Posted by: Indonesian Children | August 28, 2009

Picky Eaters, Feeding Difficulties, Swallowing or Dysphagia Disorders in Children

Feeding disorders include problems gathering food and getting ready to suck, chew, or swallow it. For example, a child who cannot pick up food and get it to her mouth or cannot completely close her lips to keep food from falling out of her mouth may have a feeding disorder.

Dysphagia, meaning difficulty swallowing, is when the swallowing of food causes it to not pass easily from the mouth to the stomach. This may cause food to get stuck in the lungs and throat. In addition, children may have difficulty eating enough—leading to nutrition problems and failure to gain weight or grow.

Swallowing disorders, also called dysphagia (dis-FAY-juh), can occur at different stages in the swallowing process:

  • Oral phase–sucking, chewing, and moving food or liquid into the throat
  • Pharyngeal phase–starting the swallow, squeezing food down the throat, and closing off the airway to prevent food or liquid from entering the airway (aspiration) or to prevent choking
  • Esophageal phase–relaxing and tightening the openings at the top and bottom of the feeding tube in the throat (esophagus) and squeezing food through the esophagus into the stomach

Signs or symptoms

The symptoms of dysphagia vary greatly from person to person. Some individuals will experience only mild symptoms while others may have severe symptoms or complications. Symptoms of dysphagia may resemble other medical conditions. Children with feeding and swallowing problems have a wide variety of symptoms. Not all signs and symptoms are present in every child.

The following are signs and symptoms of feeding and swallowing problems in very young children:

  • difficulty chewing
  • difficulty breast feeding
  • coughing or gagging during meals
  • frequent spitting up or vomiting
  • excessive drooling or food/liquid coming out of the mouth or nose
  • difficulty coordinating breathing with eating and drinking
  • increased stuffiness during meals
  • gurgly, hoarse, or breathy voice quality
  • recurring pneumonia or respiratory infections
  • less than normal weight gain or growth 
  • arching or stiffening of the body during feeding
  • irritability or lack of alertness during feeding
  • refusing food or liquid
  • failure to accept different textures of food (e.g., only pureed foods or crunchy cereals)
  • long feeding times (e.g., more than 30 minutes)




As a result, children may be at risk for:

  • dehydration or poor nutrition
  • (food or liquid entering the airway) or penetration

  • pneumonia or repeated upper respiratory infections that can lead to chronic lung disease
  • embarrassment or isolation in social situations involving eating
  • aspiration


Dysphagia is often the result of another condition or physical characteristic, some of them may include:



Child is having difficulty eating will examine your child and address any medical reasons for the feeding difficulties, including the presence of reflux or metabolic disorders. Dysphagia is diagnosed through a complete patient medical history, physical exam and sometimes radiology procedures to evaluate the mouth, throat, and esophagus which may include : 

  • ask questions about your child’s medical history, development, and symptoms
  • look at the strength and movement of the muscles involved in swallowing
  • observe feeding to see your child’ s posture, behavior, and oral movements during eating and drinking
  • special tests, if necessary:
    • modified barium swallow–child eats or drinks food or liquid with barium in it, and then the swallowing process is viewed on an X-ray.
    • endoscopic assessment–a lighted scope is inserted through the nose, and the child’s swallow can be observed on a screen.Endoscopy is a lighted, flexible instrument (containing a computer chip and camera that is attached to a TV monitor) examines the upper to lower GI tract for any condition that can cause symptoms.


Treatment varies greatly depending on the cause and symptoms of the swallowing problem.

Based on the results of the feeding and swallowing evaluation, the SLP or feeding team may recommend any of the following:

  • medical intervention (e.g., medicine for reflux)
  • direct feeding therapy designed to meet individual needs
  • postural or positioning changes (e.g., different seating)
  • behavior management techniques
  • referral to other professionals, such as a psychologist or dentist    
  • nutritional changes (e.g., different foods, adding calories to food)
  • increasing acceptance of new foods or textures
  • food temperature and texture changes


The focus on intervention may include the following:

  • increasing acceptance of different foods and liquids
  • improving sucking and/or drinking ability
  • coordinating the suck-swallow-breath pattern (for infants)
  • altering food textures and liquid thickness to ensure safe swallowing  
  • making the muscles of the mouth stronger
  • increasing tongue movement
  • improving chewing



  • ask questions to understand problems in feeding and swallowing
  • follow recommended techniques at home and school
  • talk with everyone who works with the child about the feeding and swallowing issues and treatment plan
  • provide feedback to the SLP or feeding team about what is or is not working at home
  • make sure they understand the treatment plan
  • go to treatment plans


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Copyright © 2009, Picky Eaters Clinic Information Education Network. All rights reserved.


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