Swallowing / Dysphagia

Disclaimer: This information sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

What is it?

Swallowing is a complex coordinated function involving many nerves and muscles in the mouth, neck and oesophagus (tube to the stomach). Swallowing function can be affected by disease, trauma (eg. brain injury) and strokes. Dysphagia refers to a disorder when a person's ability to control food and liquids is compromised and they are unable to swallow safely or in a coordinated manner. Dysphagia can often lead to significant discomfort, dehydration, malnutrition, choking or swallowing foods and liquids into the lungs (aspiration), causing pneumonia.

Dysphagia is fairly common following an acquired brain injury however most children recover full swallowing function after the acute stage of recovery. In some cases, children may require on going swallowing management and may require such things as, specific food and drink textures, specific positioning and at times tube feeding (refer to tube feeding for further details).

What are the symptoms?

There are various symptoms that may suggest that a child is having difficulty swallowing, these include:

• complaining that food is getting stuck in their throats
• coughing or gagging either during or directly after a meal
• a wet or gurgly voice after eating or drinking
• food remaining in the mouth after a meal (generally in the cheek pocket)
• food escaping from the mouth during eating or drinking
• refusal or fear of certain foods and food textures
• reduced intake
• difficulty drinking water
• lack of awareness of food in the mouth eg. over stuffing
• recurrent chest infections in the absence of a cold or flu

Who do I see and how is it diagnosed?

A Speech Pathologist will be able to diagnose whether a child is experiencing difficulties with their swallowing. A general clinical swallowing assessment is conducted examining the muscles and nerves that are used for swallowing. The child will be observed eating and drinking a variety of foods and drinks.

If further investigation is required, the Speech Pathologist may recommend a Modified Barium Swallow (MBS). An MBS is a video recorded X-ray examination of a person swallowing. A Speech Pathologist or Doctor will make the referral to Radiology if an MBS procedure is considered necessary.

The clinical examination and/or MBS will allow the speech pathologist to diagnose the type and severity of the swallowing disorder.

Treatment

Following a diagnosis, the Speech Pathologist may recommend a variety of treatment options.

• food and liquid texture modifications eg. puree or thickened fluids
• body and seating position
• head and neck positioning eg. chin tuck, head tilting to one side
• oral exercises to strengthen weak muscles
• desensitisation exercises
• In severe cases, tube feeding may be recommended.

Remember

• Always consult your Speech Pathologist or Doctor if you have any concerns about your child's swallowing.

Rehabilitation Department The Children's Hospital at Westmead Cnr Hawkesbury Rd & Hainsworth St, Westmead Locked Bag 4001, Westmead, 2145 Tel: (02) 9845 2132 - Fax: (02) 9845 0685 http://www.chw.edu.au/rehabilitation/