In layman's terms, swallowing is thought of to be a fairly simple and uncomplicated process. Contrary to this belief, swallowing is a very complex process, involving almost 50 pairs of muscles and nerves. You would be surprised to believe that there are actually three phases involved in the swallowing process. When one finds difficulty in swallowing, there is probably something wrong in the execution of one of these phases. This condition is called 'dysphagia'. This is a common problem in children.
Swallowing: The Three Phases
Oral preparatory and transport phase: It is a voluntary phase, carried out by the muscles in the mouth. This includes opening and closing the mouth, mastication (chewing), and mixing the food with saliva. This entire process is aimed at forming a bolus of an appropriate size. A bolus, in literal terms, is a round ball of chewed food mixed with saliva.
Pharyngeal phase: This phase starts when the bolus enters the throat. The epiglottis (a flap present in the throat), together with a temporary suppression in breathing, blocks the larynx (voice box), thus preventing the bolus from entering the lungs. The bolus passes into the esophagus or the 'food pipe' and after which the windpipe opens. The beginning of this phase (when the bolus enters the throat) is voluntary. However, the phase ends with an involuntary action of the bolus entering the esophagus.
Esophageal phase: The bolus moves further down the esophagus, to the stomach.
For children suffering from dysphagia (difficulty in swallowing), one or more than one of the above phases fail, resulting in swallowing problems.
Causes of Dysphagia in Children
Damage to any of the organs, muscles, or nerves involved in the swallowing process leads to dysphagia. Some of the causes are listed below:
Damage to brain and/or nervous system: Nervous system disorders like, stroke, Parkinson's disease, cerebral palsy, motor neurone disease, and multiple sclerosis may cause dysphagia, if any nerve involved in the swallowing process is affected.
Structural problems: Narrow esophagus, large tongue, cleft lip, large tonsils and dental problems are some structural disorders that make chewing or swallowing of food difficult, thereby leading to dysphagia.
Every child suffering from dysphagia may show different symptoms. The following are some of the symptoms that are observed:
- Feeding difficulties: Babies suffering from dysphagia are unable to coordinate sucking and swallowing breast- or bottle-milk. They may arch their bodies, while feeding.
- Taking a long time to eat.
- Drooling, vomiting, and/or coughing, frequent sneezing after eating or difficulty in chewing food.
- Unable to coordinate breathing with eating and/or drinking.
- Change in voice before or after eating.
- Weight loss
In the diagnosis of dysphagia in children, the doctor will examine the child and his medical history. Eating habits of the child will help in the diagnosis of the disease. Following are some tests that the doctor may perform:
Oral-pharyngeal video swallow: The child is fed any liquid/solid food that contains barium. Barium, a non-toxic element, is used as it visible on X-rays. The X-ray helps to examine what exactly happens when the child swallows food.
Barium swallow/upper GI series: The child is given a liquid containing barium, and X-rays are taken. Any problems in mouth, esophagus, or stomach are noted. This test helps to know the exact cause of the swallowing problem.
Endoscopy: The child is given anesthesia, and an endoscope is inserted in the digestive track. An endoscope is a flexible pipe with a light and a camera at the inserted end. Images of the mouth, esophagus and stomach are taken to locate the problem.
Esophageal manometry and laryngoscopy are some other tests that can be performed to diagnose dysphagia in small children.
Dysphagia in children can be treated but the treatment will differ for every child. Age, health, medical history of the child are factors that are considered, while giving the treatment. The severity of the disease is also an important factor. Speech and occupational therapies are some of the treatments given to such children. These include exercises that help in swallowing. Some children may be hospitalized, if the condition is severe.
Dysphagia in children gives rise to other health problems. If the form of the disease is severe, it needs urgent treatment. If he/she is suffering from dysphagia, consult a pediatrician at the earliest.