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.

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.

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.

Have any of you had experience with GERD, dysphagia or aspiration? Do you have any additional advice for little ones who are diagnosed with these conditions?

- 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.

Our post today is a special guest blog entry from Susan Weissman. Her blog is Peanutsineden.com and she is also a writer for the Huffington Post. Susan is currently working on a memoir about the challenges of parenting her allergic child. We would like to thank her for guest blogging for us.

Silent Aspirations

I must admit that sometimes I get dragged by the Non Life Threatening realities of Life Threatening food allergies. For example, now that my allergic son, Eden, is in Kindergarten, there seems to be a birthday party practically every day. I imagine that when the teachers run low on markers and glue, they announce, "Guess what children! It's Claire's three-quarters until she's seven day!" And on party days, when it's time for singing and candles, while all the children squirm and clamor and lick at their frosting with dancing, glassy eyes, Eden has his "substitute treat" and sometimes he doesn't and sometimes he does mind too much that he's different.

This past weekend we went to an event called A Worry Free Lunch. The event was pre-arranged by a clever and compassionate food allergy counselor who lives in New York City and enjoys eating out herself. The concept: Food allergic families get together for a pre-arranged restaurant meal. They eat delicious food, including French fries and dessert (two items we never eat in restaurants) and the meal is virtually “worry free.”

But -- eating different food and knowing Eden must eat different food are separate burdens.

Due to his allergies, Eden vomited a lot when he was younger. Once, his feeding therapist told me most of her baby clients had silent aspirations meaning when they swallowed, liquid went into their trachea or lungs instead of going to their intestines. You can’t see silent aspirations and babies can’t tell you about it. Maybe the baby would get a twisted look on her face, her eyes wrinkle or her mouth puckers and someone looking on might have said, “Look at her face! So cute. Right?”

Our lunch evoked one of my untold (until now) fantasies. When I dream, I dream BIG. I dream about CURES and OUTGROWTH and EDEN EATING EVERYTHING. My Silent Aspirations:

We sit at a low table, legs crossed beneath, on soft pillows. Eden, and everyone else I love, is there. On the table there are puff pastries - phyllo wrapped spinach and feta, cheddar cheese dotted with chive, lump crabmeat in shallot cream; fried wonton dumplings stuffed with juicy pork shards and small bowls of shiny soy sauce; rounds of garlic toast, slivers of roast beef; chicken mole and avocado inside wedges of tortilla; thin pizzas flecked with oregano, buffalo mozzarella; fried chicken legs circling twice baked potatoes browned to soft peaks; fluffy spinach soufflés steaming from their middle; Caesar salads anointed with homemade garlic croutons; bowls of ropey pasta, yellow teardrop tomatoes, pesto and walnuts. And there are tubs of ice cream – mint chip, vanilla bean – a gravy bowl of hot butterscotch; painted ceramic crockery piled with fresh strawberries and blueberries, soaked in whipped cream; angel food cupcakes capped with bonnets of yellow frosting; lumpy peanut butter cookies, nubs of peanuts sticking out; chocolate éclairs; two pies – lemon meringue, droplets of caramelized sugar beading off the top, coconut cream with fresh shredded coconut jutting out from the graham cracker crust. We all laugh, pass plates. Eden reaches, chews. He is a prince. I move his plates closer, butter his dinner roll, our lips anointed with oils because he is a prince and I am a queen. We rule the table.