When eating becomes difficult: Understanding swallowing problems in children
By Dr Rohan Malik
Paediatric gastroenterologist in Woolloongabba, Brisbane
A child who takes forever to finish dinner, avoids meat or bread, needs a drink with every mouthful or suddenly becomes reluctant to eat certain foods may simply seem like a fussy eater.
Sometimes, though, these behaviours can be signs that swallowing isn’t as easy or comfortable as it should be.
Swallowing difficulties in children can occur for many reasons and don’t always look the way parents might expect. Recognising some of the less obvious signs can be an important first step towards understanding what is happening.
What is dysphagia?
Dysphagia is the medical term for difficulty swallowing.
Swallowing is a complex process that moves food and liquid safely from the mouth, through the throat and oesophagus, and into the stomach. A problem at any stage of this process can make eating difficult, uncomfortable or, in some cases, unsafe.
Older children may be able to describe the feeling that food is moving slowly or getting ‘stuck’. Younger children, however, may not have the words to explain what they are experiencing.
Instead, their behaviour at mealtimes may provide the clues.
What might swallowing difficulties look like?
Depending on your child’s age and the cause, you might notice they:
- eat much more slowly than other children
- take unusually small bites
- chew food for a long time before swallowing
- avoid particular textures or harder foods
- drink frequently to help food go down
- gag, cough or choke while eating
- complain that food feels stuck
- experience pain or discomfort when swallowing
- become anxious or reluctant around mealtimes.
Some children become very good at adapting. They may cut food into tiny pieces, avoid foods they know are difficult, or simply take a long time to eat. Because these habits can develop gradually, the underlying swallowing problem isn’t always immediately obvious.
What can cause swallowing problems in children?
There is no single cause of dysphagia.
The problem may relate to the way the mouth and throat coordinate swallowing, or it may occur further down in the oesophagus.
Possible gastrointestinal causes include inflammation or narrowing of the oesophagus, reflux-related problems and conditions such as eosinophilic oesophagitis (EoE).
EoE is an inflammatory condition of the oesophagus that can make swallowing difficult. In some children, particularly younger ones, the first sign may be feeding difficulties or avoidance rather than a clear complaint that food is getting stuck.
Other developmental, neurological or structural conditions can also affect swallowing, which is why identifying where the difficulty is occurring is important.
How are swallowing difficulties investigated?
The starting point is often a detailed conversation about what happens when your child eats.
Your doctor may ask which foods cause problems, whether difficulties occur with solids, liquids or both, how long meals take, and whether your child coughs, chokes, vomits or experiences pain. Growth and nutrition are also important considerations.
Depending on the symptoms, assessment may involve different health professionals and investigations.
A paediatric gastroenterologist may recommend an upper gastrointestinal endoscopy if there is concern about a problem within the oesophagus. Other children may need a swallowing assessment or imaging to understand how food and liquid are moving from the mouth and throat.
The right investigation depends on the individual child and the pattern of their symptoms.
When should parents seek advice?
It’s worth speaking with your doctor if swallowing difficulties are persistent or your child is regularly changing the way they eat to cope.
Particular attention is needed if food repeatedly becomes stuck, your child is losing weight or not growing as expected, eating has become increasingly restricted or coughing and choking are occurring during meals.
If food becomes completely stuck and your child cannot swallow, urgent medical assessment is required.
Mealtimes can tell us a lot
Children don’t always say, ‘I’m having trouble swallowing.’
More often, families notice that meals are taking longer, the range of accepted foods is shrinking, or their child has developed little routines that make eating easier.
Those details matter. Understanding how a child eats – not just what they eat – can provide valuable clues and help identify whether an underlying swallowing problem needs further investigation.
