Dysphagia and Feeding Problems
Dysphagia means difficulty with swallowing. It may affect the aspects of swallowing that take place in the mouth, such as biting, chewing, and moving food or liquids within the mouth or from the mouth into the throat. It can also affect safe and efficient movement of the food/liquid through the throat or esophagus. Dysphagia may put a person at risk for malnutrition and dehydration, or for respiratory infections (e.g., pneumonia) if food or liquid fall into the airway.
Dysphagia may be caused by neurological injuries or diseases such as stroke, spinal cord injuries, Alzheimer's disease, Parkinson's, and cerebral palsy. Injuries, surgeries, or diseases that affect structures in the mouth and throat, such as head and neck cancer or cleft palate, may also cause dysphagia. Sometimes respiratory or gastrointestinal problems can contribute to swallowing problems as well.
Feeding problems include: difficulties getting food to the mouth or keeping it in the mouth, complete refusal of food/liquids, refusal of foods/liquids that are a certain texture or type, or refusal of foods/liquids that are presented in a certain way (e.g., cup vs. straw; spoon feeding vs. finger foods). These may occur along with or separately from swallowing problems. Causes may be similar to those of dysphagia, or they may be associated with autism, genetic syndromes, history of reflux, premature infancy, or social interaction issues with the family at mealtimes.
Symptoms of Swallowing/Feeding Problems
In older children and adults, symptoms include:
- Coughing, choking, or throat clearing during or after eating and drinking
- Drooling or loss of food/liquid from the mouth
- Food sticking in the mouth
- Feeling of food sticking in the throat or chest
- Gurgly sounding voice during or after eating and drinking
- Slow rate of chewing and swallowing, and fatigue during or after meals
- Repeated cases of pneumonia
In infants and very young children, symptoms of feeding and swallowing problems include the above plus:
- Excessive body tension during feeding
- Problems with breastfeeding
- Slower than normal or absent weight gain
- Frequent spitting up, especially during/after eating
- Difficulty breathing while eating and drinking
- Refusal to eat
Assessing and Treating Dysphagia and Feeding Problems
In order to assess swallowing and feeding problems, the speech-language pathologist (SLP) will take a complete medical history. She will examine the strength and coordination of the mouth and throat muscles used in swallowing, and assess voice quality and ability to cough and clear the throat. She will likely watch the client chew/swallow different types of food and liquids to look for signs of difficulty. If needed, she may conduct specialized tests to further check aspects of swallowing that cannot be seen any other way. One of these tests is the modified barium swallow (videofluoroscopic swallowing study), in which barium is added to food and liquid so that the entire swallowing process can be viewed on a video x-ray. Another test is fiberoptic endoscopic evaluation of swallowing (FEES), in which a thin tube equipped with a camera is passed through the nose into the throat. The SLP is then able to watch a video of the swallow on a computer screen.
The SLP's treatment plan depends on the results of the evaluation. It may include exercises to increase the strength or coordination of swallowing muscles or to improve sucking, chewing, or biting. The SLP may also teach the client to use certain postures and/or strategies that improve the safety and efficiency of the swallow; for example, swallowing with the head tilted down, swallowing two times after each bite, or chewing on one side of the mouth. She may recommend a special diet that includes only the food/liquid consistencies that can be swallowed safely. SLPs may need to work with doctors or dietitians to provide extra calories and/or to provide hydration and nutrition by other methods while the feeding/swallowing problems are being treated.
Feeding problems in young children may be addressed by a treatment team including the SLP, an occupational therapist, pediatric psychologist, dietitian, and/or doctor. Therapy may include some of the above-mentioned dysphagia techniques, as well as changing the texture or temperature of foods or the way they are presented, gradually adding different types of foods, teaching more efficient chewing patterns, and various behavior management strategies.