Swallowing difficulty (dysphagia) in children

Dysphagia refers to difficulties with swallowing, eating and/or drinking, and can affect children of all ages. Children with swallowing difficulties may find it hard to eat and drink safely. They are also at an increased risk of medical complications such as aspiration pneumonia (chest infections).

Common causes

Swallowing difficulties can occur for a variety of reasons including:

• complex medical conditions
• neurological or respiratory conditions
• premature birth/very low birth weight
• ear, nose and throat (ENT) issues
• pain and swelling of the mouth, tongue, jaw and throat due to treatment or surgery.
• side effect of medication.

Signs and symptoms

Signs and symptoms of dysphagia can include:

• coughing, choking or gaging when swallowing
• food coming back up (regurgitation).
• refusal to eat certain food textures
• weight loss
• watery or teary eyes
• nasal congestion
• change in colour (e.g., turning blue around lips)
• wet/gurgly breathing or wet/gurgly voice
• rapid or increased breathing rate
• wheezing
• apnoea (longer than normal pauses in breathing)
• recurrent chest infections/illness.

Complications of dysphagia

Swallowing difficulties can lead to:

• aspiration (see below)
• chronic lung disease
• dehydration
• aspiration pneumonia (chest infections)
• poor weight gain/malnutrition
• oral aversion (reluctance/avoidance/refusal to eat/drink).

Aspiration

Aspiration is when food, drink or other material enters the trachea (airway) and passes below the level of the vocal cords (towards the lungs).  There are two different types of aspiration:

• primary aspiration: aspiration of saliva, food or drink
• secondary aspiration: aspiration of reflux or vomit.

Aspiration can be ‘silent’. This means that a child does not show any overt signs of swallowing difficulty e.g. coughing, choking, throat clearing.

Diagnosis

Dysphagia is usually diagnosed after a consultation and examination by your child’s doctor or other health professional. Your child may also be referred for tests such as a videofluoroscopic swallow study (also called a modified barium swallow test).

Treatment

Treatment for dysphagia depends on the type or cause of your child’s swallowing disorder.

Treatment can sometimes include:

• dietary changes (changing the textures of foods or drinks)
• learning new swallowing techniques
• exercises to help swallowing muscles work better
• medication
• surgery (in severe cases).

A range of health professionals can help with dysphagia, including doctors, speech pathologists, occupational therapists, physiotherapists, dietitians, and lactation consultants.

When to seek help

See your GP or other healthcare professional if your child regularly has difficulty swallowing or if weight loss, regurgitation or vomiting happens with their dysphagia.

If you think your child is unable to swallow because food is stuck in their throat or chest, go to the nearest emergency department.

If a blockage makes it hard to breathe, call Triple Zero (000) and ask for an ambulance.

Developed by Speech Pathology Department, Queensland Children’s Hospital.  We acknowledge the input of consumers and carers.

Resource No: FS326.  Reviewed: October 2023

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.