Dysphagia Facts

Swallowing difficulties, 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

Some causes of feeding and swallowing problems in adults result from damage to the nervous system and include:

• 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

Dysphagia can also be caused by problems affecting the head and neck, including:

• Cancer in the mouth, throat, or esophagus
• Injury or surgery involving the head and neck
• Decayed or missing teeth, or poorly fitting dentures

Feeding and swallowing disorders in infants and children are usually caused by multiple factors. They can result from congenital or acquired neurological 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. Always consult your physician before serving Thick-It® brand products to children.

Kent Precision Foods Group is committed to providing our customers with safe and high-quality products while complying with applicable industry standards and regulatory requirements. For years, the U.S. Food and Drug Administration, American Academy of Pediatrics, and American Speech-Language-Hearing Association have advised caution in the use of thickening products that contain xanthan gum or similar agents, such as starch, with any infant. In the thickener industry, this caution has expanded over time.

Under these circumstances and until further information is made available, Kent Precision Foods Group has decided to update the Thick-It® brand product line labels (Clear Advantage® Instant Food & Beverage Thickener, Clear Advantage® ready-to-drink beverages, Original Food & Beverage Thickener, Original Concentrated Food & Beverage Thickener, and Original Foodservice Food & Beverage Thickener) to recommend the products should not be used by infants under 2 years old and should only be used by children under the age of 12 in consultation with a physician.

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 gurgle-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 or drink enough

People who have problems swallowing may also have:

• Poor nutrition or dehydration
• Risk of aspiration (food or liquid entering the airway), which can lead to pneumonia and chronic lung disease
• Reduced enjoyment of eating or drinking
• Embarrassment or isolation in social situations involving eating

Children with feeding and swallowing problems have a wide variety of symptoms. Not all signs and symptoms are present in every child. These signs can include:

• 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 puréed foods or crunchy cereals)
• Long feeding times (e.g., more than 30 minutes)
• Difficulty chewing
• Difficulty breastfeeding
• 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
• Gurgle, hoarse, or breathy voice quality
• Frequent spitting up or vomiting
• Recurring pneumonia or respiratory infections
• Less than normal weight gain or growth

A speech-language pathologist (SLP) specializing in swallowing disorders can evaluate individuals experiencing eating and drinking problems. The SLP will take a careful history of medical conditions and symptoms, looking at the strength and movement of the muscles involved in swallowing. They will observe feeding to determine posture, behavior, and oral movements during eating and drinking.

The SLP may also perform special tests to evaluate swallowing, such as modified barium swallow in which the individual eats or drinks food or liquid containing barium dye. The SLP can then observe the swallowing process with an X-ray. In an endoscopic assessment, a lighted scope is inserted through the nose allowing the swallowing process to be viewed on a screen.

To consult with a speech-language pathologist, visit the American Speech and Hearing Association’s (ASHA’s) Find a Professional website.

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 and helping the patient with their exercises
• Preparing the recommended textures of food and liquid, making sure that recommendations for eating safely are followed
• Keeping track of how much food or liquid is consumed

The SLP may work as part of a feeding team that may include other health professionals, such as:

• Occupational therapist
• Physical therapist
• Physician or nurse
• Dietitian or nutritionist
• Developmental specialist

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 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 should:

• Ask questions to understand problems in feeding and swallowing
• Make sure they understand the treatment plan
• Follow recommended techniques at home and school
• Discuss feeding and swallowing issues and treatment plan with everyone who works with the child
• Provide feedback to the SLP or feeding team about what is or is not working

While this list is not exhaustive and inclusion does not imply endorsement by ASHA, you can learn more about dysphagia diagnosis and treatment by visiting:

• Mayo Clinic
• Medline Plus-National Library of Medicine
• WebMD