Journal excerpt: Dysphagia—a topic not easy to swallow

By Amy Sanderson, MD

The term “dysphagia” has many synonyms used by providers in medical documentation. However, not all of these symptoms are able to describe, with specificity, the real problem so it can be translated into its corresponding code assignment.

What exactly is dysphagia? In short, it’s any abnormality in the process of swallowing that negatively affects the safety, efficiency, and adequacy of the intake of liquids and/or solids.

Why is dysphagia important to recognize and treat in the pediatric population? Infants and children must be able to consume enough energy and nutrients to grow physically and develop cognitively.

The important components of the oral phase are salivation, lingual-palatal coordination, and airway protection. Airway protection relies upon the epiglottis and laryngeal adduction. After the bolus of liquid or food is prepared during the oral phase, the swallowing reflex occurs. Next, propulsion of the bolus occurs during the pharyngeal phase. The esophageal phase consists of peristalsis and anti-reflux mechanisms.

In neonates and young infants, all four phases of swallowing are reflexive and involuntary. Older infants are able to voluntarily control the oral phase, which allows for their learning to chew solid food. Although the swallowing reflex remains involuntary as the child ages, it can be voluntarily controlled if desired. Unlike the swallowing reflex, the pharyngeal and esophageal phases are always involuntary in children of all ages.

CDI specialists can use the history of present illness to their advantage when looking for clues to dysphagia, along with diagnostic testing, and feeding team and speech-language pathologist consult notes.

Editor’s note: To read more about accurately capturing dysphagia, read the full article in the May/June edition of the CDI Journal.