Dysphagia

A Hard Problem to Swallow

By Mary Dixon Weidler

"It didn't take me long to figure out," says Jillian Hunnicutt of Atlanta, Ga., pausing to grin at her unintentional pun. "There was something about Mary."

Mary, now 6 years old, is the youngest daughter of Hunnicutt and her husband, Timothy. "Remember, I had already gone through two little girls, and I knew all about fussy eaters – or so I thought," Hunnicutt says. "Sure, I knew about tossed mashed potatoes, overturned bowls of spaghetti and little noses turned up at whatever we were offering. But with the older girls, the worst we had to handle was a 'raspberry' blown with a mouth full of peas."

"With Mary, eating dinner was living on the edge," Hunnicutt says. "She would have a hard time chewing even the softest of meals. Sometimes she would choke, her eyes would water and her breathing would slow. Eventually, she wouldn't want to eat at all. With that experience, who could blame her?"

Mary – and an estimated six to 15 million people in the United States, many of them children – is a victim of dysphagia, a mechanical dysfunction that manifests in a difficulty to chew or swallow. "Simply stated, a person with dysphagia is unable to pass food or liquid rapidly or efficiently from the mouth to the stomach," says Michael E. Groher, Ph.D., speech pathologist and author of Dysphagia: Diagnosis and Management.

To understand dysphagia, one should understand a little about something most of us take for granted – eating. A simple act of swallowing involves 26 pairs of muscles and seven cranial nerves. It begins with the sight of food and ends with that food entering (and staying in) the stomach. Dysphagia can occur at any point during the process, so symptoms could be as diverse as an inability to chew, chronic respiratory infections or choking.

"When food enters the mouth, a person uses his tongue, jaw and teeth to form the food into a ball," says Julie Reville, a speech language pathologist and clinical instructor at the University of Vermont. "The ball, clinically known as a bolus, is transferred backwards by the tongue into the posterior oral cavity. When this is done successfully, swallowing results."

In a patient with dysphagia, the swallow is defective. "The epiglottis usually covers the trachea and doesn't allow food into the airway," says Reville, who worked with pediatric dysphagia patients for more than eight years. "When the swallow is defective, the epiglottis doesn't do its job, and the bolus is mishandled." The result of such mishandling could be serious. "If food is misdirected, choking occurs," she says.

Want to see more?

• Hi, Ho, Cheerios: Pleasing Picky Palates
• Toddler Nutrition: Building a Healthy Relationship with Food
• Starting Solids Series
• Talk about it!