Feeding Issues

Dysphagia

Dysphagia is a functional or anatomical disorder in the well-coordinated act of swallowing. Dysphagia can arise from problems with the mouth, throat, and esophagus or the coordination among all 3.  

The development of an ability to swallow follows a typical progression. 

• The sucking reflex, present as early as 18 weeks’ gestation, becomes organized and efficient by 34 to 36 weeks’ gestation.
• A rapid suck rate and higher suck pressure develops during early infancy.
• Tongue movements become differentiated and more coordinated by 5 to 6 months of age to accommodate solid food.
• In late infancy and continuing into the first and second year, oral motor skills expand and gag reflex decreases to allow swallowing of an increasing amount of food textures. 

Symptoms of dysphagia in newborns and infants include 

• Gulping
• Oral spillage
• Impaired suck, swallow, and breathe coordination
• Spitting up
• Vomiting
• Prolonged feeding time
• Pulling off the nipple
• Coughing
• Choking
• Nasopharyngeal reflux
• Arching during feeding
• Aerophagia
• Feeding refusal
• Congestion during feedings
• Apnea spells causing cyanosis during feeding 

Managing dysphagia focuses on meeting the newborn’s or infant’s nutritional needs and reducing aspiration risk. 

• Consider referring to an ear, nose, and throat specialist and speech-language therapist for evaluation of fiberoptic endoscopic evaluation of swallowing. 
• If a newborn or infant is unable to achieve growth targets, supplemental feedings through a nasogastric tube may be necessary.
• If dysphagia continues beyond the age at which typical oral-motor reflexes develop, and if accompanied by growth delay or weight loss, consider referring to a pediatric dysphagia center for further evaluation. 

Dysphagia is associated with other conditions including 

• Gastroesophageal reflux disease
• Eosinophilic esophagitis 
• Chronic lung disease
• Anatomical abnormalities
• Neurological abnormalities 

Note: A multidisciplinary approach (with case studies) to evaluating infants with dysphagia symptoms is available in webinar format from the AAP, with presentation materials. 

Gastroesophageal Reflux Disease

A review of gastroesophageal reflux and gastroesophageal reflux disease from the AAP is available here.  

A review of the treatment of GER and GERD is available from this Pediatrics in Review article.