Font Size: A | A
Dysphagia

Dysphagia 101

What are feeding and swallowing disorders (dysphagia)?
Feeding disorders include problems gathering food and getting ready to suck, chew, or swallow it.

Swallowing disorders, also called Dysphagia pronounced “dis-fay-juh” can occur at different stages in the swallowing process:
Oral phase: sucking, chewing, and moving food or liquid into the throat

Pharyngeal phase: starting the swallowing reflex, squeezing food down the throat, and closing off the airway to prevent food or liquid from entering the airway (aspiration) or to prevent choking

Esophageal phase: relaxing and tightening the openings at the top and bottom of the feeding tube in the throat (esophagus) and squeezing food through the esophagus into the stomach


What causes swallowing disorders in adults?
Some causes of feeding and swallowing problems in adults are:
Damage to the nervous system, such as:

  • stroke
  • brain injury
  • spinal cord injury
  • Parkinson’s disease
  • Multiple sclerosis
  • Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)
  • Muscular dystrophy
  • Cerebral palsy
  • Alzheimer’s disease

Problems affecting the head and neck, including:

  • cancer in the mouth, throat, or esophagusbrain injury
  • injury or surgery involving the head and neck
  • decayed or missing teeth, or poorly fitting dentures

What causes swallowing disorders in children?
Feeding and swallowing disorders in infants and children are usually caused by multiple factors. They can result from congenital or acquired neurologic damage (e.g., encephalopathies), anatomic and structural problems (e.g., craniofacial anomalies, tracheoesophageal fistula), genetic conditions (chromosomal, syndromic, or inborn errors of metabolism), systemic illness (bronchopulmonary dysplasia, gastrointestinal dysmotility), and psychosocial and behavioral issues.

What are some signs and symptoms of swallowing disorders?
Several diseases, conditions, or surgical interventions can result in swallowing problems.
General signs may include:

  • coughing during or right after eating or drinking wet or gurgly sounding voice during or after eating or drinking
  • extra effort or time needed to chew or swallow
  • food or liquid leaking from the mouth or getting stuck in the mouth
  • recurring pneumonia or chest congestion after eating
  • weight loss or dehydration from not being able to eat enough

As a result, adults may have:

  • poor nutrition or dehydration
  • risk of aspiration (food or liquid entering the airway), which can lead to pneumonia and chronic lung disease
  • less enjoyment of eating or drinking
  • embarrassment or isolation in social situations involving eating

What are some signs or symptoms of feeding and swallowing disorders in children?
Children with feeding and swallowing problems have a wide variety of symptoms. Not all signs and symptoms are present in every child.

The following are signs and symptoms of feeding and swallowing problems in very young children:

  • arching or stiffening of the body during feeding
  • irritability or lack of alertness during feeding
  • refusing food or liquid
  • failure to accept different textures of food (e.g., only pureed foods or crunchy cereals)
  • long feeding times (e.g., more than 30 minutes)
  • difficulty chewing
  • difficulty breast feeding
  • coughing or gagging during meals
  • excessive drooling or food/liquid coming out of the mouth or nose
  • difficulty coordinating breathing with eating and drinking
  • increased stuffiness during meals
  • gurgly, hoarse, or breathy voice quality
  • frequent spitting up or vomiting
  • recurring pneumonia or respiratory infections
  • less than normal weight gain or growth


As a result, children may be at risk for:

  • dehydration or poor nutrition
  • aspiration (food or liquid entering the airway) or penetration
  • pneumonia or repeated upper respiratory infections that can lead to chronic lung disease
  • embarrassment or isolation in social situations involving eating

How are swallowing disorders diagnosed?
A speech-language pathologist (SLP) who specializes in swallowing disorders can evaluate individuals who are experiencing problems eating and drinking. The SLP will

  • take a careful history of medical conditions and symptoms
  • look at the strength and movement of the muscles involved in swallowing
  • observe feeding to see posture, behavior, and oral movements during eating and drinking
  • possibly perform special tests to evaluate swallowing, such as
    • modified barium swallow- individual eats or drinks food or liquid with barium in it, and then the swallowing process is viewed on an X-ray
    • endoscopic assessment- a lighted scope is inserted through the nose, and then the swallow can be viewed on a screen

To contact a speech-language pathologist, visit ASHA's Find a Professional.

What treatments are available for people with swallowing disorders?
Treatment depends on the cause, symptoms, and type of swallowing problem.

A speech-language pathologist may recommend:

  • specific swallowing treatment (e.g., exercises to improve muscle movement)
  • positions or strategies to help the individual swallow more effectively
  • specific food and liquid textures that are easier and safer to swallow

After the evaluation, family members or caregivers can help by:

  • asking questions to understand the problem and the recommended treatment
  • assisting in following the treatment plan
    • help with exercises
    • prepare the recommended textures of food and liquid, making sure that recommendations for eating safely are followed
    • keep track of how much food or liquid is consumed

The SLP may work as part of a feeding team. Other team members may include:

  • an occupational therapist
  • a physical therapist
  • a physician or nurse
  • a dietitian or nutritionist
  • a developmental specialist
     

What treatments are available for children with feeding and swallowing disorders?
Treatment varies greatly depending on the cause and symptoms of the swallowing problem.
Based on the results of the feeding and swallowing evaluation, the SLP or feeding team may recommend any of the following:

  • Medical Intervention (e.g., medicine for reflux)
  • direct feeding therapy designed to meet individual needs
  • nutritional changes (e.g., different foods, adding calories to food)
  • increasing acceptance of new foods or textures
  • food temperature and texture changes
  • postural or positioning changes (e.g., different seating)
  • behavior management techniques
  • referral to other professionals, such as a psychologist or dentist

If feeding therapy with an SLP is recommended, the focus on intervention may include the following:

  • making the muscles of the mouth stronger
  • increasing tongue movement
  • improving chewing
  • increasing acceptance of different foods and liquids
  • improving sucking and/or drinking ability
  • coordinating the suck-swallow-breath pattern (for infants)
  • altering food textures and liquid thickness to ensure safe swallowing

After the evaluation, family members or caregivers can:

  • ask questions to understand problems in feeding and swallowing
  • make sure they understand the treatment plan
  • go to treatment plans
  • follow recommended techniques at home and school
  • talk with everyone who works with the child about the feeding and swallowing issues and treatment plan
  • provide feedback to the SLP or feeding team about what is or is not working at home

What other organizations have information about feeding and swallowing disorders?
This list is not exhaustive and inclusion does not imply endorsement of the organization or the content of the Web site by ASHA.

Mayo Clinic 
Medline Plus-National Library of Medicine
WebMD

©1997-2012 American Speech-Language-Hearing Association