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Dysphagia
A Hard Problem to Swallow
By Mary Dixon Weidler
"When food enters the mouth, a person uses his tongue, jaw and teeth to form the food into a ball," says Julie Reville, a speech language pathologist and clinical instructor at the University of Vermont. "The ball, clinically known as a bolus, is transferred backwards by the tongue into the posterior oral cavity. When this is done successfully, swallowing results."
In a patient with dysphagia, the swallow is defective. "The epiglottis usually covers the trachea and doesn't allow food into the airway," says Reville, who worked with pediatric dysphagia patients for more than eight years. "When the swallow is defective, the epiglottis doesn't do its job, and the bolus is mishandled." The result of such mishandling could be serious. "If food is misdirected, choking occurs," she says.
Another great danger of dysphagia in youngsters is also one of its best indicators. "Many of these children end up with recurring pneumonia," says Dr. Diane Barsky, medical director of the Pediatric Center for Dysphagia and Feeding Management at the Children's Seashore House of the Children's Hospital of Philadelphia. There are, however, less frightening symptoms of dysphagia, including changes in vocal quality, fussy feeding patterns, decreased alertness, reddened or watery eyes and a lowered or increased breathing rate while eating.
Justas there are numerous manifestations of dysphagia, its causes are also many. "You often see dysphagia in premature babies, who will develop very irregular suck patterns while nursing," Reville says.
For toddlers, older children and adults, the reasons for dysphagia could be as serious as a stroke or as correctable as a cleft palate. "Sometimes it's due to a structural problem, like a cleft palate, although it's more likely to be a dysfunction of the nerves that control swallowing," Reville says. "It can also be caused by neurological insult, inappropriate brain development, stroke, hemorrhage or damage to the muscles involved in swallowing. It could be that there's nothing really wrong with the child, but they do not like the feel of food in their mouth. Often this happens to young children who are tube-fed for a long period of time. They don't like the texture of food because they don't understand how to eat it."
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