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Pediatric Dysphagia
Pediatric Dysphagia Defined
Dysphagia is a disorder of feeding and swallowing, and in children may present with the child refusing food, accepting a limited variety of food or amount of foods and liquids, and demonstrating difficulty that may be observed by coughing, gagging or choking during mealtime.
Incidence & Prevalence
25 – 45% of typically developing children demonstrate feeding and swallowing problems
25 – 45% of typically developing children demonstrate feeding and swallowing problems 30-80% of children with developmental disorders present with feeding and swallowing disorders
30-80% of children with developmental disorders present with feeding and swallowing disordersThe prevalence of pediatric dysphagia is increasing due to improved care leading to increased survival rates of babies born prematurely, with low birth weight and with complex medical and health conditions
The prevalence of pediatric dysphagia is increasing due to improved care leading to increased survival rates of babies born prematurely, with low birth weight and with complex medical and health conditionsSigns & Symptoms
The American Speech-Language-Hearing Association highlights the following signs and symptoms of dysphagia which vary based on the age of the child:
•Back arching
Back arching•Breathing difficulties when feeding
Breathing difficulties when feeding•Coughing and/or choking during or after swallowing
Coughing and/or choking during or after swallowing•Crying during mealtime
Crying during mealtime•Dehydration
Dehydration•Difficulty chewing certain textured food
Difficulty chewing certain textured food•Difficulty initiating a swallow
Difficulty initiating a swallow•Frequent respiratory illness
Frequent respiratory illness•Gagging
Gagging•Loss of food/liquid from mouth when eating
Loss of food/liquid from mouth when eating•Prolonged feeding times
Prolonged feeding times•Noisy or wet vocal quality noted during and after feeding
Noisy or wet vocal quality noted during and after feeding•Refusal of certain textures
Refusal of certain textures•Taking only small volumes; over-stuffing mouth, and/or pocketing food
Taking only small volumes; over-stuffing mouth, and/or pocketing food•Vomiting
Vomiting•Weight loss or lack of appropriate weight gain
Weight loss or lack of appropriate weight gainCauses
Common causes of dysphagia in children according to The American Speech-Language-Hearing Association:
•Developmental disability
Developmental disability•Neurological disorders such as cerebral palsy, meningitis, encephalopathy, pervasive developmental disorders, traumatic brain injury, muscle weakness in face and neck
Neurological disorders such as cerebral palsy, meningitis, encephalopathy, pervasive developmental disorders, traumatic brain injury, muscle weakness in face and neck•Prematurity, low birth weight
Prematurity, low birth weight•Complex medical conditions such as heart disease, pulmonary disease, gastroesophageal reflux disease (GERD), delayed gastric emptying
Complex medical conditions such as heart disease, pulmonary disease, gastroesophageal reflux disease (GERD), delayed gastric emptying•Structural abnormalities such as cleft lip/palate, laryngomalacia, tracheoesophageal fistula, esophageal atresia, head and neck abnormalities and choanal atresia
Structural abnormalities such as cleft lip/palate, laryngomalacia, tracheoesophageal fistula, esophageal atresia, head and neck abnormalities and choanal atresia•Genetic syndromes such as Pierre Robin, Prada-Willi, Treacher-Collins for example
Genetic syndromes such as Pierre Robin, Prada-Willi, Treacher-Collins for example•Medication side effects
Medication side effects•Sensory issues
Sensory issues•Social, emotional and environmental issues
Social, emotional and environmental issuesLong term effects for a child diagnosed with pediatric dysphagia (ASHA) include:
•Poor weight gain/failure to thrive
Poor weight gain/failure to thrive•Aspiration pneumonia and/or compromised pulmonary status
Aspiration pneumonia and/or compromised pulmonary status•Food aversion
Food aversion•Dehydration/malnutrition
Dehydration/malnutrition•Ongoing need for enteral or parenteral nutrition
Ongoing need for enteral or parenteral nutritionChildren with feeding and swallowing disorders very often will require a modified textured diet in order to improve nutrition and decrease risk of malnutrition and dehydration as well as decrease risk/episodes of aspiration which can lead to pneumonia.
Diagnosing a child with dysphagia requires a team approach.
Members of the team include the following professionals:
A speech language pathologist who specializes in swallowing and feeding
A speech language pathologist who specializes in swallowing and feedingOne or more physicians that can be a pediatrician, neurologist, otolaryngologist, pulmonologist, neurosurgeon, cardiologist, gastroenterologist, plastic surgeon
One or more physicians that can be a pediatrician, neurologist, otolaryngologist, pulmonologist, neurosurgeon, cardiologist, gastroenterologist, plastic surgeonNurse/nurse practitioner
Nurse/nurse practitionerOccupational therapist
Occupational therapistPsychologist
PsychologistSocial worker
Social workerPhysical therapist
Physical therapistAudiologist
AudiologistThe Evaluation
The evaluation consists of both clinical observation, parent report and several objective test measures including:
Video Fluoroscopic Swallowing Study (VFSS)
Video Fluoroscopic Swallowing Study (VFSS)Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)Fiberoptic Endoscopic Evaluation of Swallowing and Sensory Testing (FEESST)
Fiberoptic Endoscopic Evaluation of Swallowing and Sensory Testing (FEESST)Treatment
The goals of treatment include:
•To maintain adequate nutrition and hydration while ensuring safe swallowing
To maintain adequate nutrition and hydration while ensuring safe swallowing•Work together with family to determine dietary preferences
Work together with family to determine dietary preferences•Minimize risk of aspiration and pulmonary complications
Minimize risk of aspiration and pulmonary complications•Improve quality of life
Improve quality of life•Help the child eat and drink efficiently and safely to the highest degree possible
Help the child eat and drink efficiently and safely to the highest degree possibleDiet Modifications
Diet modifications are made by ensuring consistency and safety and should follow the guidelines outlined by The International Dysphagia Diet Standardization Initiative (IDDSI) which have several levels for liquids and solids.
In addition to the texture modification, taste and temperature may be modified for those children who experience sensory issues as well.
USFDA WARNING:
The USFDA has cautioned consumers about commercial, gum based thickeners for use with children because of adverse effects that have been reported.
NOTE: Textured Food Innovation’s products DO NOT contain any type of commercial thickeners .
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