PE3334 Difficulty Swallowing (Dysphagia)

Home , Epiglottis, Esophageal dysphagia, Laryngeal cleft, Throat

This handout talks about problems your child has in the throat (pharynx) when they swallow, how we diagnose it and how we treat it.

What is dysphagia? Dysphagia means difficulty swallowing. Food and drink can get stuck (dis-FAY-je-ya) in the esophagus or “go down the wrong pipe” to the lungs (called aspiration) instead of the stomach. It can also go into the voice box but not all the way into the lungs (called penetration).

Epiglottis up for breathing

Mouth Throat Liquid in throat (oral (pharyngeal cavity) space) Epiglottis down for eating and drinking

Windpipe Liquid in Swallowing tube (Airway or airway (Esophagus) Trachea)

Where does dysphagia Difficulty swallowing can happen in 3 places: in the mouth (oral happen? dysphagia), in the throat (pharyngeal dysphagia), and in the swallowing tube (esophageal dysphagia). This handout focuses on pharyngeal dysphagia.

Why is pharyngeal When swallowing doesn’t happen the right way in the throat, it can dysphagia a problem? lead to liquid or food getting into the lungs (penetration and aspiration).

What are the Food and drink going down the windpipe can damage the lungs. consequences of Some examples of damage are: getting liquid or food • Frequent or long-lasting colds or lung infections into the lungs • Frequent wheezing, coughing, or asthma symptoms (aspiration)? • Difficulty with feeding and growth • In the long-term, this can result in permanent damage to the lungs

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To Learn More Free Interpreter Services • Otolaryngology • In the hospital, ask your nurse. 206-987-2105 • From outside the hospital, call the • Ask your child’s healthcare provider toll-free Family Interpreting Line, 1-866-583-1527. Tell the interpreter • seattlechildrens.org the name or extension you need.

Difficulty Swallowing (Dysphagia)

What causes pharyngeal dysphagia?

Things that happen while When a baby is: your baby is growing • Born before they are due (premature) (development) • Exposed to certain drugs like alcohol, marijuana, cocaine, etc. before birth (intrauterine drug exposure)

The way your child’s body is • The vocal cords don’t move the way they should. built (structure) • There is a hole between the windpipe and the swallowing tube (tracheo-esophageal fistula). • The throat has a gap between the voice box (larynx) and the swallowing tube that shouldn’t be there (laryngeal cleft).

Vocal cord Vocal cord

Laryngeal cleft

Example of larynx, Example of laryngeal cleft no laryngeal cleft

The way your child feels Possible causes of sensory problems include: things in their throat • The way your child developed before birth (genetic or congenital (sensation) problems) • Swelling or inflammation in the throat or voice box (infections, allergies, acid reflux) • When your child is not breathing well during feeding resulting in aspiration

The way your child’s brain • A brain deformity that affects the muscles that control swallowing and nerves work (neurology) called a Chiari (KEY-are-ee) malformation • Conditions with low muscle tone

How is it diagnosed? To help us diagnose, we look at how your child swallows using some or all of these methods: • Clinical feeding evaluation • X-rays to look at the throat (videofluoroscopic swallow study or VFSS) • Camera and light to look inside the throat (flexible endoscopic evaluation of swallowing or FEES) • X-rays that look inside the body at the esophagus (esophagram)

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Are there any other We may do any of these: tests needed? • Use X-rays, CT scan or MRI (imaging) to look inside the chest, brain, etc. • Test your child’s blood • Look for problems in the throat, lungs, and esophagus with cameras (endoscopes) under anesthesia and bulk up the area where laryngeal clefts occur to see if this can help (diagnostic injection augmentation)

How is it managed? • We may ask you to observe how your child eats and drinks at home over time before we treat them (watchful waiting). We want to see if it improves on its own first. • We may make changes in how your child drinks, for example using a different cup, using a straw, etc. • Add thickeners to drinks like Simply Thick or Thick-It. • Work with a therapist in-clinic to practice feeding, drinking, and swallowing. • We may use medications or inhalers to prevent long term damage to the lungs or the rest of the body • For severe cases, we may place a feeding tube in your child to bypass the mouth. An NG-tube (non-gastric) goes in the nose and a G-tube (gastrostomy) goes through the belly. • We might do surgeries to help the structural problems like vocal cord injections or building up the area where a laryngeal cleft occurs (a laryngeal cleft repair or suture augmentation).

Summary This is a complicated problem that usually requires follow-up for months and often years. Your regular doctor may manage this problem with help from specialists. We also have an Aerodigestive Program at Seattle Children’s, which includes different specialists who work together to treat this problem.

Where can I get more Learn more by visiting the Aerodigestive Program webpage at: information? seattlechildrens.org/clinics/aerodigestive-program

Seattle Children’s offers interpreter services for Deaf, hard of hearing or non-English speaking patients, family members and legal representatives free of charge. Seattle Children’s will make this information available in alternate formats upon request. Call the 5/21 Family Resource Center at 206-987-2201. This handout has been reviewed by clinical staff at Seattle Children’s. However, your child’s PE3334 needs are unique. Before you act or rely upon this information, please talk with your child’s healthcare provider.

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