Dysphagia

Speech and language therapists also support eating, drinking and swallowing needs for babies and children. Difficulties with eating, drinking and swallowing is called dysphagia.

What is dysphagia

Dysphagia, is the medical name for eating, drinking and swallowing difficulties. This type of difficulty usually occurs due to an underlying condition such as being born prematurely, developmental delay, cerebral palsy, Down's syndrome, head injury, learning disabilities etc or may even be as a result if another medical issue such as reflux.

Swallowing can be difficult because the muscles used for chewing and swallowing (lips, jaw, tongue, palate and throat muscles) can be weak or poorly coordinated or they may not have developed mature patterns of movement.

What can go wrong?

Children with difficulties eating, drinking and swallowing may find it difficult to prepare the food in the mouth before swallowing.  They may not be able to chew effectively or they may present with food or drink  'going down the wrong way' down the windpipe and into the lungs instead of the stomach (known as aspiration).  Some people with dysphagia will only have problems swallowing certain types of food or drink, others cannot swallow anything at all.

The symptoms of dysphagia

  • Difficulties chewing or preparing food in the mouth.
  • Difficulties developing more mature eating and drinking skills.
  • Difficulties with bottle or breast feeding skills.
  • Coughing or choking when eating or drinking.
  • Recurrent chest infections.
  • Food or drink coming out of the nose.
  • Feeling that food or drink has ‘gone down the wrong way’.
  • Voice sounding gurgly, bubbly or wet after eating or drinking.
  • Feeling that food is stuck in your throat or chest.
  • Runny nose or eyes during or immediately after meals.
  • Food or drink coming out of your mouth.
  • Pouching of food in the cheeks.
  • Eating slower than usual or avoiding eating/drinking.
  • Leftover food in the mouth after swallowing.
  • Pain or discomfort when swallowing.
  • Unexplained weight loss.

Top tips for safer swallowing

Ensure the child is fully alert before offering food or drink.

Follow all recommendations made by your speech and language therapist and dietitian.

Ensure the child remains upright for at least 30 minutes after eating and drinking.

Make sure children are sitting in an upright position for meals and drinks. A reclined position when eating or drinking can make swallowing difficult and unsafe.

Reduce distractions as much as possible while eating or drinking.

Encourage small bites or sips of food and drink - large mouthfuls can be difficult to swallow.

Pause between mouthfuls, making sure the mouth is clear before offering another bite or sip.

If you notice fatigue during meal times, it may be easier to have smaller meals/smacks more frequently.

If chewing is becoming effortful or difficult then offer foods that are soft and require minimal chewing until further advice has been offered by speech and language therapy.

What is the speech and language therapist's role with swallowing difficulties

Speech and language therapists are trained in assessing and managing difficulties swallowing.  They are able to assess the level of risk of aspiration and choking and make recommendations and treatments plans to help maintain safety when swallowing.

If there are concerns about weight loss, nutrition and hydration requirements, reflex issues or tube feeding queries then a referral to a dietitian would be needed.

International Dysphagia Diet Standardisation Initiative (IDDSI)

Following assessment by a speech and language therapist, some children may be recommended certain drinks and textures of food to ensure safety when swallowing.

IDDSI is a global framework using common terminology to describe food textures and drink thickness.

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For more information go to the IDDSI website.

Eating and drinking