Dysphagia
Dysphagia is a term that means "difficulty swallowing." It is the inability
of food or liquids to pass easily from the mouth, into the throat, and down into
the esophagus to the stomach during the process of swallowing.
What causes dysphagia?
To understand dysphagia, we must first understand how we swallow. Swallowing
involves three stages. These three stages are controlled by nerves that connect
the digestive tract to the brain.
- Oral preparation stage
Food is chewed and moistened by saliva. The
tongue pushes food and liquids to the back of the mouth towards the throat.
(This phase is voluntary: we have control over chewing and beginning to
swallow.)
- Pharyngeal stage
Food enters the pharynx (throat). A flap called the
epiglottis closes off the passage to the windpipe so food cannot get into the
lungs. The muscles in the throat relax. Food and liquid are quickly passed
down the pharynx (throat) into the esophagus. The epiglottis opens again so we
can breathe. (This phase starts under voluntary control, but then becomes an
involuntary phase that we cannot consciously control.)
- Esophageal stage
Liquids fall through the esophagus into the stomach by
gravity. Muscles in the esophagus push food toward the stomach in wave-like
movements known as peristalsis. A muscular band between the end of the
esophagus and the upper portion of the esophagus (known as the lower
esophageal sphincter) relaxes in response to swallowing, allowing food and
liquids to enter the stomach. (The events in this phase are involuntary.)
Swallowing disorders occur when one or more of these stages fails to take
place properly. Children's health problems that can affect swallowing include:
- Cleft lip or cleft palate
- Dental problems (teeth that do not meet properly, such as with an
overbite)
- Large tongue
- Diseases that affect the nerves and muscles, such as a stroke, tumor,
nerve injury, brain injury, or muscular dystrophy, and can cause paralysis or
poor function of the tongue or the muscles in the throat and esophagus
- Large tonsils
- Tumors or masses in the throat
- Problems with the prenatal development of the bones of the skull and the
structures in the mouth and throat (known as craniofacial anomalies)
- Prenatal malformations of the digestive tract, such as esophageal atresia
or tracheoesophageal fistula
- Oral sensitivity that can occur in very ill children who have been on a
ventilator for a prolonged period of time · irritation of the vocal cords
after being on a ventilator for long periods of time (as may occur with
premature babies or very ill children)
- Paralysis of the vocal cords
- Having a tracheostomy (artificial opening in the throat for breathing)
- Irritation or scarring of the esophagus or vocal cords by acid in
gastroesophageal reflux disease (GERD)
- Compression of the esophagus by other body parts, such as the heart,
thyroid gland, blood vessels, or lymph nodes
- Foreign bodies in the esophagus, such as a swallowed coin · developmental
delays
- Prematurity