Feeding & Swallowing Disorders
When children have difficulty eating or drinking, they may have a swallowing or feeding disorder.
Feeding disorders is a term used to describe developmental feeding problems, such as difficulty in breastfeeding or feeding from a bottle. As children grow older, there may be problems chewing food, eating from a spoon, or drinking from a cup. Children also may refuse to eat certain types of foods or experience pain while eating.
Swallowing disorders, also called dysphagia, occur when children (or adults) have trouble during the swallowing process with either food or liquids, or both. Gastroenterologists generally categorize swallowing disorders based upon where they occur: In the mouth (oral); in the throat or pharynx (the tube that runs from the back of the nose to the neck); or in the esophagus (tube that goes from the mouth to the stomach). Feeding aversion is when your child can physically eat but exhibits partial or full feeding refusal.
These disorders may result in weight loss and nutritional deficiencies and may require nutritional supplements or other interventions. Other serious problems include breathing problems, aspiration (food going into the airway), pneumonia or other lung infections, and failure to thrive.
Symptoms
Consult with a doctor if your child:
- Cries or fusses during feeding
- Stiffens or arches the back while feeding
- Has problems chewing, eating, or breast-feeding
- Has difficulty breathing while eating or drinking
- Gags or coughs whenever eating
- Spits up or vomits repeatedly during or after feedings
- Refuses to eat or drink
- Is extremely picky about food (consistency, texture, color, size, etc.)
- Has poor weight gain
Causes
A wide range of illnesses or disorders can impact a child’s ability to feed or swallow. These include:
Achalasia is rare, affecting the esophagus, the passageway from the throat to the stomach. It is characterized by the failure of the lower muscle in the esophagus to contract and then relax to move food down the digestive tract. Once diagnosed, achalasia can be treated with medications in most cases. Another highly effective treatment option is balloon dilation to increase the size of the lower esophageal sphincter muscle. This procedure may have to be repeated as a child grows older. When necessary, surgery to release the tight muscle fibers is warranted.
Eosinophilic esophagitis (EoE) is a chronic, allergic inflammatory disease of the esophagus. The inflammation damages the esophagus, making it hard to eat and swallow. Children may complain of abdominal pain and vomit or refuse to eat. If the inflammation is severe, it may cause a narrowing of the esophagus and lead to an emergency because food can get stuck within the esophagus. EoE is a rare disease, with children often having additional food or environmental allergies. There is a potential inherited risk for this disease, although it usually appears to be caused by a large immune response to specific foods. Treatment can be diet modifications, specialized nutrition supplements, medications, or surgery.
Oral aversion is when your child does not want anything touching their mouth. This condition, common with many premature babies, can cause a persistent gag reflex when eating and result in a refusal to eat or drink. That can lead to dangerous complications such as malnutrition or stunted growth, or failure to thrive. Sometimes, oral aversion occurs when a baby or child has had a previous choking incident. It also can be caused by GERD, or congenital anomalies within the digestive tract. Tube feeding also can cause oral aversion.
Treatment options
Treatment for mild feeding and swallowing difficulties could be as simple as changing your child’s position while eating or breastfeeding or adjusting the temperature of the food to encourage your child to eat more. Doctors also may prescribe therapy to strengthen the muscles in the mouth and throat. Sensory or behavioral issues also can be addressed with therapy.
- Gastroesophageal reflux disease (GERD)
- Eosinophilic esophagitis (EoE)
- Cleft lip, cleft palate or other structural anomalies in mouth or throat
- Neurologic, cardiac, or pulmonary issues
- Vocal cord paralysis
- Autism
- Asthma or other breathing problems
- Gut injuries
- Oral motor delays
- Sensory issues
- Behavior issues
Dedicated Feeding and Swallowing Team
At SSM Health Cardinal Glennon Children’s Hospital, we have an interdisciplinary Pediatric Feeding Team. The team includes:
- Occupational therapist
- Registered dietitian
- Pediatric psychologist
Gastroenterologists and surgeons are consulted as needed. The team is dedicated to diagnosing and treating the full continuum of feeding and swallowing disorders. Learn more about Pediatric Feeding Services at SSM Health Cardinal Glennon Children’s Hospital.
We also have a dedicated Pediatric Neuro-Gastroenterology and Motility Center, which is one of the few dedicated centers in the country focused on the diagnosis and treatment of pediatric dysphagia as well as other childhood motility disorders.