Infancy and childhood represent a time of unparalleled physical growth and cognitive development. In order for infants and children to reach their linear and neurological growth potential, they must be able to reliably and safely consume sufficient energy and nutrients. Swallowing difficulties (dysphagia) in pediatric populations can have a detrimental effect on dietary intake and, thus, growth and development. As a result, it is imperative to accurately identify and appropriately manage dysphagia in pediatric populations. This article provides an overview of dysphagia in children, as well as common causes of childhood swallowing difficulties, populations at risk for pediatric dysphagia, techniques used to assess swallowing in pediatric patients, and the current treatment options available for infants and children with dysphagia.

Dodrill P: Infant feeding development and dysphagia. J Gastroenterol Hepatol Res 2014, Epub ahead of print.
Bhattacharyya N: The prevalence of pediatric voice and swallowing problems in the United States. Laryngoscope 2015;125:746-750.
Lefton-Greif MA, Arvedson JC: Pediatric feeding and swallowing disorders: state of health, population trends, and application of the international classification of functioning, disability, and health. Semin Speech Lang 2007;28:161-165.
Lefton-Greif MA: Pediatric dysphagia. Phys Med Rehabil Clin N Am 2008;19:837-851, ix.
Newman LA, Keckley C, Petersen MC, Hamner A: Swallowing function and medical diagnoses in infants suspected of dysphagia. Pediatrics 2001;108:E106.
Roden DF, Altman KW: Causes of dysphagia among different age groups: a systematic review of the literature. Otolaryngol Clin North Am 2013;46:965-987.
Durvasula VS, O'Neill AC, Richter GT: Oropharyngeal dysphagia in children: mechanism, source, and management. Otolaryngol Clin North Am 2014;47:691-720.
Lefton-Greif MA, McGrath-Morrow SA: Deglutition and respiration: development, coordination, and practical implications. Semin Speech Lang 2007;28:166-179.
Lefton-Greif MA, Arvedson JC: Schoolchildren with dysphagia associated with medically complex conditions. Lang Speech Hear Serv Sch 2008;39:237-248.
Kakodkar K, Schroeder JW Jr: Pediatric dysphagia. Pediatr Clin North Am 2013;60:969-977.
Prasse JE, Kikano GE: An overview of pediatric dysphagia. Clin Pediatr (Phila) 2009;48:247-251.
Abadie V, Couly G: Congenital feeding and swallowing disorders. Handb Clin Neurol 2013;113:1539-1549.
Alnassar M, Oudjhane K, Davila J: Nasogastric tubes and videofluoroscopic swallowing studies in children. Pediatr Radiol 2011;41:317-321.
Lefton-Greif MA, Carroll JL, Loughlin GM: Long-term follow-up of oropharyngeal dysphagia in children without apparent risk factors. Pediatr Pulmonol 2006;41:1040-1048.
Jadcherla SR, Hogan WJ, Shaker R: Physiology and pathophysiology of glottic reflexes and pulmonary aspiration: from neonates to adults. Semin Respir Crit Care Med 2010;31:554-560.
Tutor JD, Gosa MM: Dysphagia and aspiration in children. Pediatr Pulmonol 2012;47:321-337.
Steele CM, Cichero JA: Physiological factors related to aspiration risk: a systematic review. Dysphagia 2014;29:295-304.
Weir K, McMahon S, Barry L, Ware R, Masters IB, Chang AB: Oropharyngeal aspiration and pneumonia in children. Pediatr Pulmonol 2007;42:1024-1031.
Ko MJ, Kang MJ, Ko KJ, Ki YO, Chang HJ, Kwon JY: Clinical usefulness of Schedule for Oral-Motor Assessment (SOMA) in children with dysphagia. Ann Rehabil Med 2011;35:477-484.
Sheppard JJ, Hochman R, Baer C: The dysphagia disorder survey: validation of an assessment for swallowing and feeding function in developmental disability. Res Dev Disabil 2014;35:929-942.
Benfer KA, Weir KA, Boyd RN: Clinimetrics of measures of oropharyngeal dysphagia for preschool children with cerebral palsy and neurodevelopmental disabilities: a systematic review. Dev Med Child Neurol 2012;54:784-795.
Weir K, McMahon S, Barry L, Masters IB, Chang AB: Clinical signs and symptoms of oropharyngeal aspiration and dysphagia in children. Eur Respir J 2009;33:604-611.
Suiter DM, Leder SB, Karas DE: The 3-ounce (90-cc) water swallow challenge: a screening test for children with suspected oropharyngeal dysphagia. Otolaryngol Head Neck Surg 2009;140:187-190.
