Pediatric Dysphagia

Disruptions in swallowing may occur in any or all of the phases of swallowing—oral preparatory, oral transit, pharyngeal, and esophageal. Signs and symptoms vary based on the phase(s) affected and the child’s age and developmental level. They may include the following:

  • Back arching.
  • Breathing difficulties when feeding that might be signaled by
    • increased respiratory rate;
    • changes in normal heart rate (bradycardia or tachycardia);
    • skin color change such as turning blue around the lips, nose and fingers/toes (cyanosis);
    • temporary cessation of breathing (apnea);
    • frequent stopping due to uncoordinated suck-swallow-breathe pattern; and
    • desaturation (decreasing oxygen saturation levels).
  • Coughing and/or choking during or after swallowing.
  • Crying during mealtimes.
  • Decreased responsiveness during feeding.
  • Difficulty chewing foods that are texturally appropriate for age (may spit out or swallow partially chewed food).
  • Difficulty initiating swallowing.
  • Difficulty managing secretions (including non-teething-related drooling of saliva).
  • Disengagement/refusal shown by facial grimacing, facial flushing, finger splaying, or head turning away from food source.
  • Frequent congestion, particularly after meals.
  • Frequent respiratory illnesses.
  • Gagging.
  • Loss of food/liquid from the mouth when eating.
  • Noisy or wet vocal quality during and after eating.
  • Taking longer to finish meals or snacks (longer than 30 minutes).
  • Refusing foods of certain textures or types.
  • Taking only small amounts of food, overpacking the mouth, and/or pocketing foods.
  • Vomiting (more than typical “spit-up” for infants).

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