Feeding and Swallowing Disorders

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

Feeding and swallowing disorders in infants and children are usually caused by multiple factors.

Problems with swallowing can occur at any stage of the eating process:

• When food is in the mouth
• When food passes into the esophagus
• When food passes into the stomach

Feeding disorders occur when an infant or child has problems gathering food and getting ready to suck, chew or swallow. Feeding disorders include problems with:

• Sucking from a bottle
• Spoon-feeding
• Chewing
• Transferring the food or liquid to the throat to swallow

Feeding disorders in children are common:

• 25% of children are reported to have a feeding disorder
• 80% of children with developmental disorders are reported to have a feeding disorder

Swallowing disorders in children are common:

• 25%-45% of children who are developing appropriately may experience swallowing problems
• 30%-80% of children with developmental disorders may experience swallowing problems

Patients can be seen by Texas Children's experts in Aerodigestive Program and Ear Nose and Throat (Otolaryngology) and Speech, Language and Learning.

Causes & Risk Factors

Causes include:

• Nervous system disorders (for example,  cerebral palsy)
• Gastrointestinal conditions (for example, gastroesophageal reflux)
• Prematurity and low birth weight
• Heart disease
• Cleft lip and palate
• Muscle weakness in the face and neck
• Respiratory difficulties
• Medications that cause lethargy or decreased appetite
• Problems with parent-child interactions at meal times 

Children with feeding and swallowing disorders may be at risk for:

• Dehydration (excessive loss of fluids in the body)
• Poor nutrition
• Aspiration (food or liquid entering the airway)
• Pneumonia or repeated upper respiratory infections
• Embarrassment or isolation in social situations involving eating

Symptoms & Types

Symptoms include:

• Arching or stiffening of the body during feeding
• Irritability or lack of alertness during feeding
• Refusing food or liquid
• Failure to accept different textures of food
• Long feeding times
• Difficulty chewing
• Coughing or gagging during meals
• Food/liquid coming out of the nose
• Difficulty coordinating breathing with eating and drinking
• Increased stuffiness (congestion) during meals
• Frequent spitting up or vomiting
• Recurring pneumonia or respiratory infections
• Less than normal weight gain or growth

Diagnosis & Tests

Your child's doctor may refer you to a speech-language pathologist. This is a health care professional who specializes in treating eating, swallowing and language disorders.

To make a diagnosis, your child may need a clinical feeding evaluation. This test includes:

• Getting a detailed history of the problem
• Looking at the strength and movement of muscles involved in swallowing
• Observing feeding during eating and drinking

Additional tests may include:

• Swallow function study (also known as modified barium swallow). The child eats or drinks food or liquid that contains barium. The swallowing process is viewed on a video X-ray.
• Endoscopic assessment. A lighted scope is inserted through the nose, and the child's swallowing is observed on a screen.

Treatment & Care

Treatment may include:

• Medical intervention (for example, medicine for gastroesophageal reflux)
• Direct feeding therapy designed to meet individual needs
• Nutritional changes (for example, eating different foods or adding calories to meals)
• Increasing the acceptance of new food temperatures and texture changes
• Postural or positioning changes (for example, using a different type of seating)
• Behavior management techniques
• Referral to other professional

Living & Managing

Clinical evidence shows that children with swallowing and feeding problems benefit from the services of a speech-language pathologist. The speech-language pathologist will give you tips on how to help your child outside of appointments.