Dysphagia in children: causes and methods of treatment. The child choked on food and refuses to eat solid food. Phobia of swallowing food in 9-year-old children.

In any child, the swallowing reflex is well developed from infancy. Therefore, when he has difficulty eating, parents begin to panic. After all, if you do not get rid of this disease in time, it can lead to quite serious problems in the future. What should be done if a child is afraid to swallow food? To answer this question, you need to understand the root causes of the disease.

Causes of phagophobia

Fear of choking (phagophobia) is incredibly destructive to a child’s body. The cause of this unpleasant disease largely depends on the age of the baby. If we are talking about a baby, such fear may arise due to an excessive amount of milk in the mother's breast. The baby does not have time to eat and chokes, his desire to swallow completely disappears.

In older children, the fear of choking appears for completely different reasons. For example, after suffering from a sore throat, a child is afraid to swallow solid food, because during illness this process caused severe pain. Perhaps he accidentally swallowed some kind of foreign body, as a result of which he is now terrified of solid food.

The reason may also be that the baby cannot concentrate on one process or is too lazy to chew food. The main reason for the occurrence of this disease is that the child is afraid to eat after choking.

In mild form, phagophobia manifests itself in relation to certain types of food. This could be fish with small bones, dry flour products, nuts, tablets, etc. In more severe cases, any food causes fear.

This phobia can lead to exhaustion and pose a serious threat to the body of your son or daughter. Therefore, when a child becomes afraid of swallowing food, you need to take all possible measures to rid him of fear as soon as possible.

How to fight?

Treatment of phagophobia is possible without causing psychological trauma to the baby. No harm modern methods getting rid of this disease and digestive system toddler. So, there is a special facial massage that can develop a swallowing reflex.

So, you have a difficult situation in front of you - your child is afraid to swallow food. What to do to treat such a disease, psychologists suggest:

If a child is choking and is afraid to eat, then you can use a gradual swallowing technique, starting with small and ending with larger objects. Talk to him seriously and explain that all people choke from time to time, but are alive and well.

Where to go for treatment?

If the baby’s fear of swallowing does not go away, despite all the efforts and persuasion of the parents, it’s time to turn to professionals. Specialists of the psychological center "Insight" will select the most effective method treatment of phagophobia, taking into account individual characteristics little patient.

If your child has choked and is now afraid to swallow, trust our staff to solve this problem! To make an appointment with the company's certified psychologists, call the managers or fill out an application on the website. We provide both individual and group lessons.

Last week, the father of a 6.5-year-old daughter contacted me for advice (names removed for privacy reasons):

Hello Tatiana! The girl choked on food 10 days ago. While eating, I watched a cartoon on my tablet. We began to warn her that while eating she should not be distracted by TV and gadgets, as she could choke and die. Apparently they went too far.
Gradually, over the course of a week, she increasingly refused solid food. For the last three days he has been eating only very liquid semolina and mashed potatoes ground in a blender, and even then it is very bad. Actively drinks water or milk.

We don't put pressure on her. We try not to focus on eating. But every day it only gets worse. The child is very active, sociable, but timid and cautious. Please, give recommendations on how to act, we will be very grateful.

I encounter such cases very often. I see how many parents are completely lost and don’t know how to behave. Panic and acute fear for the child settle in the family. And they can be understood.

Therefore, I decided to briefly outline what is happening to the child at this moment, what psychological mechanisms are activated in his mind, and how one can move from an acute period to a mild one, and then return to the previous track. During the period when the child calmly ate everything.

Until the critical moment (i.e., before the girl choked on food), there was normal and stable eating behavior.
According to her father, she ate almost automatically, calmly chewing and swallowing the chewed food. This automaticity was developed against the background of previous positive experiences with chewing and swallowing food.

What happened to her at that critical moment? An explosion of fear. Panic. The old automatism has disintegrated. The brain's strongest survival mechanism turned on. And if a girl has melancholy-type temperamental traits, these feelings intensify.
It is for this reason that her brain is now blocking solid foods and instructing her body to only eat safe foods.
The child does not realize this - he acts as he feels intuitively, and this cannot be interfered with. Those. by choosing liquid and “light” food, the child’s body at this transitional moment seems to be trying to make sure that the food is safe and that it is possible to move on with solid food.

