Dysphagia (swallowing disorders) in children
Swallowing disorders in children, known in medical terms as dysphagia, are more common than most people realize—affecting approximately 1% of the population. The spectrum of dysphagia is broad, ranging from mild discomfort or pain during swallowing to complete refusal to eat, or episodes where food becomes lodged in the esophagus.
In many cases, parents recall signs of swallowing difficulties beginning in infancy—for example, when solids were first introduced, or when the child experienced coughing fits shortly after feeding. In other instances, dysphagia may not become apparent until later in childhood, sometimes presenting suddenly in the emergency department due to food getting stuck in the esophagus.
Because swallowing difficulties in children can stem from a variety of causes, they always require thorough medical evaluation.
The following post on dysphagia was written by a leading expert in the field, senior pediatric gastroenterologist
Dr. Lev Dorfman.
What are the main groups of dysphagias (swallowing disorders) in children?
These can be divided into two main groups:
The first group – pharyngeal dysphagia
This type of swallowing disorder originates in the oral cavity or from an abnormal swallowing technique. Children may struggle to chew food effectively, have difficulty swallowing, or present with drooling. Diagnosis is made using X-ray swallowing studies that assess oral and pharyngeal coordination. Treatment typically involves occupational and speech therapists to strengthen chewing and swallowing muscles, and dietary adjustment of food consistency to prevent aspiration into the airway.
The second group – esophageal dysphagia
This disorder originates from abnormal esophageal contractions. The esophagus, composed of two types of muscles, relies on synchronized waves (peristalsis) to move food to the stomach. Main causes include:
Structural disorder – Congenital or acquired strictures can narrow the esophageal lumen. Complaints often involve difficulty swallowing solids.
Reflux disease – Stomach acid irritates the esophagus, causing inflammation, ulcers, and possible scarring. Reflux is managed with antacids, lifestyle changes, and in some cases dilation of strictures via gastroscopy.
Eosinophilic esophagitis – An allergic inflammation characterized by eosinophil accumulation. Untreated, it leads to motility issues, structural changes, and scarring. Early diagnosis is crucial, and a future dedicated chapter will address this condition.
Motility disorders – These occur without structural or inflammatory abnormalities, but the esophagus does not contract properly. Conditions range from weak peristalsis to disorders of sphincter function like achalasia.
What is the workup required for children with a swallowing disorder?
Workup is typically carried out in three stages:
1. Structural assessment – A contrast swallow X-ray series examines the esophageal anatomy, identifies strictures or dilation, and provides insight into sphincter function.
2. Mucosal assessment – Gastroscopy allows direct visualization and biopsy of the esophageal lining to detect inflammation or allergic conditions.
3. Functional assessment – Esophageal manometry measures pressure patterns and sphincter activity during swallowing. It’s the gold standard for esophageal motility evaluation. A newer technique, EndoFLIP, used during gastroscopy, assesses strictures and their distensibility in specialized centers.
The importance of early detection of dysphagia in children
Early detection relieves daily suffering and prevents long-term complications.
In pharyngeal dysphagia, the greatest risk is aspiration—food entering the lungs—leading to pneumonia, chronic lung damage, or recurrent infections.
In esophageal dysphagia, complications include:
1. Aspiration – Similar mechanism to above.
2. Food impaction – Ranging from mild (relieved by repositioning and fluids) to severe cases requiring emergency endoscopic removal.
3. Structural damage – Chronic inflammation (in reflux or eosinophilic conditions) may lead to scarring and strictures. Even after dilation, motility may remain impaired.
How can swallowing disorders be treated in children?
Treatment begins with identifying the underlying cause:
Pharyngeal issues: Managed with speech and occupational therapy.
Anatomical issues: Strictures treated with endoscopic dilation; complex cases may require surgery.
Inflammatory issues: Reflux treated with antacids, dietary modifications, and sometimes surgery. Eosinophilic esophagitis is managed with dietary elimination or topical/systemic medications.
Motility disorders: Lifestyle changes and pro-motility medications; achalasia may require endoscopic dilation or surgical intervention (laparoscopic or endoscopic myotomy).
In summary, swallowing disorders in children always warrant comprehensive evaluation—structural, mucosal, and functional—to avoid serious complications. Tailored treatment depending on the underlying cause generally leads to significant symptom relief and favorable outcomes.
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