Difficulty swallowing – almost everyone has experienced the horrible feeling of food “going down the wrong way”. But some children (and adults) have to deal with trouble swallowing every day.
Just like breathing, swallowing is a reflex that’s essential for life. Speech Pathology Australia say that humans swallow 700 times per day on average – around three times an hour during sleep, once per minute while awake and more often during meals.
According to estimates from the US Centers for Disease Control and Prevention, 0.9% of children aged 3–17 have swallowing problems – known medically as ‘dysphagia’. The incidence of feeding and swallowing disorders is assumed to be increasing because of improved survival rates of children with complex and medically fragile conditions, plus the improved longevity of people who develop dysphagia during childhood.
In 2020, Speech Pathology Australia are hosting Swallowing Awareness Day on Wednesday 18 March to bring attention to swallowing disorders and connect people with speech pathologists – the professionals who can help.
The 2020 theme is “Dysphagia. A difficult diagnosis to swallow!”
Why would a child have trouble swallowing?
Although many people take swallowing for granted, it’s a complex process involving several pumps and valves. These move food and drink from the mouth to the stomach via a tube called the oesophagus.
An important part of safe swallowing is its coordination with breathing. Speech Pathology Australia note that swallowing is an exquisitely timed process that uses 26 muscles and many nerves to ensure food and drink goes down the oesophagus, not the breathing tube into the lungs.
Swallowing skills are needed from birth so babies can drink milk from their mother’s breast or a bottle. Once solid food is introduced, children must learn to shift food to the back of the mouth where it triggers the swallowing reflex. Chewing also becomes important, as the food gets broken down and mixed with saliva to form a ball (called a ‘bolus’) that’s easy to swallow.
Because swallowing is such a finely tuned process, there are many reasons why a child may have trouble swallowing. Anything that interferes with the structures of the head and neck, or the muscles or nerves that control swallowing, may cause paediatric dysphagia – the medical term for swallowing difficulties in children.
Common causes of paediatric dysphagia
Some of the more common reasons a child may have swallowing difficulties include:
- neurological conditions eg cerebral palsy, meningitis, epilepsy, traumatic brain injury
- genetic syndromes eg Down syndrome, Prader-Willi syndrome, Rett syndrome
- premature birth or very low birth weight, hyper- or hypotonia (high or low muscle tone)
- breathing and/or respiratory difficulties eg need for oxygen, chronic neonatal lung disease
- ear, nose and throat issues eg choanal atresia, tracheostomy, vocal fold palsy
- complex medical conditions such as heart or lung diseases, delayed gastric emptying, oesophageal atresia (a birth defect affecting the oesophagus)
- side effects of medication eg lethargy, poor appetite
- developmental disability
- structural abnormalities eg cleft lip and/or palate and other abnormalities of the head or neck.
Dysphagia symptoms in children
A swallowing problem can stem from an issue with any phase of the swallowing process.
Signs and symptoms that your child might be having swallowing difficulties include:
- coughing or throat clearing
- choking or gagging on food and/or drink
- multiple swallow attempts
- fussy eating such as refusal to eat certain food types/textures
- watery or teary eyes
- nasal congestion
- colour change (eg turning blue around the lips)
- wet/gurgly breathing or voice
- increased breathing rate, stridor or wheezing
- apnoea (longer than usual breathing pauses)
- recurrent chest infections.
What are the problems associated with paediatric dysphagia?
Swallowing difficulties can have serious consequences, including dehydration, undernutrition, malnutrition and something known as oral aversion – the reluctance, avoidance, or fear of eating or drinking.
One major concern with swallowing difficulties is aspiration risk. Aspiration occurs when food, drink or other material enters the breathing tube and passes below the vocal cords towards the lungs. It can be ‘silent’, meaning the child has none of the usual outward signs of swallowing difficulty such as coughing or choking.
Aspiration can lead to chest infections like pneumonia and chronic lung disease.
How do I know if my baby has swallowing problems?
In babies, signs of a swallowing problem may include:
- Coughing or choking during or after swallowing
- Crying or decreased responsiveness when feeding
- Breathing difficulties when feeding eg faster breathing rate, temporarily not breathing
- Turning blue around the lips, nose and fingers/toes
- Frequent stopping during feeds
- Drooling (not related to teething)
- Gagging, loss of food/liquid from mouth during feeds
- Disengagement/refusal shown by grimacing, facial flushing, or turning head away
- Frequent congestion (especially after meals), frequent respiratory illnesses
- Noisy or wet gurgles during and after eating
- Vomiting (more than usual baby “spit-up”).
What is a swallowing assessment?
If you suspect your child has a swallowing problem, it’s vital to get them assessed by a professional. Speech-Language Pathologists are highly trained and qualified health professionals who conduct swallowing assessments.
When assessing swallowing difficulties in children, the Speech-Language Pathologist will take a holistic approach to your child’s problem, considering factors such as their age, and any congenital abnormalities, disabilities, and/or chronic conditions that may be affecting feeding and swallowing function.
A clinical evaluation of swallowing and feeding will usually include taking a history of your child’s problem, any family history and an assessment of their overall development. Your Speech-Language Pathologist will conduct a comprehensive assessment of the structure and function of tissues involved in swallowing (eg their jaw, lips, tongue, hard and soft palate etc).
The functional swallowing assessment involves observing your child eating or being fed by a family member or caregiver, using foods and/or drinks and feeding practices that are typical at home. Your SLP will be looking at your child’s head and neck control, swallowing reflexes and typical developmental skills that are age-appropriate – such as sucking in infants, mastication (chewing) in older children, and manipulation and transfer of the food bolus.
They’ll also look at skills such as secretion management (the ability to swallow saliva) and the coordination of breathing and swallowing.
The assessment will be sensitive and tailored to your family’s cultural background, beliefs, and preferences. Your Speech-Language Pathologist may also liaise with other professionals involved in your child’s healthcare, such as surgeons, dietitians, lactation consultants, psychologists and occupational therapists.
Dysphagia treatment for children
Once an assessment has been completed, your Speech-Language Pathologist will work with you to develop a management plan. It will be based on the findings of the swallowing assessment and tailored to your child’s needs and your family’s preferences.
It may include changes to the textures of foods or drinks, and exercises to help improve your child’s swallow. For children with severe swallowing difficulties, your Speech-Language Pathologist may refer for further assessment and support from other health professionals to consider other management methods such as the use of a feeding tube that delivers food and drink directly to the stomach. This may be because your child is at high risk of aspiration and developing lung complications.
Your Speech-Language Pathologist will continue to work with any related health professionals involved in your child’s care. Your child will be reviewed regularly.
Concerned your child may have a swallowing problem?
At Growing Early Minds, our team of qualified Speech-Language Pathologists can conduct swallowing assessments and treat paediatric dysphagia. They are experienced in working with children who have complex needs, developmental delay or disability (including Autism) and who have experienced trauma.
We can assess your child at our clinic in Blacktown (Western Sydney) or see your child at home, their childcare centre, school or playgroup. We can also provide telehealth services to families in remote, regional or interstate locations.
All our Growing Early Minds Speech-Language Pathologists are certified practising members of Speech Pathology Australia – the national peak body for the speech pathology profession in Australia.
You don’t need a referral from a GP or paediatrician, although this may help offset the cost of therapy. We’ll discuss treatment pathways, fees and any other important information you’ll need to know. You can download our referral form directly from here and find out more on our website.