If the girl previously had a successful conditioned reflex “I eat calmly,” now she has formed a new conditioned reflex of rejecting solid food against the backdrop of fear of choking.

Now the question. How to unlock this reflex so that it does not become stable and fade away?

Remember how habits are acquired and then lost. There are 2 ways:

1. We need some fairly powerful signal or situation that will override the previous one and form a new conditioned reflex.

2. Or you need to stop reinforcing the unwanted behavior and it stops.
At the same time, the previous habit (fear and choice of liquid food) does not fade away instantly, but gradually. It can appear once, twice - then less and less often. And finally, until it is replaced by a stable new one (eat regular food).

In other words, a girl needs to create such a successful situation in which she can eat something freely and at will. Now it doesn’t matter what exactly: liquid or solid. It is important to have a calm attitude towards food.
And the family should stop worrying and reminding them about food (since the family’s worry only reinforces the child’s fear and does not solve the problem), provide understanding and maximum support.

As soon as the girl relaxes and becomes free to eat as she chooses, she will also gradually move on to her usual food. This is the only way this fear will go away.

Few parents realize that this problem lies at the intersection of biology and psychology. I had a case when a mother was angry with a child because he did not want to eat as much as she put on his plate. Everything seemed not enough to her. And the child’s attempt to refuse some dish infuriated her.

There were so many tears and suffering from both the child and the mother! When she found out what was wrong, she completely changed her approach to nutrition.

I spoke in more detail about the mechanisms of formation of conditioned food reflexes and the chain of normal eating behavior in the course “” (click on the link and see Full description, the course itself is in the format PDF, 131 pages and in format audio MP3, duration 4 hours).

The course is suitable both for those mothers who are just starting to feed their children complementary foods and who have everything ahead, as well as for those who are trying to straighten out their problems. various reasons child nutrition. And the mechanisms described in the course are universal for any age, because... they are very ancient, based on biological laws, plus the peculiarities of our human psyche are added here.

Dysphagia is a pathological process characterized by impaired swallowing. In the literature, this process is described as difficulty swallowing solid and soft foods. It is worth understanding that this is not an independent disease, but only a consequence. Disorders can occur in both adults and children, and in the latter, dysphagia has its own characteristics of the course, consequences and complications. What are the main causes of dysphagia, and can it indicate serious illnesses? How to diagnose dysphagia and what treatment does modern medicine offer?

Table of contents:

The mechanism of the act of swallowing

The act of swallowing is a complex process, although it seems to us as a matter of course. First, the child chews the food, crushing it, for easier swallowing. During this process, salivation and the production of gastric juice are stimulated. Saliva wets every piece of food and contributes to the formation of a food bolus. With the help of the coordinated work of the tongue and cheeks, food is pushed to the root of the tongue.

There is a reflex zone on its surface. When it is touched, a reflex is triggered - the food bolus is swallowed and moves into the pharynx. At the same time, the soft palate begins to move, separating the nasal cavity from the pharynx, and the muscles that lift the larynx also contract - this is necessary so that the food bolus gets into that “throat” and does not go to the larynx, bronchi and lungs.

As soon as the necessary pressure has been created in the throat, the esophagus opens and food begins its movement towards the stomach. The circular muscles of the esophagus and their alternating contraction ensure the advancement of the food bolus and the creation of an area of low pressure.

note

Despite the complexity of the process, only chewing of food and its pushing to the root of the tongue occurs consciously. Otherwise, the process is unconscious and can be controlled by the nervous system and pharyngoesophageal structures.

If we talk about dysphagia, then it is characterized by a violation of precisely the stages that are not amenable to conscious control, which can manifest itself in the following:

reverse throwing of a bolus of food from the pharynx into the oral cavity;
the appearance of pain in the center of the sternum, one can tell as the food bolus moves;
a “lump” forms in the throat, children feel like they have a lump of food stuck in them.

