Feeding and Swallowing Disorders in Children

feeding_and_swallowing_disorders

What are feeding and swallowing disorders?

Feeding and Swallowing difficulties are collectively termed as Dysphagia. Oral Dysphagia is a condition in which there is trouble in the mouth to control liquids and food. Pharyngeal Dysphagia is the trouble in the throat while swallowing. A feeding or swallowing disorder comprises of the following atypical eating and drinking behaviours-

  • In acceptance of age-appropriate foods or liquids
  • Inability to use age-appropriate feeding procedures and utensils
  • Inability to self-feed.

A child with dysphagia can:

  • reject food
  • agree to take only a limited assortment or quantity of foods and liquids
  • Show mealtime behaviours that are unsuitable for his age.

What is a typical swallow?

Dysphagia can occur in any phase of the swallow. Typically, the phases of the swallow are –

ORAL PHASE— This includes 2 sub stages. First is the preparatory stage which involves preparing the food or liquid in the oral cavity to form bolus-including sucking liquids, manipulating soft boluses, and chewing solid food. The next comes the oral transition stage which involves propelling the bolus backwards through the oral cavity.

PHARYNGEAL PHASE— This includes starting the swallow and moving the bolus through the pharynx.

ESOPHAGEAL PHASE—This involves moving the bolus through the cervical and thoracic esophagus and into the stomach via esophageal peristalsis.

What are the symptoms of a swallowing disorder?

Your child can have a problem in any of the three phases mentioned above. He can also have feeding problems.

Oral Difficulties 

  • Trouble sucking from a bottle or breast
  • Problem in synchronizing the suck and swallow with the breathing cycle
  • Trouble in closing the lips after taking food from a spoon, fork or hand.
  • Problem in keeping the food in the mouth
  • Problem in chewing the food and in moving the food from the mouth to the throat.
  • Inability to control the food in the mouth, so that it enters the throat too quickly
  • Having some food left in the mouth after swallowing, this is called residue
  • Having food stuck in the cheek, called Pocketing

Pharyngeal Difficulties

  • Having a tough time starting the swallowing
  • Getting food and liquid into the airway, called Aspiration
  • Having some food left in the throat after the swallow, called residue

Esophageal Difficulties

  • Having difficulty in moving the food down the throat into the esophagus, food may get stuck.
  • Poor movement of the esophagus while food moves down into the stomach
  • Food might come back, called reflux
  • Pockets in the esophagus that collect food and don’t let it pass into the stomach

What are the symptoms of a feeding disorder?

Your child may have issues eating with his hand or a spoon/fork. He may also:

  • refuse certain types of foods like crunchy or smooth foods
  • eat only certain foods like pizza or chips
  • gag easily when food is brought near his mouth
  • take a long time to eat – often more than 30 minutes for a single meal
  • have difficulty paying attention while eating

What are the causes of feeding and swallowing disorders?

  • Disorders of the nervous system, like cerebral palsy,meningitis, encephalopathy, pervasive developmental disorders, traumatic brain injury, muscle weakness in face and neck
  • Premature birth, low birth weight. This affects neuromuscular coordination.
  • Breathing disorders
  • Developmental disorders like Down Syndrome, Autism etc
  • complex medical conditions (e.g., heart disease, pulmonary disease, gastroesophageal reflux disease [GERD], delayed gastric emptying);
  • structural abnormalities (e.g., cleft lip and/or palate, laryngomalacia, tracheoesohageal fistula, esophageal atresia, head and neck abnormalities, choanal atresia);
  • genetic syndromes (e.g., Pierre Robin, Prader-Willi, Treacher-Collins, 22q11 deletion);
  • medication side effects (e.g., lethargy, decreased appetite);
  • sensory issues as a primary cause or secondary to limited food availability in early development
  • behavioral factors (e.g., food refusal);
  • social, emotional, and environmental issues (e.g., difficult parent-child interactions at mealtimes).

What are the incidence and prevalence figures of swallowing and feeding disorder?

  • Around 25 % – 45 % of typically developing children have feeding and swallowing problems
  • 35 % – 80 % of children with developmental disorders are affected
  • Severe consequences of feeding and swallowing problems are seen in 25 % – 90 % of children with physical disabilities
  • Prevalence of pediatric dysphagia is increasing due to improved survival rate of children born pre maturely, low birth weight and with other complicated medical conditions.

What happens if your child has a feeding or swallowing disorder?

  • If your child has dysphagia, he might not get adequate nutrition to grow and learn. A child who doesn’t eat well may
  • Not get enough food or water to get healthy. He may get dehydrated and is at high risk of poor nutrition
  • Not develop appropriately
  • be at a high risk for aspiration ( food going in the air way)
  • get pneumonia and other respiratory tract infections
  • not eat in front of others and feel embarrassed and isolated