What is dysphagia?

Dysphagia is difficulty, pain or discomfort when eating, drinking or swallowing – foods or fluids going “down the wrong way”.

Difficulties with eating, drinking or swallowing can affect people at any stage in life including babies, children and adults.

Some individuals with dysphagia have problems swallowing certain foods or liquids, while others cannot swallow at all.

Dysphagia can improve, remain the same or get worse over time, depending on the underlying cause.

What are the signs of dysphagia?

Signs of dysphagia in both adults and children may include (but is not limited to):

• Coughing or choking when eating or drinking
• Change in breathing pattern when eating or drinking
• Colour change after swallowing a food/drink
• Bringing food back up, sometimes through the nose
• A sensation that food is stuck in your throat or chest
• Persistent drooling of saliva
• Being unable to chew food properly / prolonged chewing time
• A ‘gurgly’ wet sounding voice when eating or drinking
• Difficulty holding food or fluid in the mouth
• Spitting out food or saliva
• Taking a long time to finish a meal / bottle / breast feed or refusing to eat
• Weight loss
• Recurrent chest infections

Causes of dysphagia

In adults, problems with eating, drinking, or swallowing (dysphagia) are usually linked to another health condition. These can include:

• Conditions that affect the brain or nervous system, such as stroke, head injury, multiple sclerosis, or dementia
• Head and neck cancers
• Learning or physical disabilities
• Gastro-oesophageal reflux disease (GORD), where stomach acid flows back up into the food pipe
• Chronic obstructive pulmonary disease (COPD)
• Mental health conditions

Swallowing difficulties can also develop as part of ageing, due to frailty, or during recovery after an illness.

Causes of dysphagia in children

In children difficulties eating, drinking and swallowing may occur due to a number of reasons:

• Before swallowing: difficulties preparing the food or fluid in the mouth (oral phase of the swallow)
• During swallowing: Moving the food or fluid from the mouth to the throat in order to swallow (pharyngeal stage of the swallow) or
• After swallowing: when the food / fluid moves from the throat into the stomach (oesophageal stage of the swallow).

Difficulties with eating, drinking and swallowing in babies and children can happen for a number of reasons:

• A problem which affects the physical action of eating drinking ands such as children born with cleft lip and/or palate, cerebral palsy or dyspraxia.
• A problem associated with a particular syndrome such as downs syndrome, rhetts etc.
• Children who have a learning disability.
• Babies who have a history of respiratory (breathing,) cardiac (heart) problems, poor weight gain and /or weight loss.
• Gastro-oesophageal reflux disease.

Problems swallowing difficulties can cause

Aspiration and choking

When someone has a swallowing difficulty, food & fluid can go down the wrong way into the lungs (aspiration) which can lead to chest infections or pneumonia (known as aspiration pneumonia). Swallowing difficulties can also lead to choking.

Aspiration pneumonia and choking can be fatal.

Weight loss and malnutrition

Often people find they eat less when the texture of their food has been changed.  Having a swallowing difficulty can mean it can take much longer to eat There may also be certain foods they are unable to eat safely so they may have less variety in their diet.

Poor nutrition affects every system in the body and always results in increased vulnerability to illness and increased health complications. Losing weight rapidly can lead to loss of muscle strength, which can affect an individual’s ability to mobilise and care for themselves independently.

Older adults should note that frailty / weight loss is not an inevitable part of aging. If you or someone you are caring for is losing weight unintentionally, contact your GP.

Find out more about malnutrition and work out if you are at risk.

Dehydration

Often people drink less because they are anxious about choking on drinks or dislike drinks that have been thickened. This can lead to problems such as urinary tract infections, tiredness or constipation.

Dysphagia information and support

If you or someone you care for has difficulty swallowing, the following information and resources can help you understand dysphagia and how to manage it safely.
Use the links below to access practical advice, self-help tools, and guidance on what to do in an emergency.

Opportunities to get involved

If you have experience of living with an eating, drinking or swallowing difficulty, or care for someone who does, we would welcome your involvement.

To express your interest, please send your name and contact details to:

• Email: dysphagia.supportteam@northerntrust.hscni.net

You can also find more information on how to get involved on the Engage website.