Types of dysphagia

In clinical practice, there are several types of dysphagia, which can be conditionally classified by its localization:

In addition to the types of dysphagia, there are also degrees of severity, of which there are 4:

inability to swallow only certain types of solid food;
swallowing solid food is difficult, with soft, semi-liquid food there are no problems;
it remains possible to swallow only liquid food;
There is no way to swallow anything at all.

Causes of dysphagia in children

Swallowing disorders in pediatric practice have some features, which are justified by the characteristics of the child’s body. So what diseases and conditions can cause impaired swallowing?

cerebral palsy

Other specialists are also involved in the process of diagnosis and further treatment: neurologist, ENT, endocrinologist, gastroenterologist, etc.

How is dysphagia treated?

Only after confirmation of the diagnosis is a treatment plan developed individually, which is carried out in a hospital under the supervision of doctors. Due to the fact that the causes of dysphagia can be more than diverse, therefore, treatment will be aimed specifically at its elimination.

For example : diagnosed tumor will require appropriate treatment: surgical intervention, chemotherapy, radiation therapy. If dysphagia is caused by inflammatory diseases of the oropharynx, drug therapy is prescribed: anti-inflammatory drugs and antibiotics. A psychotherapist must be involved in diagnosing functional dysphagia.

In addition to the treatment of dysphagia, which is aimed at eliminating the cause, the little patient is required to be prescribed a diet. Although children can swallow liquid foods without problems, there is a list of foods that can aggravate dysphagia. These include:

fast carbohydrates;
strong tea or even coffee;
lemonades, carbonated drinks;
some types of citrus fruits;
fried and smoked.

note

Such foods can cause an increase in intragastric pressure and stimulate the acid-forming function of the stomach, which causes impaired swallowing.

Dysphagia is dangerous because of its acute symptoms: while eating, pieces of food can be directed into the respiratory tract and the child may choke and begin to choke. Parents must be able to provide first aid correctly. To avoid accidents, treatment should be carried out in a hospital, where doctors can provide first aid in a timely and correct manner.

IN advanced cases, feeding the baby can be done using a special tube.

Why is dysphagia dangerous for children?

Dysphagia in children is a dangerous condition, especially if timely treatment was not started and the dysphagia itself and the cause that provoked its appearance occurred.

If difficulty swallowing occurs, it can cause serious complications. There is a high risk of inflammation of the esophagus, which can become chronic. This form of inflammation is a risk factor for the formation of tumor processes, not only in the esophagus, but also in other organs.

If a child is unable to swallow food normally, he may completely refuse to eat it, which threatens the development of anorexia. And, as you know, this condition already threatens health and even life. Refusal to eat is stressful for a child’s body.

Doctors remind that dysphagia and its cause must be diagnosed promptly and an effective treatment plan drawn up.

Alena Paretskaya, pediatrician, medical columnist

Weight

Doesn't sleep well

Daytime nap

Hysterics

Parents of babies know very well that all stages of a child’s development are placed in certain categories by modern pediatrics. age limits, which will be more convenient for mothers and fathers to navigate in the process of raising a child. So, the timing of the introduction of complementary foods and the approximate timing of the appearance of the first teeth are called. There are also deadlines for skills such as independently holding a spoon while eating, as well as the ability to chew and swallow solid food.

According to medical standards, a child at 7-8 months can easily eat from a spoon with the help of his mother, and by the age of one year he can hold it independently. According to official textbooks on pediatrics, a child should be able to confidently use a spoon by the age of one and a half years. The baby should be able to bite and chew solid food by the age of one year, if the number of teeth allows.

In theory, everything looks even and smooth. In practice, parents often face problems. The child does not want to eat solids, even if he has teeth, the baby refuses to pick up a spoon, quickly loses interest in eating with a spoon, stops eating or chokes on pieces. Authoritative children's doctor Evgeniy Komarovsky tells parents what to do in this situation.

Dr. Komarovsky will tell you all the feeding rules in the next video.

Komarovsky about the problem

Doesn't chew

There are no children in the world who have not learned to chew and swallow by the age of 5-6, says Evgeny Komarovsky. All people have a chewing reflex (and this is not a skill, but a reflex!), it is only activated in different time. For some it is earlier, for others it is later. When asked what prevents the reflex from developing early, the doctor answers one thing - parents!

