Pediatric Dysphagia

Pediatric dysphagia is a swallowing disorder in infants and children that affects one or more phases of the swallowing process—oral preparatory, oral, pharyngeal, or esophageal. It involves difficulties not only with the physical act of swallowing but also with feeding behaviors, and can stem from a wide array of developmental, structural, or medical causes.

There are two primary classifications:

1. Swallowing disorders – Involving one or more phases of the swallow (oral, pharyngeal, esophageal).
2. Feeding disorders – Encompass difficulties in food intake and mealtime behaviors, which may or may not involve swallowing difficulties.

Types of Dysphagia

Pediatric dysphagia can be categorized by the phase it affects:

• Oral phase dysphagia – Issues with chewing, bolus formation, and oral control.
• Pharyngeal phase dysphagia – Difficulty initiating a swallow or protecting the airway.
• Esophageal phase dysphagia – Problems with bolus movement down the esophagus due to motility disorders or structural issues.
  

It can also be:

• Motor-based (e.g., cerebral palsy)
• Sensory-based (e.g., children with autism spectrum disorder)
• Anatomical or structural (e.g., cleft palate, tracheoesophageal fistula)
• Behavioral/psychological (e.g., avoidant/restrictive food intake disorder – ARFID)

Causes of Pediatric Dysphagia

The underlying causes are varied and often multifactorial:

1. Developmental anomalies:
   • Cleft lip/palate
   • Laryngeal/tracheal malformations (e.g., laryngomalacia, tracheomalacia)
   • Tongue tie (ankyloglossia)
2. Neurological conditions:
   • Cerebral palsy
   • Premature birth-related brain injury
   • Genetic syndromes (e.g., Down syndrome, Pierre Robin sequence)
3. Gastrointestinal conditions:
   • GERD (Gastroesophageal reflux disease)
   • Eosinophilic esophagitis (EOE)
   • Pyloric stenosis
4. Cardiorespiratory conditions:
   • Congenital heart disease
   • Chronic lung disease or frequent respiratory infections
5. Psychosocial or sensory dysfunction:
   • Food aversion
   • Sensory processing disorder

Symptoms and Red Flags

Pediatric dysphagia can present with various observable signs:

• Oral symptoms:
  • Gagging or choking during meals
  • Pocketing food in cheeks
  • Anterior loss of liquids
  • Prolonged mealtime duration
• Respiratory symptoms:
  • Coughing or sneezing during or after eating
  • Stridor or noisy breathing
  • Frequent respiratory infections
• Feeding/behavioral symptoms:
  • Food refusal or extreme selectivity
  • Negative mealtime behaviors (crying, tantrums)
  • Fatigue during meals or inability to finish them
• Growth and GI symptoms:
  • Poor weight gain or weight loss
  • Vomiting or projectile spit-ups
  • Constipation or diarrhea linked to feeding
    

Treatment and Management

Treatment should be multidisciplinary and individualized. It may include:

1. Swallowing Therapy

• Conducted by speech-language pathologists (SLPs)
• Includes oral-motor exercises, positional strategies, and modified feeding techniques
  

2. Feeding Therapy

• Gradual exposure to textures and flavors
• Behavioral interventions and parent education
  

3. Medical Interventions

• GI consultation for reflux or EOE
• ENT for structural issues or airway evaluation
• Pulmonology for chronic aspiration or respiratory symptoms
  

4. Dietary Adjustments

• Thickening liquids
• Modifying food textures
• Addressing allergies/intolerances
  

5. Specialist Collaboration

• Working with gastroenterologists, occupational therapists, dietitians, and psychologists is essential for comprehensive care.

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