Diagnostic Division: Food/Fluid

Definition: Abnormal functioning of the swallowing mechanism associated with deficits in oral, pharyngeal, or esophageal structure or function.

RELATED FACTORS

Congenital Deficits
Upper airway anomalies; Mechanical obstruction (e.g., edema, tracheostomy tube, tumor); History of tube feeding; Neuromuscular impairment (e.g., decreased or absent gag reflex, decreased strength or excursion of muscles involved in mastication, perceptual impairment, facial paralysis); Conditions with significant hypotonia; Respiratory disorders; Congenital heart disease; Behavioral feeding problems; Self-injurious behavior; Failure to thrive; Protein energy malnutrition

Neurological Problems
Nasal/nasopharyngeal cavity defects; Upper airway anomalies; Oropharyngeal/ laryngeal abnormalities; Tracheal/laryngeal/esophageal defects; Gastroesophageal reflux disease; Achalasia; Traumas; Acquired anatomic defects; Cranial nerve involvement; Traumatic head injury; Prematurity; Developmental delay; Cerebral palsy

DEFINING CHARACTERISTICS

Subjective

Esophageal Phase Impairment
Complaints [reports] of “something stuck”; Odynophagia; Food refusal; Volume limiting; Heartburn; Epigastric pain; Nighttime coughing/awakening

Objective

Oral Phase Impairment
Weak suck resulting in inefficient nippling; Slow bolus formation; Lack of tongue action to form bolus; Premature entry of bolus; Incomplete lip closure; Food pushed out of/falls from mouth; Lack of chewing; Coughing/choking/gagging before a swallow; Piecemeal deglutition; Abnormality in oral phase of swallow study; Inability to clear oral cavity; Pooling in lateral sulci; Nasal reflux; Sialorrhea or drooling; Long meals with little consumption

Pharyngeal Phase Impairment
Food refusal; Altered head positions; Delayed/multiple swallows; Inadequate laryngeal elevation; Abnormality in pharyngeal phase by swallow study; Choking; Coughing; Gagging; Nasal reflux; Gurgly voice quality; Unexplained fevers; Recurrent pulmonary infections

Esophageal Phase Impairment
Observed evidence of difficulty in swallowing (e.g., stasis of food in oral cavity, coughing/choking); Abnormality in esophageal phase by swallow study; Hyperextension of head (e.g., arching during or after meals); Repetitive swallowing; Bruxism; Unexplained irritability surrounding mealtime; Acidic smelling breath; Regurgitation of gastric contents (wet burps); Vomitus on pillow; Vomiting; Hematemesis