Choking, Gulping, Gagging

Does your baby experience choking, gulping, gagging and coughing during a feeding? How about arching and fussiness? Sound like your baby? Then read on. These worrisome noises from the tiny digestive system of your baby may signal a swallowing problem, GERD or both.

Recently, I attended the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) meeting to learn more about pediatric Gastroesophageal Reflux Disease (GERD). I met a team of doctors and speech language pathologists who wanted to find out how common dysphagia (a medical term for a swallowing disorder) was in a group of babies diagnosed with GERD. The study was presented at the meeting and the results were surprising.

GERD and dysphagia have overlapping symptoms including: arching, gagging, coughing and feeding refusal. The researchers identified a group of babies who had been diagnosed with GERD. Out of the large group, the researchers studied a smaller group with symptoms of both GERD and dysphagia.

The symptoms of dysphagia include:

• Irritable after feedings/colic symptoms
• Milk dribbling from the mouth
• Coughing with feeds
• Gagging
• Air intake/Gas
• Big gulps when swallowing
• Slow feeding
• Congestion
• Poor color with feeds (medical term: cyanosis)
• Arching
• Refusing to eat
• Respiratory issues
• Poor tongue control

A feeding evaluation was completed for all babies with symptoms suggestive of GERD and dysphagia. The researchers found that many babies were diagnosed with dysphagia upon testing. However, they were surprised to find that many of the babies evaluated had severe dysphagia. Risk factors for GERD and dysphagia include developmental delay and poor weight gain. Reflux medications were not found to prevent dysphagia and the vast majority of the infants were on a prescription medication at the time of the study.

Dysphagia may be under-diagnosed in infants since there are many similarities in symptoms. Certainly Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) are more common so doctors will be more inclined to treat reflux first. However, if a baby does not respond to medical treatment, it may be necessary to investigate other causes of the symptoms. A speech language pathologist with training and expertise in infant swallowing and feeding problems is skilled at identifying and treating feeding problems. Unfortunately, a feeding specialist may not be available in every community. It might be necessary to get a referral to a larger regional hospital, children’s hospital or feeding clinic. Once the problem is identified, parents and caregivers can be trained to use special feeding techniques at home to help a baby eat and grow.