Swallowing problems

Swallowing is an activity that most of us do not even think about, it just happens.  However, it is a complex process that involves a large number of nerves and muscles that all have to work together to stop any food or liquid entering the windpipe (trachea) and ‘going down the wrong way’.  We all momentarily ‘close’ our airway and stop breathing as we swallow.  To do this we must have good control over our breathing.  When our breathing is disrupted for any reason it can be more difficult to coordinate the swallow with breathing and food or drink may enter the windpipe as we swallow.  This is known as aspiration.  Regular aspiration can cause lung infections or pneumonia.  Difficulty swallowing is known as dysphagia.

After a slide tracheoplasty some children have difficulties swallowing.  We think this is due to changes in coordination of breathing and swallowing, although research is ongoing in this area.  While children are in intensive care immediately after surgery we use a tube to feed them, called a naso-gastric tube.  This means children can be fed without needing to swallow.  Once children are breathing on their own a Speech and Language Therapist (SLT) specialising in swallowing will carry out an assessment to check the safety of the swallow.  This is a quick and simple test done at the bedside.  The SLT will watch and listen to the child’s swallow.  About 50% of children having a slide tracheoplasty will then have an x-ray of their swallow, called a videofluoroscopy.  More information about this x-ray can be found here (link to GOSH videofluoroscopy information). 

The Speech and Language Therapist will work with the rest of the team to make sure children are feeding safely (no food or drink is going down the wrong way).  Most children will go home eating and drinking normally.  About 20% of children will still have swallowing difficulties by the time they are ready to go home.  This can usually be treated by using a thickening powder added into drinks.  Sometimes children will need the naso-gastric tube to help with feeding when at home.  Any children with swallowing difficulties will be referred to a Speech and Language Therapist in their local area or seen by a Speech and Language Therapist as an outpatient at Great Ormond Street Hospital.  In most cases swallowing difficulties that occur after a slide tracheoplasty get better without any other treatment within a couple of months.