Arvedson J, Rogers B, Buck G, Smart P, Msall M: Silent aspiration prominent in children with dysphagia. Int J Pediatr Otorhinolaryngol 1994;28:173-181.
DeMatteo C, Matovich D, Hjartarson A: Comparison of clinical and videofluoroscopic evaluation of children with feeding and swallowing difficulties. Dev Med Child Neurol 2005;47:149-157.
Beer S, Hartlieb T, Müller A, Granel M, Staudt M: Aspiration in children and adolescents with neurogenic dysphagia: comparison of clinical judgment and fiberoptic endoscopic evaluation of swallowing. Neuropediatrics 2014;45:402-405.
Arvedson JC: Assessment of pediatric dysphagia and feeding disorders: clinical and instrumental approaches. Dev Disabil Res Rev 2008;14:118-127.
Bülow M: Videofluoroscopic swallow study: techniques, signs and reports. Nestle Nutr Inst Workshop Ser 2012;72:43-52.
Stuart S, Motz JM: Viscosity in infant dysphagia management: comparison of viscosity of thickened liquids used in assessment and thickened liquids used in treatment. Dysphagia 2009;24:412-422.
Cichero J, Nicholson T, Dodrill P: Liquid barium is not representative of infant formula: characterisation of rheological and material properties. Dysphagia 2011;26:264-271.
Cichero JA, Steele C, Duivestein J, Clavé P, Chen J, Kayashita J, Dantas R, Lecko C, Speyer R, Lam P, Murray J: The need for international terminology and definitions for texture-modified foods and thickened liquids used in dysphagia management: foundations of a global initiative. Curr Phys Med Rehabil Rep 2013;1:280-291.
Hiorns MP, Ryan MM: Current practice in paediatric videofluoroscopy. Pediatr Radiol 2006;36:911-919.
Bader CA, Niemann G: Dysphagia in children and young persons. The value of fiberoptic endoscopic evaluation of swallowing (in German). HNO 2008;56:397-401.
Boseley ME, Ashland J, Hartnick CJ: The utility of the fiberoptic endoscopic evaluation of swallowing (FEES) in diagnosing and treating children with type I laryngeal clefts. Int J Pediatr Otorhinolaryngol 2006;70:339-343.
Sitton M, Arvedson J, Visotcky A, Braun N, Kerschner J, Tarima S, Brown D: Fiberoptic endoscopic evaluation of swallowing in children: feeding outcomes related to diagnostic groups and endoscopic findings. Int J Pediatr Otorhinolaryngol 2011;75:1024-1031.
Ulualp S, Brown A, Sanghavi R, Rivera-Sanchez Y: Assessment of laryngopharyngeal sensation in children with dysphagia. Laryngoscope 2013;123:2291-2295.
Willging JP, Thompson DM: Pediatric FEESST: fiberoptic endoscopic evaluation of swallowing with sensory testing. Curr Gastroenterol Rep 2005;7:240-243.
da Silva AP, Lubianca Neto JF, Santoro PP: Comparison between videofluoroscopy and endoscopic evaluation of swallowing for the diagnosis of dysphagia in children. Otolaryngol Head Neck Surg 2010;143:204-209.
Brady S, Donzelli J: The modified barium swallow and the functional endoscopic evaluation of swallowing. Otolaryngol Clin North Am 2013;46:1009-1022.
Almeida ST, Ferlin EL, Parente MA, Goldani HA: Assessment of swallowing sounds by digital cervical auscultation in children. Ann Otol Rhinol Laryngol 2008;117:253-258.
Frakking TT, Chang AB, O'Grady KA, Walker-Smith K, Weir KA: Cervical auscultation in the diagnosis of oropharyngeal aspiration in children: a study protocol for a randomised controlled trial. Trials 2013;14:377.
Lee J, Blain S, Casas M, Kenny D, Berall G, Chau T: A radial basis function classifier for pediatric aspiration detection. Conf Proc IEEE Eng Med Biol Soc 2006;1:3553-3556.
Merey C, Kushki A, Sejdić E, Berall G, Chau T: Quantitative classification of pediatric swallowing through accelerometry. J Neuroeng Rehabil 2012;9:34.
Geddes DT, Chadwick LM, Kent JC, Garbin CP, Hartmann PE: Ultrasound imaging of infant swallowing during breast-feeding. Dysphagia 2010;25:183-191.
