Swallowing difficulties in infants and children

Swallowing and feeding difficulties

Feeding problems are common in infants and babies. 50% of parents report feeding issues in their healthy children. A large number of factors can influence the process of feeding. Reflux and dysphagia are among the most common disruptors in your little ones.

Won’t go down well: dysphagia

Dysphagia is when your child has trouble swallowing. The condition does not allow safe passing of food or liquids from the mouth to the stomach. It is a skill-based disorder, and not a behavioural feeding issue.

Symptoms can include:

  • Arching or stiffening of the body during feeding
  • Chest congestion after feeding
  • Coughing or choking during or after feeding
  • Difficulties breathing, during or after feeding
  • Reflux
  • Drooling
  • Eating slowly
  • Weight loss

Swallowing difficulties occur in around 1% of healthy children. They are more common in infants born prematurely and in children with chronic medical conditions.

Dysphagia can be serious. It can affect the lungs. It can also interrupt normal development, as the child has trouble gaining sufficient energy and nutrients. Dysphagia can lead to dehydration, undernutrition, malnutrition, and food aversion if not properly managed.

Comes back up: reflux

If your child has reflux, also called gastro-oesophageal reflux (GER), his or her foods may come back up from the stomach to the oesophagus. Reflux can be associated with regurgitation or vomiting. It is a common, normal physiological event: at least 40% of infants are affected. The condition is rarely serious, and the stomach contents are not too acidic to irritate the throat or oesophagus. Generally, babies with reflux feed and thrive well and have no further symptoms other than regurgitation: they are described as ‘happy spitters’.

When the content is very acid, which is rare, reflux is a cause for concern. This is known as gastro-oesophageal reflux disease (GERD).

When should I worry?


If your little one is showing signs of dysphagia, consult your paediatrician early on, especially when food or liquids go down the ‘wrong way’ into the child’s windpipe and lungs (aspiration). This can lead to lung infections.

Reflux (GER)

Your child may not even notice reflux. Reflux is usually not a cause for concern. In babies with vomiting and regurgitation, see your doctor in case of the following ‘red flag’ symptoms that may suggest disorders other than GER:

  • Poor weight gain
  • Projectile vomiting
  • Unusual irritability after eating
  • Food refusal
  • Bile stained vomiting
  • Blood in stool
  • Abdominal pain
  • Crying when feeding

How can the doctor help?

After performing a complete medical evaluation of your child, your paediatrician will decide on the best therapy:

  • The right solution to support your child’s natural swallowing
  • The right solution to reduce your child’s regurgitation and vomiting

How do I MANAGE swallowing and feeding difficulties in my child?

    Early intervention can help maintain safe oral feeding in your little one who suffers from dysphagia or reflux. The use of thickeners is generally recommended to address these issues.

What are thickeners and how do they work?

Thickeners are food-based products that thicken the liquid your little one drinks. This gives your child extra time to control the food while swallowing. They are generally proposed in the form of powders that are added to milk or other liquids. They are often composed of gum-based products such as xanthan gum or carob bean gum, modified food starches, or rice and cereals.

The right thickener should:

  • Ensure safe and enjoyable feeding
  • Improve food appreciation and diet diversification
  • Improve nutritional status and hydration

What makes a good thickener?

By working effectively in a wide variety of liquids, the right thickener will help:

The right thickener should provide the right level of thickness in liquids, to support and strengthen natural swallowing safely and effectively.

The right thickener should also preserve the original taste of liquids, to make them palatable for little ones.

This will help children:

  • Develop their sense of taste
  • Increase drink enjoyment and diversification
  • Improve the positive experience of oral feeding
  • Support long-term taste and swallowing education