Dysphagia and Swallowing Disorders
From Holoprosencephaly
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Dysphagia or swallowing disorder
People with dysphagia have difficulty swallowing and may also experience pain while swallowing. Some people may be completely unable to swallow or may have trouble swallowing liquids, foods, or saliva. Eating then becomes a challenge. Often, dysphagia makes it difficult to take in enough calories and fluids to nourish the body.
Dysphagia occurs when there is a problem with any part of the swallowing process. Weak tongue or cheek muscles may make it hard to move food around in the mouth for chewing. Food pieces that are too large for swallowing may enter the throat and block the passage of air.
Other problems include not being able to start the swallowing reflex (a stimulus that allows food and liquids to move safely through the pharynx) because of a stroke or other nervous system disorder. People with these kinds of problems are unable to begin the muscle movements that allow food to move from the mouth to the stomach. Another difficulty can occur when weak throat muscles cannot move all of the food toward the stomach. Bits of food can fall or be pulled into the windpipe (trachea), which may result in lung infection.
Some causes of feeding and swallowing problems in children are:
- nervous system disorders (cerebral palsy, meningitis, encephalopathy)
- gastrointestinal conditions
- prematurity/low birth weight
- heart disease
- cleft lip or palate
- conditions affecting the airway
Signs and symptoms of feeding and swallowing problems in very young children may include:
- arching or stiffening of the body during feeding
- irritability or lack of alertness during feeding
- failure to accept different textures of food
- prolonged feeding times (more than 30 minutes)
General signs may include:
- excessive drooling or leaking food/liquid from the mouth
- gurgly, hoarse, or breathy voice quality
- coughing or gagging during meals
- recurring pneumonia or respiratory infections
- difficulty coordinating breathing with eating or drinking
- frequent spitting up
- less than normal weight gain or growth
Problems
Dysphagia can be serious. Someone who cannot swallow well may not be able to eat enough of the right foods to stay healthy or maintain an ideal weight.
Sometimes, when foods or liquids enter the windpipe of a person who has dysphagia, coughing or throat clearing cannot remove it. Food or liquid that stays in the windpipe may enter the lungs and create a chance for harmful bacteria to grow. A serious infection (aspiration pneumonia) can result.
Swallowing disorders may also include the development of a pocket outside the esophagus caused by weakness in the esophageal wall. This abnormal pocket traps some food being swallowed. While lying down or sleeping, a person with this problem may draw undigested food into the pharynx. The esophagus may be too narrow, causing food to stick. This food may prevent other food or even liquids from entering the stomach.
Treatment
There are different treatments for various types of dysphagia. First, doctors and speech-language pathologists who test for and treat swallowing disorders use a variety of tests that allow them to look at the parts of the swallowing mechanism. One test, called a fiber optic laryngoscopy, allows the doctor to look down the throat with a lighted tube. Other tests, including video fluoroscopy, which takes videotapes of a patient swallowing, and ultrasound, which produces images of internal body organs, can painlessly take pictures of various stages of swallowing. Once the cause of the dysphagia is found, surgery or medication may help. If treating the cause of the dysphagia does not help, the doctor may have the patient see a speech-language pathologist who is trained in testing and treating swallowing disorders. The speech-language pathologist will test the person's ability to eat and drink and may teach the person new ways to swallow.
Treatment may involve muscle exercises to strengthen weak facial muscles or to improve coordination. For others, treatment may involve learning to eat in a special way. For example, some people may have to eat with their head turned to one side or looking straight ahead. Preparing food in a certain way or avoiding certain foods may help other people. For instance, those who cannot swallow liquids may need to add special thickeners to their drinks. Other people may have to avoid hot or cold foods or drinks.
For some, however, consuming foods and liquids by mouth may no longer be possible. These individuals must use other methods to nourish their bodies. Usually this involves a feeding system, such as a feeding tube, that bypasses the part of the swallowing mechanism that is not working normally. See also: Feeding Tubes
Sources: http://www.nidcd.nih.gov/health/voice/dysph.asp http://www.asha.org/public/speech/swallowing/Swallowing-Disorders-in-Children.htm
Resources: American Speech-Language-Hearing Association (ASHA)-http://www.asha.org American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)- http://www.entnet.org
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