Many children and adults require feeding tubes because of an impaired swallow, which may be called a swallowing disorder or dysphagia. When individuals cannot swallow safely, they are at risk for aspirating their food, liquids, or formula into their lungs, which can lead to pneumonia. In addition, individuals who cannot swallow well may have difficulty consuming enough liquids, foods, or specific thicknesses or textures to meet their nutritional needs.
Symptoms of Swallowing Problems
Coughing or choking on feedings
Difficulty moving food/liquid around the mouth
A “lump” in the throat
Drooling or spitting out food/liquid
Changes in voice after eating/drinking
Weight loss or failure to gain
Inability to eat certain textures or thicknesses
Excessively long time required for eating or drinking
Falling asleep during feedings or “sleep-eating”
Causes of Swallowing Problems
There are many possible causes of swallowing disorders specific to children. They include the following:
Neurological and genetic conditions: children with neurological disorders, including cerebral palsy, epilepsy, brain tumors, and neuromuscular disease, as well as children with genetic conditions that affect muscle tone, are at the highest risk for swallowing disorders. They may be unable to coordinate their muscles to effectively suck, chew, move food/liquid to the back of the throat, or swallow safely. These children often aspirate some or all of their food/liquid into their airway and lungs.
Stroke or brain injury: children who experience a stroke or brain injury may have difficulty swallowing safely. They present similarly to children with neurological and genetic conditions.
Prematurity and NICU care: babies born before 34 weeks typically do not have a coordinated suck/swallow reflex, and the care required in the NICU may have prevented it from developing correctly.
Low muscle tone or uncoordinated swallow: some children without any other medical problems have weak muscles in their face, mouth, or throat that make swallowing difficult.
Lip and tongue tie: tight tissue in the mouth may make it difficult for a baby to suck and swallow.
Cleft lip/palate and other craniofacial anomalies: these anomalies may interfere with the suck and swallow.
Sensory problems and autism: some children with sensory disorders or autism may refuse to swallow certain textures, temperatures, or thicknesses. Some children also will develop a fear of swallowing after a choking episode.
Fatigue due to other medical conditions: some children with cardiac or respiratory conditions may become so fatigues while eating/drinking that they are unable to swallow safely.
Motility problems or anomalies of the esophagus: children with motility problems of the esophagus or anomalies of the esophagus, such as narrowing, webbing, or a fistula, typically get food caught in the esophagus while swallowing.
Other Causes of Swallowing Problems
Other causes of swallowing problems include head and neck cancer, head and neck injury, later-onset neurological conditions such as MS or Parkinson’s Disease, and spinal cord injuries. These are more common in adults.
Tests and Treatments
The gold-standard test for swallowing problems is the Swallow Study. This test watches the movement of food or liquid as it is swallowed using fluoroscopy. Other tests may include an endoscopy to look for problems in the esophagus, a flexible bronchoscopy to look for problems in the throat, and motility testing of the esophagus. See our page on tests for more information.
Treatment of Swallowing Problems
Many swallowing disorders can be improved or even fully resolved with treatment. Some babies and young children may even outgrow their swallowing disorders. Treatment may include any of the following:
Speech or feeding therapy
Surgery for anatomical conditions
Treatment of underlying conditions
Use of special tools or positions for feeding, such as special spoons, cups, or bottles