Overly caring parents who are in no hurry to give their child solid food are all afraid that the baby will choke. As a result, a baby at 2 years old, when he is already physiologically able to eat pieces on his own, continues to receive pureed food from his mom and dad.

Doesn't eat from a spoon

Local pediatricians, especially the older generation, very often remind mothers that by the age of 8-9 months a child should eat normally from a spoon, and at the age of one year, hold it independently and at the same time put it in the mouth. Allegedly, this skill can be used to judge the child’s neuropsychic development.

A spoon is more of a psychotherapeutic device for mom and dad, and not an extremely necessary thing for the child himself.

In other words, if the baby eats from a spoon, and even on his own, the parents begin to respect themselves immensely, be proud of their upbringing of the baby, and in every possible way feel “like everyone else” and even better. But if he doesn’t take a spoon or, worse, denies it at all, then for many the mother is a distress signal, indicating that somewhere she, the mother, made a mistake - she was too lazy to teach, did not insist, did not demand, did not interest .

In fact, the child will sooner or later develop the need to eat with a spoon on his own. And then the baby will quickly (because there is motivation and interest!) learn to hold a spoon and bring it to the mouth. Therefore, if your baby prefers to eat liquid porridge from a bottle at 9-11 months, you should not force him to do it with a spoon. Everything has its time.

Doesn't want to eat food in pieces

Evgeny Komarovsky warns that this problem is quite common among children who have been breastfed for a long time, and their parents were in no hurry to introduce complementary foods. But if such questions arise, then it’s too late to look for reasons; you need to think about what to do.

Komarovsky encourages parents to reasonably and objectively assess their child’s ability to chew. To do this, you need to count how many teeth he has and how they are located. Letting a baby chew an apple or a bagel if he only has two teeth is a real parental crime, especially considering that the overwhelming majority of parents do not know how to provide first aid. Two teeth are enough to bite off a piece, but not enough for reflex chewing.

Therefore, it is better to adhere to the same approach to food consistency in the diet that manufacturers of ready-made foods adhere to. baby food, and they change it gradually - first puree, then puree with small pieces, then thick, homogeneous food and, finally, thick food with solid fragments. But it’s difficult to define age limits here, says Evgeniy Olegovich, since all children are individual, and one a year old chews an apple with a whole mouthful of teeth, while another one a year and a half with three or four or a little more teeth continues to eat puree.

Doesn't want to eat until the cartoons come on

This is another common problem. The child looks at his parents, copies them, and 90% of the population is used to eating while watching TV. In addition, some especially “insightful” mothers deliberately turn on cartoons so that the child is distracted from violent resistance to eating while she, caring mother, will stuff a couple of extra spoons of porridge or puree into it.

Yes, the baby will eat more while watching TV. But this is precisely the main danger. When a child looks at his plate while eating, he produces gastric juice, which is so necessary for normal digestion. And if he looks at cartoon characters, then juice is not produced, and such food will not bring benefits, and threatens stomach diseases. Even for this good reason, you can’t eat while watching cartoons.

If a child does not chew, but tries to lick or suck an apple or a cookie, there is no need for him to rush to grate the apple or soak the cookie in milk. Give him solid food more often, if the number of teeth allows, let him exercise. It turns out for everyone without exception. No child has ever gone to school without knowing how to chew food.
It is best to give complementary foods with a special baby spoon, rather than an ordinary tea spoon. This cutlery is made of plastic, which will not hurt the baby; it has a smaller volume, which will not make swallowing difficult. If the child does not accept such a spoon, you should not force-feed him. Let him eat from a bottle for now.
If a child refuses to chew, swallow and pick up a spoon, Komarovsky advises reconsidering the diet. It is likely that the baby simply does not have time to get really hungry. This happens in families where the baby is given food “when it’s time,” and not when he himself asks for food. Overfeeding is not only the reason for the baby’s reluctance to take part in the process itself, it can trigger the mechanisms of a variety of diseases. Therefore, overfeeding is more harmful than underfeeding.
It is not difficult to teach a child to eat on his own, says Komarovsky, the main thing is to “seize the moment” and help the child, unobtrusively supporting him in his desire to take a spoon or cup in his hands. But to teach by force, especially if the child is not yet ready for independent actions at the table, and even more so “putting pressure” on the baby, is not the best parental decision.
If a child is selective in food (he only eats something specific), then this is definitely not a hungry child, says Dr. Komarovsky. Real hunger completely eliminates selectivity. Therefore, you should not indulge in such selectivity; the child should eat what his mother puts in front of him. If he doesn’t eat, it means he doesn’t want to eat. It's better to wait until he's really hungry.
There is no need to do for the child what he is already capable of doing himself. If we are talking about the fact that a baby at one year of age and a little older does not take a spoon, this is one thing. But everything changes if a child at 3-4 years old does not want to eat on his own and demands his mother to feed him. After two years, Komarovsky advises putting down a plate, giving a spoon and leaving the kitchen for a while, increasing the time of absence every day.

