Swallowing Difficulties

Infants and children who have problems with swallowing have a condition called dysphagia.

Difficulty can occur at any stage of the eating process-from when food is in the mouth, when it passes into the esophagus and then into the stomach.

About 25%-45% of children who are developing appropriately may experience swallowing problems.

Approximately 30%-80% of children with developmental disorders may experience swallowing problems.

Patients can be seen by Texas Children's experts in Ear Nose and Throat (Otolaryngology).

Causes & Risk Factors

Causes include:

• Developmental disorders
• Neurological disorders
• Prematurity at birth or low birth weight
• Digestive disorders (delayed gastric emptying, gastroesophageal reflux disease [GERD], etc.)
• Structural abnormalities ( cleft lip/palate, head and neck abnormalities, etc.)
• Genetic syndromes ( Prader-Willi, Treacher-Collins, etc.)
• Side effects of medicine

Symptoms & Types

Symptoms include:

• Stopping frequently when eating because of uncoordinated suck-swallow-breathe pattern
• Coughing and choking during or after swallowing
• Difficulty when starting to swallow
• Difficulty managing secretions (such as drooling when not teething)
• Frequent congestion, particularly after meals
• Frequent respiratory illnesses
• Recurrent pneumonia
• Gagging
• Loss of food and liquid from the mouth when eating
• Noisy or wet vocal quality noted during and after feeding
• Refusing foods of certain texture or type
• Taking only small volume of food, over packing the mouth or pocketing food
• Vomiting (more than typical spit-up for infants)
• Weight loss or lack of appropriate weight gain

Diagnosis & Tests

The doctor will do a physical examination of your child:

• Address any medical reasons for the problem
• Ask questions about what happens when the child swallows

The doctor considers multiple factors when deciding tests that may be needed. These factors include:

• The area of the body causing the problem with swallowing
• The type of problem that needs to be evaluated

The doctor will:

• Look at the strength and movement of muscles used in swallowing
• Watch when your child eats to observe posture, behavior and oral movements

What the doctor finds during these observations will help to decide what tests are needed. These tests may include:

• Modified barium swallow (swallow function study) during which the child eats or drinks food or liquid with barium in it, and then the swallowing process is viewed on an X-ray.
• Endoscopy, in which a lighted scope is inserted through the nose to look at the child's swallow on a screen.

Treatment & Care

Treatment and care depend on what causes the swallowing problem. Types of treatment include:

• Medication for acid reflux
• Making dietary changes, such as foods with different textures, adding new foods, changing the temperature of the food
• Swallow or feeding therapy to make the muscles of the mouth stronger
• Increasing tongue movement
• Improving chewing
• Improving sucking and drinking ability
• Coordinating the suck-swallow-breath pattern in infants
• Tube feeding

Living & Managing

Living with swallowing difficulties can be challenging. It is important to follow the treatment given by the doctor. If your child continues to have problems, make another appointment to see the doctor.