Food Allergy Living Blog Tagged Results

There has been a lot of talk about dysphagia lately so we wanted to repost our blog from a few months ago called “Dysphagia, GERD and Silent Aspiration”

Dysphagia, GERD and Silent Aspiration

We’ve talked about Gastroesophageal reflux disease (GERD) before, and today we wanted to talk about dysphagia and aspiration, two things that can be associated with GERD.

GERD

Dysphagia refers to the inability of food and/or liquids to pass easily from the mouth, into the throat, through the esophagus and into to the stomach during the process of swallowing.[1] In more simple terms, it means “difficulty swallowing.” Many medical conditions can cause dysphagia but in children, it is usually due to physical malformations, neurological conditions or digestive problems like GERD.

How can GERD cause dysphagia?

GERD is a condition where the muscles at the end of the esophagus do not close properly and allow stomach contents to leak back into the esophagus. The acidity of stomach contents can cause inflammation in the esophagus (esophagitis) and may lead to ulcers and scaring. The scarring can result in narrowing of the esophagus which may make swallowing more difficult. Patients with dysphagia may experience pain in the throat or chest, heartburn, regurgitation or the feeling that they have something stuck in their throat or chest.

Aspiration:

Both GERD and dysphagia are risk factors for aspiration, where foreign substances (food, liquid and/or stomach contents) are inhaled into the lungs. GERD can cause stomach contents to flow back into the esophagus and dysphagia can cause food and/or liquid to remain in the esophagus after swallowing. If these substances are inhaled and move into the lungs, it can lead to serious respiratory problems, such as aspiration pneumonia[2].

Silent Aspiration:

Silent aspiration describes aspiration without any obvious signs of swallowing difficulty, such as coughing or breathing difficulty[3]. Silent aspiration is especially common among children with dysphagia. In fact, an estimated 94% of children with dysphagia experience silent aspiration. This form can be especially dangerous because caregivers may not know that aspiration is occurring until the child becomes sick.

Because GERD and dysphagia are risk factors for aspiration and because children are more likely than adults to experience silent aspiration, you may want to do a swallow study if your child has these conditions to rule out aspiration. If it is detected, don’t worry! There are various ways to manage it so that respiratory problems don’t develop, such as altering the thickness of your child’s food and drinks.

*Update*

Eosinophilic Esophagitis

Our previous post focused on GERD as it relates to dysphagia and silent aspiration but in this post, I want to mention Eosinophilic Esophagitis (EoE), which is another condition that is linked to dysphagia and silent aspiration. Patients with EoE may have feeding problems, vomiting, dysphagia, abdominal pain or food impaction. In fact, a recent study urged professionals to screen for EoE when patients present with dysphagia. If your child has been diagnosed with EoE, you may want to discuss the possibility of silent aspiration with your health care provider since dysphagia is a risk factor for aspiration. Symptoms of EoE are often controlled by diet so dietary management may be sufficient to control dysphagia and the risk for silent aspiration. Feeding therapy and food thickeners may be considered as well.

Have any of your children with GERD or EE experienced dysphagia? How do you manage the dysphagia and the risk for silent aspiration?

-Mallory

[1] Dysphagia. Children’s Hospital Boston:
http://www.childrenshospital.org/az/Site815/mainpageS815P0.html.
[2] Palmer & Drennan et al. Evaluation and Treatment of Swallowing Impairments. Am Fam Physician 2000;61:2453-62
[3] Lee J, Blain S, Casas M, Kenny D, Berall G, Chau T. A radial basis classifier for the automatic detection of aspiration in children with dysphagia. J Neuroeng Rehabil. 2006 Jul 17;3:14.

Happy New Year! Before we jump into 2011 on Food Allergy Living, we wanted to recap our top ten blog posts of 2010. We tackled topics from food allergy recipes to tube feeding and everything in between and had some excellent guest bloggers share their stories. Based on reader traffic, here were our most popular posts:

1) Baby Rashes (when is it a milk allergy?)

In this post, Christine talks about how to tell if your child has a typical rash or if it is a sign of an allergic reaction to cow’s milk.

2) Dysphagia, GERD and Silent Aspiration

Mallory tackled the topic of GERD, or gastroesophageal reflux disease, and two other conditions commonly associated with it: dysphagia and silent aspiration.

3) Accidental Injections of Epinephrine from an EpiPen

If you or your child uses an EpiPen, this blog is a must-read in case you ever have an accidental injection.

4) Fun Summer Camps for Kids with Food Allergies

Children with food allergies don’t have to miss out on summer camp fun with these allergy-friendly options.

5) How Can Duocal Help My Child Gain Weight?

If your child is underweight or has been diagnosed with failure to thrive, the supplement Duocal can help provide extra calories in their diet.

6) Baby Formula and Food Thickeners: What are the Options?

Thickeners can help treat reflux, but children with food allergies often react to the rice cereals or oatmeals that are commonly recommended. Christine offers some other options that are allergy-friendly.

7) Guest Blog: Living with Eosinophilic Esophagitis - Norman’s Story

Kendra Tiedemann shared her son Norman’s journey with eosinophilic esophagitis.

8) Understanding How Infant Taste Buds Work

If you’ve ever wondered if your baby can taste her food, then be sure to read this post from Mallory.

9) Failure to Thrive: My Child is Underweight, What Should I Do?

In this post, Nita helped to clear up some common confusions about what a failure to thrive diagnosis means and how it is treated.

10) Guest Blog: Food Protein-Induced Entercolitis Syndrome – Roland’s Story

Lorelei Alvarez, one of the founders of the Reflux Rebels group, shared her son Roland’s journey with FPIES in this guest blog.

Which blog posts were your favorite over the last year? Are there any topics you’d like to see us cover in 2011?

- Sarah

To follow up on Mallory’s post on Dysphagia, GERD, and Silent Aspiration in children, I wanted to discuss the use of thickeners to help with the treatment of GERD/GER, dysphagia and aspiration.

If your little one is showing signs of GERD/GER, dysphagia or aspiration, you should always see a doctor to determine exactly what condition needs to be treated. One thing to remember is that children with Eosinophilic Esophagitis (EoE) can also have symptoms of dysphagia and often have symptoms very similar to that of GERD. EoE is caused by food allergies and can be treated effectively by eliminating the allergens in your child’s diet. Thickening their food or formula may not be needed once the allergens are removed. Be sure to check with your doctor or speech pathologist to see if a food thickener is appropriate for your little one before trying one.

Thickening Foods and Liquids

If your child does have GERD/GER, dysphagia or aspiration, altering the thickness of food and liquids can help make them easier to swallow. When fluids are too thin, some children have trouble using their tongues correctly, causing liquid to get caught in the airway passage and then get into their lungs. Thickening the formula and other fluids will help to ensure that the liquids stay together in the esophagus, decreasing the risk of aspiration.

For infants with GERD symptoms, using rice cereal in their formula to thicken it may help. The recommended amount to add to formulas is one tablespoon per 2 to 4 ounces of formula to reduce vomiting. (Rudolph et al 2001). There are also other thickeners on the market to choose from. It is important to read labels and call the company if your child has food allergies to ensure that they aren’t ingesting any allergens in the thickener. A few options include:

• Thick-It
• ThickenUp
• Simply Thick

Have you used a thickener before for your child? If so let us know which you tried and how it worked!

- Christine