When returning, the mother should not be interested in how much the baby ate with a spoon; she should pretend that nothing surprising happened. Usually, after a few days, the child begins to eat at least half of the prescribed portion on his own. Remember to show maximum patience and tact.

One day, a mother of two wonderful children (at her request, I will omit the names) came to me with an alarming message that her youngest daughter was 3 years old. refuses to eat chunky solid foods(afraid to swallow).

Since this problem is quite interesting, because it relates more to the psychology of a child’s perception of a particular situation (provided that physical health leaves no doubt), I agreed to our meeting.

A consultation was held via Skype, during which all issues were worked out, including the girl’s medical history, her psychological and physical development, as well as the system of relationships in her family.

Hello, readers of the blog “Your Child Psychologist”!

I would like to express my deep gratitude to Tatyana for her invaluable help in my situation.

I am an ordinary mother of two children – a son (6 years old) and a daughter (3 years old). I will say right away that I was prepared for hysterics, but I was not at all prepared for the fact that my child would not eat and fell into a stupor. My daughter refused to eat rough food - she only drank (and only fruit kefir, drinking yoghurts, tea and juices). The reason, according to the striker 🙂 “ The crumbs are in the way and I'm afraid to swallow».

The pediatrician, who looked at my daughter twice, said that the child is completely healthy, just wait. But, like any mother who thought that my child was not eating enough, having read all sorts of horror stories on the Internet, she could not leave this situation. “Why didn’t you feed her puree?!”, you ask. Yes, because my daughter hasn’t opened her mouth on puree since she was 10 months old, when she learned to chew adult food, because even if puree was forced into her, she spat it out. God forbid, if any lump or tiny thing comes across (even a clot of yogurt) - my daughter immediately started scraping everything out of her mouth, spitting, even before the gag reflex.

Why - my child is hungry, my child is not eating enough, my child is losing weight, my brain screamed! Therefore, I cooked rolled oats, broccoli, carrots, rubbed them through a sieve (God, I didn’t rub so much as a baby), bought ready-made sweet potato puree (because it’s sweet) and green beans (at least some variety) and mixed it in fruit kefir, orange juice (it turns out that orange juice overpowers many of the flavors of J), mixed with chocolate milk once a week. If only my daughter received at least some nutrients. And God forbid, if there was a speck, my daughter would spit it out; if I overdo the puree, my daughter would immediately feel that the taste was changing...

Since the child is healthy in body (according to the pediatrician), then it is necessary to show his soul, or rather, his brains, to a specialist, and not only my daughters, but also mine :)

I turned to Tatyana after the child had been fasting for more than two weeks. And so, having sent a detailed letter about the situation, photographs of the child, her drawings, works, my consultation with Tatyana Egorova took place.

Omitting all the details of the conversation, I will say one thing: Tatyana skillfully dotted all the “I’s” and directed me to the right direction, pointed out my mistakes and indicated my further tactics. The hardest strike tactic was to turn off my brain, my MOTHER brain. God, I did it too!

Educational psychologist, neuropsychologist, family consultant and coach on child-parent relationships. She has published in the magazines “9 Months” and “Nanny” as a medical psychologist, and led the column “Question to a Psychologist” in the magazine “9 Months”. Published in Rossiyskaya Gazeta. Author of seminars, courses and trainings for parents on practical child psychology.