Dysphagia means a person has trouble swallowing food, drinks, or saliva (spit). There are 3 types of dysphagia:
- Oral dysphagia means trouble chewing food or moving food or liquid around in the mouth.
- Pharyngeal dysphagia means a person can chew food but has trouble swallowing food or liquid and moving it into the throat or esophagus.
- Esophageal dysphagia happens when the esophagus does not move food from the throat to the stomach.
Children may have trouble in only one part of swallowing, or they may have trouble in more than one part, or all parts, of swallowing.
If your child has problems chewing or swallowing, they may be at risk for:
- Choking
- Food or liquid entering the airway
- Not getting enough nutrients or fluids
Safe chewing and swallowing help make sure your child gets the nutrition and fluids they need.
Chewing and swallowing problems can cause food, liquids, or saliva to get in the lungs. This is called aspiration. Aspiration can cause breathing problems or lung infections, such as pneumonia and bronchitis.
Dysphagia can happen at any age. The symptoms of dysphagia can look different depending on your child's age and their stage of development.
Infants
Infants with dysphagia may have trouble with both bottle and breastfeeding, such as:
- Refusing to feed
- Taking a long time to complete a feeding
- Trouble sucking or swallowing
- Coughing, choking, or gagging
- Showing signs of problems breathing during feedings, such as blue lips, fast breathing, or having a hard time catching their breath
- Eyes watering
- Liquid leaking from the mouth or nose
- Losing weight or not gaining weight
Toddlers and older children
Toddlers and older children with dysphagia often have different symptoms, such as:
- Coughing, choking, or gagging
- Avoiding hard-to-chew or hard-to-swallow foods and textures
- Holding food in their mouth (called pocketing) and not swallowing
- Taking a long time to chew or swallow
- Saying that food feels stuck in their throat or chest
- Pain when swallowing
- Liquid leaking from the mouth or nose
- Changes in their voice during or after eating or drinking
Dysphagia can result from conditions affecting the mouth, throat, or esophagus. It is often related to problems with the nerves and muscles that control swallowing. Common causes include:
- Medical treatments: Surgery, chemotherapy, radiation therapy near the throat, or having a breathing tube can cause swallowing problems.
- Neurological conditions: Problems with the brain, spinal cord, or nerves, such as cerebral palsy, stroke, or brain injury, can affect chewing and swallowing.
- Muscle problems: Muscles in the mouth or throat may be weak or not work correctly.
- Structural problems: Physical differences or problems, such as vocal cord paralysis, a narrowed or blocked esophagus, or a cleft lip or cleft palate (a split or opening in the upper lip or roof of the mouth), can make chewing and swallowing more difficult.
- Developmental delays: Feeding or swallowing skills may develop more slowly.
- Gastroesophageal reflux disease (GERD): Stomach acid can irritate or damage the esophagus.
- Esophageal conditions: Birth defects, nerve problems, or damage from other medical conditions can affect how food moves through the esophagus.
Early help from your child’s care team can improve dysphagia. If your health care provider thinks your child has dysphagia, they will watch how your child eats and drinks or recommend additional testing. Tests for dysphagia include:
- Bedside swallow evaluation: A speech-language pathologist watches your child eat or drink different food items. They look for signs of dysphagia such as coughing, choking, or trouble swallowing. This test helps the care team understand how your child manages food and liquid in a natural setting.
- Modified barium swallow (MBS) study (videofluoroscopic swallow study): This test uses a “live” x-ray to watch how food and liquid move when your child swallows. It shows how food and drinks move from your child’s mouth through the throat and esophagus. Your care team can also see how changes in consistency, texture, feeding position, or the way your child drinks impact swallowing.
Many people work together to help with diagnosis and care. These include:
Your child’s care team works closely with you and your family. They ask about your child’s eating habits and meals at home and include your family in making care plans. This is called a family-centered approach. It helps make sure the child gets the best care that fits their needs.
If your child has dysphagia, the speech-language pathologist will suggest ways to make eating safer and easier.
Tips for mealtimes
- Sit your child in a well-supported, upright position during meals
- Offer small bits of food and small sips of liquid
- Allow plenty of time to chew and swallow before offering more
- Make mealtimes calm with limited distractions
Your child may also benefit from changing how they eat or drink. The speech-language pathologist may suggest using a different cup, straw, bottle, or nipple to support safe swallowing.
Food textures and thickened liquids
Your provider will tell you which texture or thickness level is right for your child. The International Dysphagia Diet Standardization Initiative (IDDSI) provides a clear system to help families and caregivers understand how to modify the texture of foods and thicken liquids.
The IDDSI framework
The IDDSI system uses numbers and colors to describe food and drink textures. The levels range from 0 to 7:
- Level 0 (thin liquid): Thin liquids flow easily through a straw or nipple. This level is used when a person does not have a swallowing problem.
- Level 1 (slightly thick liquid): Slightly thick liquids are a little thicker than water and flow more slowly. They can still flow through a nipple and spout cup. A regular cup can also be used.
- Level 2 (mildly thick liquid): Mildly thick drinks flow more slowly than thin and slightly thick liquids. Drinking from a straw requires effort. A special nipple may be needed. A spout cup or a regular cup can also be used to drink mildly thick liquids.
- Level 3 (moderately thick liquid): Moderately thick drinks are thicker liquids, need some effort to drink, and have a smooth texture. A person can drink moderately thick drinks from a cup or a spoon.
- Level 3 (liquidized food): Liquidized foods are smooth, thick foods that cannot be eaten with a fork. These foods can be eaten with a spoon.
- Level 4 (extremely thick liquid): Extremely thick drinks are very thick liquids that will not flow easily from a cup. These liquids are best taken from a spoon.
- Level 4 (pureed food): Pureed food is smooth, soft food. It does not need to be chewed. It can be eaten with a spoon.
- Level 5 (minced and moist food): Minced and moist food is soft food cut into small pieces that are easy to chew and swallow. This food can be eaten with a spoon, fork, or fingers.
- Level 6 (soft and bite-sized food): Soft and bite-sized food is cut into small, soft pieces that are easy to chew and swallow. This food can be eaten with a fork, spoon, chopsticks, or fingers.
- Level 7 (easy-to-chew food): Easy-to-chew food is soft, tender food cut into pieces that are easy to chew and swallow. These foods can be eaten with a fork, spoon, chopsticks, or fingers.
- Level 7 (regular food): Regular food is everyday food.
Find printable handouts for each level from IDDSI.
Follow-up care for dysphagia
Every child is different. The best plan for your child is the one you make with your care team. Safe eating and drinking can help your child enjoy meals and stay healthy.
Questions to ask your care team