Cappabianca S, Reginelli A, Monaco L, Del Vecchio L, Di Martino N, Grassi R: Combined videofluoroscopy and manometry in the diagnosis of oropharyngeal dysphagia: examination technique and preliminary experience. Radiol Med 2008;113:923-940.
Jadcherla SR, Stoner E, Gupta A, Bates DG, Fernandez S, Di Lorenzo C, Linscheid T: Evaluation and management of neonatal dysphagia: impact of pharyngoesophageal motility studies and multidisciplinary feeding strategy. J Pediatr Gastroenterol Nutr 2009;48:186-192.
Nativ-Zeltzer N, Kahrilas PJ, Logemann JA: Manofluorography in the evaluation of oropharyngeal dysphagia. Dysphagia 2012;27:151-161.
Omari TI, Dejaeger E, Van Beckevoort D, Goeleven A, De Cock P, Hoffman I, Smet MH, Davidson GP, Tack J, Rommel N: A novel method for the nonradiological assessment of ineffective swallowing. Am J Gastroenterol 2011;106:1796-1802.
Noll L, Rommel N, Davidson GP, Omari TI: Pharyngeal flow interval: a novel impedance-based parameter correlating with aspiration. Neurogastroenterol Motil 2011;23:551-e206.
Rommel N, Dejaeger E, Bellon E, Smet M, Veereman-Wauters G: Videomanometry reveals clinically relevant parameters of swallowing in children. Int J Pediatr Otorhinolaryngol 2006;70:1397-1405.
Rommel N, Selleslagh M, Hoffman I, Smet MH, Davidson G, Tack J, Omari TI: Objective assessment of swallow function in children with suspected aspiration using pharyngeal automated impedance manometry. J Pediatr Gastroenterol Nutr 2014;58:789-794.
Lefton-Greif MA, Okelo SO, Wright JM, Collaco JM, McGrath-Morrow SA, Eakin MN: Impact of children's feeding/swallowing problems: validation of a new caregiver instrument. Dysphagia 2014;29:671-677.
Arvedson J, Clark H, Lazarus C, Schooling T, Frymark T: The effects of oral-motor exercises on swallowing in children: an evidence-based systematic review. Dev Med Child Neurol 2010;52:1000-1013.
Harding C, Cockerill H: Managing eating and drinking difficulties (dysphagia) with children who have learning disabilities: what is effective? Clin Child Psychol Psychiatry 2014, Epub ahead of print.
Morgan AT, Dodrill P, Ward EC: Interventions for oropharyngeal dysphagia in children with neurological impairment. Cochrane Database Syst Rev 2012;10:CD009456.
Christiaanse ME, Mabe B, Russell G, Simeone TL, Fortunato J, Rubin B: Neuromuscular electrical stimulation is no more effective than usual care for the treatment of primary dysphagia in children. Pediatr Pulmonol 2011;46:559-565.
Steele CM, Alsanei WA, Ayanikalath S, Barbon CE, Chen J, Cichero JA, Coutts K, Dantas RO, Duivestein J, Giosa L, Hanson B, Lam P, Lecko C, Leigh C, Nagy A, Namasivayam AM, Nascimento WV, Odendaal I, Smith CH, Wang H: The influence of food texture and liquid consistency modification on swallowing physiology and function: a systematic review. Dysphagia 2015;30:2-26.
Weir K, McMahon S, Chang AB: Restriction of oral intake of water for aspiration lung disease in children. Cochrane Database Syst Rev 2012;9:CD005303.
Suskind DL, Thompson DM, Gulati M, Huddleston P, Liu DC, Baroody FM: Improved infant swallowing after gastroesophageal reflux disease treatment: a function of improved laryngeal sensation? Laryngoscope 2006;116:1397-1403.
Lefton-Greif MA, Carroll JL, Loughlin GM: Long-term follow-up of oropharyngeal dysphagia in children without apparent risk factors. Pediatr Pulmonol 2006;41:1040-1048.
Kim BR, Sung IY, Choi KH, Kim LS, Ryu JS: Long-term outcomes in children with swallowing dysfunction. Dev Neurorehabil 2014;17:298-305.
Richter GT: Management of oropharyngeal dysphagia in the neurologically intact and developmentally normal child. Curr Opin Otolaryngol Head Neck Surg 2010;18:554-563.
Ojha S, Ashland JE, Hersh C, Ramakrishna J, Maurer R, Hartnick CJ: Type 1 laryngeal cleft: a multidimensional management algorithm. JAMA Otolaryngol Head Neck Surg 2014;140:34-40.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.