of GERD 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 your child’s GERD may include:

  • thickening your child’s liquids
  • remaining upright for at least an hour after eating
  • medications to decrease stomach acid production
  • medications to help food move through the digestive tract faster
  • an operation to help keep food and acid in the stomach (fundoplication)  

Dysphagia | Programs & Services