Dysphagia

Dysphagia is the term given to eating, drinking and swallowing disorders. Dysphagia occurs when there is a problem with any stage of the process of eating, chewing, drinking and swallowing. This includes aspects such as trying food with different textures, picking up food, bringing it to the mouth, chewing and swallowing.

Dysphagia can be very serious as a child who cannot swallow certain foods or liquids may not receive the right nutrition or amount of food to stay healthy and maintain a healthy weight. Problems with swallowing can be hazardous as they can result in aspiration.

Our speech and language therapists can work with you and your child to provide techniques and therapy to increase a safe swallow and reduce the levels of aspiration and infection.

Dysphagia is name given to eating, drinking and swallowing disorders. A difficulty can occur at any stage of the process. There are 5 stages in the swallowing process:

Pre-oral stage

This stage includes, thinking about food, smelling food, feeling the food and bringing it to your mouth.

Oral preparatory stage

Tongue moves the food around the mouth to help with chewing, by chewing food is reduced to a small size and combined with saliva.

Oral stage

Food is collected into a bolus at the back of the mouth, the soft palate is elevated (to avoid food entering the nasal cavity) ready for swallowing. Swallowing is triggered once the bolus (food) touches the pillars of fauces.

Pharyngeal stage

Food is passed through the pharynx by peristalsis to the oesophagus, the voice box (larynx) is elevated and completely closed by the folding of the epiglottis over the larynx and the closure of the vocal folds. This is to avoid food entering the airway.

Oesophageal stage

Food goes down the oesophagus (food pipe) to the stomach - this takes around 3- 20 seconds.

Problems in these area can occur for a number of reasons such as:

• Weak muscles needed for chewing.
• Limited or disordered motor patterns affecting the tongue, lips, jaw, cheek and soft palate.
• Over sensitive gag reflex.
• Reduced or absent cough reflex.
• Delayed swallow.
• Uncoordinated swallow.
• Difficulty in coordinating suck - swallow - breathe pattern.
• Immature chew.
• Difficulties in communicating food preferences.

The long term effects of dysphagia can contribute to:

• Malnutrition.
• Weight loss.
• Dehydration.
• Choking.
• Chest infections.

Dysphagia is associated with increased levels of morbidity and mortality as well as reducing a child’s quality of life.

Dysphagia is usually a secondary disorder to a primary neurological, physical, psychological or emotional condition. Any illness that impacts the nerves and muscles needed in eating, drinking and swallowing can cause dysphagia.

Some conditions that cause dysphagia include:

• Acquired head / brain injury
• Stroke
• Head and neck cancer
• Premature birth
• Learning disability
• Surgery on spine or brain
• Developmental disorders
• Neurological disorders such as cerebral palsy
• Progressive neurological diseases
• Complex medical conditions
• Gastro-oesophageal reflux
• Genetic syndromes
• Structural abnormalities such as cleft lip/palate
• Behavioural issues

Dysphagia can occur at any stage of the swallowing process and therefore can manifest in different forms. The signs and symptoms will vary between children as they may have difficulties at different stages of the process. Children may not present with all signs and symptoms.

Some signs and symptoms include:

• Refusal of food or liquids.
• Rejecting different textured food- has strong preferences to certain textures.
• Difficulty with chewing.
• Difficulties with breastfeeding.
• Coughing , choking or gagging during or after meals.
• Excessive drooling.
• Regurgitation of food.
• Inability to control saliva.
• Oral residue after swallow.
• Dry mouth.
• Food sticking in the throat.
• Food or drink coming out the nasal cavity.
• Difficulty managing breathing with eating and drinking.
• Pocketing food in food the mouth.

Dysphagia can impact a child’s health and well-being as it can result in a lack of nutrition that can hinder a child’s growth and development. Dysphagia can also affect a child’s daily activity and participation of activities that involve eating and drinking.

Impact of dysphagia on a child’s life include:

• Anxiety and distress experienced by the patient and family members.

• Increased hospitalisation.
• Reduced quality of life.
• Lack of food enjoyment.
• Embarrassment during social situations that involve eating or drinking.
• Isolation or avoidance in social situations that require eating or drinking.
• Bullying or teasing.
• Low self esteem.

Our speech and language therapists can provide your child with strategies and advice that can improve their difficulties and reduce the level of risk.

Our speech and language therapists can assess your child during mealtimes at home, school or while eating and drinking in clinic to establish where the difficulties and potential risks lie. The role of the speech and language therapist in dysphagia management is to ensure your child has a safe swallow. The speech and language therapy assessment process for dysphagia usually includes the following:

• Full case history including background information from the client and their family.
• Bedside assessment: This includes assessment of consciousness, posture, voluntary cough, voice quality and control of saliva.
• Clinical assessments: Includes assessment of oral cavity, strength and movement of muscles used in eating drinking and swallowing.
• Instrumental assessments.
• Formal assessments.

Speech and language therapists work as part of a multi-disciplinary team (doctors, nurses, paediatrician, dietician, ear nose and throat specialists) when managing dysphagia.

The role of the speech and language therapist in the management and treatment of dysphagia is to ensure your child has a safe swallow, by initially identifying the type of difficulty, the level of difficulty, and the cause of the difficulty along with any potential risks. After identifying the potential areas of risk our speech and language therapists will provide you and your child with recommendations, strategies and advice, as well as modifications to their eating, drinking and swallowing habits and environment.

Many children with dysphagia may not be aware of their difficulties, our speech and language therapists will educate the child and the parents on appropriate swallowing techniques and point out potential risks. Our speech and language therapists will give safety recommendations to avoid potential aspiration.

Interventions used by our speech and language therapists in dysphagia include:

• Modification of the consistency of food.
• Modification of the consistency of liquids.
• Modification of the types of feeding strategies already being used or introducing new strategies.
• Changing swallow techniques.
• Modifying the physiology of the swallow mechanism during swallowing.
• Modifying body posture during eating and drinking.
• Improving oral hygiene.
• Introducing strategies to increase confidence levels of the child and reduce the fear of choking.
• Educating the child, parents, carers, family and other professionals involved.

• Individual therapy.
• Group therapy.

Dysphagia that is not managed appropriately can be dangerous and result in a poor quality of life. Our speech and language therapists can work with you and your child to identify potential risks and reduce the level of difficulties faced by your child while eating and drinking.